Obese patients with CEAP (clinical, etiology, anatomy, pathophysiology) C2 and C3 disease show enhanced symptom improvement after endovenous thermal ablation

Zachary R Zottola; Joshua T Geiger; Geena E Choo; Baqir J Kedwai; Mark D Balceniuk; Jennifer L Ellis; Adam J Doyle; Karina A Newhall

doi:10.1016/j.jvsv.2024.101873

Obese patients with CEAP (clinical, etiology, anatomy, pathophysiology) C2 and C3 disease show enhanced symptom improvement after endovenous thermal ablation

J Vasc Surg Venous Lymphat Disord. 2024 Mar 19:101873. doi: 10.1016/j.jvsv.2024.101873. Online ahead of print.

Authors

Zachary R Zottola¹, Joshua T Geiger¹, Geena E Choo¹, Baqir J Kedwai¹, Mark D Balceniuk¹, Jennifer L Ellis¹, Adam J Doyle¹, Karina A Newhall²

Affiliations

¹ Division of Vascular Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY.
² Division of Vascular Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY. Electronic address: Karina_newhall@urmc.rochester.edu.

PMID: 38513798
DOI: 10.1016/j.jvsv.2024.101873

Abstract

Objective: Endovenous thermal ablation (EVTA) is a prevalent treatment option for patients with severe venous disease. However, the decision to intervene for patients with less severe disease (CEAP [clinical, etiology, anatomy, pathophysiology] C2 and C3) is less clear and becomes further complicated for patients with obesity, a pathology known to increase venous disease symptom severity. Therefore, the objective of this study was to use the Society for Vascular Surgery Vascular Quality Initiative database to evaluate outcomes after EVTA in obese patients with CEAP C2 and C3 venous insufficiency.

Methods: Using the Society for Vascular Surgery Vascular Quality Initiative database, we retrospectively analyzed the initial procedure of all patients with a CEAP clinical class of C2 or C3 who underwent EVTA from January 2015 to December 2021. Patients were grouped by obesity, defined as a body mass index of ≥30 kg/m². The primary outcome was the change in venous clinical severity score (VCSS) from the procedure to the patient's initial follow-up. The secondary outcomes included the change in patient-reported outcomes at follow-up via the HASTI (heaviness, achiness, swelling, throbbing, itching) score, incidence of follow-up complications, and recanalization of treated veins. The change in the VCSS and HASTI score were analyzed using Student t tests, and complications and recanalization were assessed using the Fisher exact test. Significant outcomes were confirmed by multiple variable logistic regression. The remaining significant variables were then analyzed, with obesity categorized using the World Health Organization classification system to analyze how increasing obesity levels affect outcomes.

Results: There were 8146 limbs that met the inclusion criteria, of which 5183 (63.6%) were classified as nonobese and 2963 (36.4%) as obese. Obesity showed no impact on improvement in the VCSS (-3.29 vs -3.35; P = .408). Obesity was found to be associated with a larger improvement in overall symptoms, as evidence by a greater improvement in the HASTI score (-7.24 vs -6.62; P < .001). Obese limbs showed a higher incidence of superficial phlebitis (1.5% vs 0.7%; P = .001), but no difference was found in recanalization or any other complication.

Conclusions: These data suggest that obese patients with CEAP clinical class C2 or C3 experience greater improvement in their perceived symptoms after EVTA with little difference in clinical improvement and complications compared with nonobese patients. Although obesity has been associated with increased severity of venous disease symptoms, obese patients are able to derive significant relief after treatment during the short term and may experience greater relief of symptoms than nonobese patients when treated at more mild disease presentations.

Keywords: Laser therapy; Obesity; Patient-reported outcome measures; Radiofrequency ablation; Venous insufficiency.