Correlation of Body Mass Index with Recanalization Risk after Endovenous Thermal Ablation

Objective

Chronic venous insufficiency (CVI) has an increased prevalence among obese individuals with body mass indices (BMI) over 30. A safe, efficacious, and evidence-based recommended treatment for CVI due to superficial venous reflux (SVR) in great saphenous veins (GSV), small saphenous veins (SSV), accessory saphenous veins (ASV), and reflux in the perforator veins (PV) is endovenous thermal ablation (EVTA). We sought to identify if BMI is an independent risk factor for recanalization following EVTA.

Methods

All patients with CVI were initially managed conservatively, and those with pathologic SVR refractory to compression therapy were offered EVTAs dependent on the site of reflux. Sonographic confirmation of SVR was defined as >500 milliseconds of reflux in the GSV, SSV, and ASV and a diameter >4 millimeters. PV reflux was confirmed as >350 milliseconds of reflux and a diameter >2.5 millimeters. All patients received a follow-up duplex ultrasound 1 week after the procedure, every 3 months for the first year, and every 6 months thereafter. Multivariate analysis with logistic regression was performed regarding patients’ age, ablation modality (laser vs radiofrequency ablation), vein location and laterality, BMI, and recanalization.

Results

From 2013 – 2018, 9739 endovenous ablations were performed on 3070 patients. Endovenous laser was utilized in 3862 procedures and radiofrequency ablation (RFA) in 5831 procedures. The distribution of veins treated with EVTA were 6182 GSVs, 2509 SSVs, 597 ASVs, and 451 PVs. Mean patient age was 61.1 years (15 – 99, SD +/- 15.6) with a mean BMI of 31.2 kg/m2 (13.7 – 69.5, SD +/- 7.3). Patients were 68.4% women and 31.4% men. Mean follow-up was 25.8 months (0 – 65.9, SD +/- 12.9). Multivariate statistical analysis with logistic regression was used to determine potential statistical significance between BMI and vein recanalization following EVTA. Overall obese patients experienced more recanalizations than non-obese patients (p=0.032), with an average BMI of 33 kg/m2 for recanalizations. PVs were statistically more likely to recanalize than any other vein (p=0.0001). A secondary analysis was performed with the exclusion of PVs, due to their 5 times increased risk of recanalization, and showed no significant difference of recanalization across all BMI subgroups (p=0.127).

Conclusion

BMI does not predict recanalization risk following EVTA, except for ablations performed on PVs.

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