Recanalization in Large Diameter Saphenous Veins After Thermal Ablation: A Retrospective Review of Vascular Quality Initiative Data.

Introduction: Endovenous ablation has become the treatment of choice for saphenous venous insufficiency in recent years. There is debate as to whether veins with large diameters are more likely to recanalize. In this study, we explore the relationship between vein diameter and recanalization rates using a nationwide database.

Methods: Patients undergoing thermal ablation of the great or small saphenous veins between 2015-2019 were identified from the Vascular Quality Initiative varicose vein module. Demographics, vein diameter, procedure characteristics, and post-operative course were queried from the database. Patients were divided into large (≥10mm) and small diameter vein cohorts. Multivariate logistic regression and Cox proportional hazards models were used to compare outcomes.

Results: A total of 16,937 procedures were identified in 13,263 patients. Patients with large veins were more likely to develop hematomas (0.7% vs 0.4%, p=0.0195) or superficial phlebitis (1.5% vs 0.8%, p<0.001). There were no significant differences in rates of other post-operative complications. Post-intervention symptom improvement was greater in patients with large veins (-7.47 vs -7.01 on standardized Heaviness-Achiness-Swelling-Throbbing-Itching scale, p=0.001). On Cox proportional hazards modeling, large veins were not associated with worse recanalization-free survival (OR 0.74, p=0.24).

Conclusions: Large vein diameter was not associated with worse recanalization after thermal ablation. Thermal ablation procedures can be considered a first line treatment for managing large veins.