Higher Clinical CEAP Classification is Associated with Lower Odds of Improvement in Patient-Reported Outcomes After Endovenous Thermal Ablation of Truncal Veins.

Abstract

Objective: Endovenous thermal ablation (EVTA) of superficial lower extremity veins performed with laser or radiofrequency ablation has high rates of technical success. However, it is understudied how improvement in patient-reported outcomes (PROs) after EVTA is related to the pre-operative clinical class in the clinical, etiological, anatomical, and pathophysiological (CEAP) classification. This study investigated whether patients with higher CEAP clinical class have lower odds of perceived symptomatic improvement than patients with lower pre-procedural clinical class.

Methods: A retrospective cohort analysis of Vascular Quality Initiative (VQI) Varicose Vein Registry data from 2014-2021 was conducted. Patients >18 years of age that underwent EVTA alone and followed up within 3 months were included, while those with a clinical CEAP class of C0 or C1, non-truncal ablation, missing baseline CEAP score, or weight and height outside VQI data standards were excluded. Patient-reported limb appearance, work impact, and a composite score of heaviness, achiness, swelling, throbbing and itching (HASTI) were analyzed on a per-limb basis. Factors associated with improvement in PROs were tested with multivariable mixed-effects logistic regression. The models adjusted for CEAP class, demographics, and anatomic variables as fixed effects and were clustered by VQI center. Demographic and comorbidity data were compared across CEAP classes with Chi-squared, Kruskal-Wallis, or ANOVA testing as appropriate.

Results: 6,364 patients met inclusion criteria, and 7,607 limbs were analyzed for the study period. Patient demographics and comorbid venous pathologies were not evenly distributed among the CEAP classes. Patients with C6 disease (odds ratio [OR]:0.63, 95% confidence interval [CI]:0.45-0.88; p=0.01) and patients with a history of phlebitis (OR:0.76, 95% CI:0.59-0.99; p=0.04) had lower odds of improvement in HASTI score. For patient-reported appearance, C3 (OR:0.79, 95% CI:0.66-0.94; p=0.01) and C6 (OR:0.50, 95% CI:0.38-0.67; p<0.01) disease were associated with lower odds of improvement. Obesity (OR:0.87, 95% CI:0.76-0.99; p=0.04), preoperative anticoagulation (OR:0.77, 95% CI:0.62-0.97; p=0.03), and prior vein treatment (OR:0.81, 95% CI:0.71-0.93; p<0.01) were also negatively associated with appearance, while age ≥ 65 was positively associated (OR:1.17, 95% CI:1.01-1.35; p=0.04). Clinical class showed no association with an improvement in impact on work. Female sex was positively associated with improved impact on work (OR:1.17, 95% CI:1.02-1.36; p=0.03).

Conclusions: Higher CEAP clinical class was associated with odds of improvement in HASTI and appearance but not associated with improvement in patients' perception of impact on work. These findings are important for patient counseling regarding what outcomes they can expect with EVTA based on their pre-operative clinical presentation.