Abstract Objective

Low-grade primary superficial venous reflux (C0 – C3EpAsPr) is a common feature of chronic venous disease. However, the procedural efficacy focusing on symptom characteristics and improvement patterns in this population has not been fully explored.

Methods

From 2018 to 2019, 325 limbs from 279 patients with C0 – C3EpAsPr (including 66.1% with C0-1) who underwent cyanoacrylate ablation (CA) with ultrasonography-guided foam sclerotherapy (UGFS) or endovenous laser ablation (EVLA) with UGFS were included in this study. Venous symptoms were classified into five categories: leg heaviness, calf cramping, itching sensation, pain, and numbness. A retrospective propensity score-matched analysis of a prospectively designed case report form (CRF) was performed to identify the improvement magnitude of each symptom. As secondary outcomes, postoperative changes in symptom severity (0 – 5 points), the Venous Reflux Originated Severity Score (VROSS), the Venous Clinical Severity Score (VCSS), and the ChronIc Venous Insufficiency Quality of Life Questionnaire (CIVIQ-14) were evaluated by performing a three-month postoperative data analysis.

Results

After adjusting the data, 174 limbs (87 CA with UGFS and 87 EVLA with UGFS) were matched. Symptoms that showed the greatest improvement after treatment were night cramping (94.7%) and itching (93.8%), followed by heaviness (85.2%), numbness (77.8%), and pain (60.9%). All symptom improvement scores after each endovenous procedure showed similar patterns in both groups. Advantages of CA with UGFS over EVLA with UGFS were observed in procedure time (20.1± 10.6 min vs. 28.4± 10.9 min, p = .001) and perioperative visual analogue pain scores (2.99± 2.34 vs. 3.74 ± 2.49, p = .03). Compared to preoperative values, VROSS, VCSS, CIVIQ-14, and symptom severity scores were significantly improved in both groups (all p < .001). Improvements in all five symptoms (p = .085 to 1.0), VCSS (p = .435), CIVIQ-14 (p = .788) and satisfaction scores (p = .392) three months postoperatively were comparable between the two groups. There were two cases of endovenous glue-induced thrombosis and 24 (27.6%) cases of type IV hypersensitivity reactions in the CA group.

Conclusions

Minimally invasive endovenous surgery with CA and EVLA provides significant symptom improvement for patients with low-grade CEAP classes.

Article InfoPublication History

Accepted: July 1, 2021

Received: December 28, 2020

Publication stageIn Press Journal Pre-ProofFootnotes

Article highlights

• Type of Research: Single-center, case-control, retrospective study

• Key Findings: In low-grade CEAP clinical classes, cyanoacrylate glue embolization and endovenous laser ablation procedures significantly improved symptoms three months after surgery. VCSS, CIVIQ- and patient-reported satisfaction scores after the procedure were similar in both groups.

• Take Home Message: Minimally invasive surgery of low-grade CEAP classes results in significant symptom improvement.

Table of Contents Summary

Cyanoacrylate glue embolization and endovenous laser ablation significantly improved chronic venous disease symptoms in this propensity score-matched case-control study of 174 limbs with low-grade CEAP classes suggesting that endovenous procedure can reduce severe symptoms in patients with low-grade CEAP clinical classes.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Conflict of interests

No conflicts of interest have been declared by the author.

Author Contributions

Yie K confirms that the work presented in this study has been analyzed and interpreted solely by myself as the major contributor to writing the manuscript.

Acknowledgment

I am grateful to my colleagues who always faithfully record my surgery and treatment and strive for patient safety and well-being. In particular, A-Rom Shin B.S, Eun-Hee Jung, Jung-Eun Suk, Sung-Do Kim and Eun-Jung Hwang, R.N helped with the chart review and data collection for this study.

Identification

DOI: https://doi.org/10.1016/j.jvsv.2021.07.002

Copyright

© 2021 Published by Elsevier Inc. on behalf of the Society for Vascular Surgery.

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