Objective

Venous insufficiency is commonly bilateral, and patients often prefer single-episode care compared with staged procedures. Few studies have investigated clinical outcomes after unilateral vs bilateral venous ablation procedures or between staged and concurrent bilateral procedures. Here, we report data from the Vascular Quality Initiative regarding truncal venous ablation for chronic venous insufficiency.

Methods

Using data from the Vascular Quality Initiative, we investigated immediate postoperative as well as long-term clinical and patient-reported outcomes of patients undergoing unilateral vs bilateral truncal endovenous ablation from 2015 to 2019. We further investigated outcomes between staged bilateral and concurrent bilateral ablations. Preprocedural and postprocedural comparisons were performed using t-test, χ² test, or their nonparametric counterpart when appropriate. Multivariable ordinal logistic regression was performed on ordinal outcome variables.

Results

A total of 5029 patients were included, of whom 3782 (75.2%) underwent unilateral procedures. Median follow-up was 227 days (interquartile range [IQR], 55-788 days). Unilateral patients were less likely to be female (67.0% vs 70.3%; P = .031) and white (86.3% vs 91.2%; P < .001) and had lower body mass index (30.3 ± 7.3 kg/m² vs 31.8 ± 7.6 kg/m²; P < .001) compared with patients undergoing bilateral procedures. In addition, unilateral patients had fewer prior varicose vein treatments (23.0% vs 15.7%; P < .001) and had higher median preprocedural Venous Clinical Severity Score (VCSS; 8 [IQR, 6-10] vs 7 [IQR, 5.5-9]; P < .001). No difference was seen in complications (6.9% vs 8.2%; P = .292), and systemic complications were rare in both groups. No difference was seen in VCSS improvement after treatment (median, 3 [IQR, 1-6] for unilateral; median, 3 [IQR 1-5] for bilateral; P = .055). In comparing staged with concurrent bilateral procedures, there was no difference in overall complications (7.5% vs 12.2%; P = .144). Staged bilateral patients were older (56.9 ± 13.3 years vs 54.2 ± 12.9 years; P = .002), less likely to have had prior varicose vein treatment (14.3% vs 19.8%; P = .020), and more likely to be therapeutically anticoagulated (10.8% vs 6.5%; P = .028) compared with concurrent bilateral patients. Staged patients also have higher preprocedural VCSS compared with concurrent patients (median, 8 [IQR, 6-10] vs 7 [IQR, 5.5-9]; P < .001). In multivariable analysis, there was no difference in the likelihood of VCSS improvement for concurrent compared with staged procedures (odds ratio, 0.70; 95% confidence interval, 0.40-1.24; P = .226).

Conclusions

Concurrent bilateral truncal endovenous ablation can be performed safely without increased morbidity compared with staged bilateral or unilateral ablations.

中文翻译：

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在血管质量倡议中比较单侧与双侧以及分阶段双侧与同步双侧躯干静脉内消融术。

客观的

静脉功能不全通常是双侧的，与分期手术相比，患者通常更喜欢单期治疗。很少有研究调查单侧与双侧静脉消融手术后或分阶段和同步双侧手术之间的临床结果。在这里，我们报告来自血管质量倡议的关于慢性静脉功能不全的躯干静脉消融的数据。

方法

使用来自血管质量倡议的数据，我们调查了 2015 年至 2019 年接受单侧与双侧躯干静脉内消融术的患者术后即刻以及长期临床和患者报告的结果。我们进一步调查了分阶段双侧和同步双侧消融术之间的结果。适当时使用t检验、χ ²检验或其非参数对应物进行程序前和程序后比较。对有序结果变量进行多变量有序逻辑回归。

结果

共纳入 5029 例患者，其中 3782 例（75.2%）接受单侧手术。中位随访时间为 227 天（四分位距 [IQR]，55-788 天）。单侧患者不太可能是女性（67.0% 对 70.3%；P  = .031）和白人（86.3% 对 91.2%；P  < .001），并且体重指数较低（30.3 ± 7.3 kg/m ²对 31.8 ± 7.6 kg/m ²；P  < .001) 与接受双侧手术的患者相比。此外，单侧患者先前接受过的静脉曲张治疗较少（23.0% vs 15.7%；P  < .001），并且术前静脉临床严重性评分中位数（VCSS；8 [IQR，6-10] vs 7 [IQR，5.5-]）更高9]; P < .001）。并发症方面没有差异（6.9% 对 8.2%；P  = .292），并且两组的全身并发症都很罕见。治疗后 VCSS 改善无差异（单侧中位数，3 [IQR，1-6]；双侧中位数，3 [IQR 1-5]；P  = .055）。在比较分期手术和同时进行的双侧手术时，总体并发症没有差异（7.5% 对 12.2%；P  = .144）。分期双侧患者年龄较大（56.9 ± 13.3 岁与 54.2 ± 12.9 岁；P  = .002），先前接受过静脉曲张治疗的可能性较小（14.3% 对 19.8%；P  = .020），并且更有可能接受治疗抗凝（10.8% 对 6.5%；P = .028) 与并发双侧患者相比。与同期患者相比，分期患者的术前 VCSS 也更高（中位数，8 [IQR，6-10] vs 7 [IQR，5.5-9]；P  < .001）。在多变量分析中，与分阶段手术相比，同期手术 VCSS 改善的可能性没有差异（优势比，0.70；95% 置信区间， 0.40-1.24 ；P = .226）。

结论

与分期双侧或单侧消融相比，同时进行的双侧躯干静脉内消融可以安全地进行，而不会增加发病率。