Obese Patients with CEAP C2 and C3 Disease Show Enhanced Symptom Improvement after Endovenous Thermal Ablation.

OBJECTIVE: Endovenous thermal ablation (EVTA) is a prevalent treatment option in patients with severe venous disease. However, the decision to intervene on patients with less severe disease (CEAP C2 & C3) is less clear and becomes further complicated in patients suffering from 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 (SVS-VQI) database to evaluate outcomes following EVTA in obese patients with CEAP C2 and C3 venous insufficiency.

METHODS: Using the SVS-VQI database, we retrospectively analyzed the initial procedure of all patients with a CEAP clinical class of C2 or C3 who underwent EVTA from Jan 2015-Dec 2021. Patients were grouped by obesity defined as a BMI ≥ 30. The primary outcome was change in venous clinical severity score (VCSS) from procedure to the patient's initial follow-up. Secondary outcomes included the change in patient reported outcomes at follow-up via HASTI (heaviness, achiness, swelling, throbbing, itching) score, incidence of follow-up complications, and recanalization of treated veins. ΔVCSS and ΔHASTI were analyzed using students t-tests, while complications and recanalization were assessed using Fisher's exact tests. Significant outcomes were confirmed by multiple variable logistic regressions. Remaining significant variables were then analyzed with obesity categorized based on the WHO classification system to analyze how increasing obesity levels impact outcomes.

RESULTS: There were 8,146 limbs that met criteria, of which 5,183 (63.6%) were classified as non-obese and 2,963 (36.4%) classified as obese. Obesity showed no impact on improvement of VCSS (ΔVCSS: -3.29 vs -3.35, p=0.408). Obesity was found to be associated with a larger improvement in overall symptoms as evidence by a greater improvement in HASTI score (ΔHASTI: -7.24 vs -6.62, p<0.001). Obese limbs showed a higher incidence of superficial phlebitis (1.5% vs 0.7%, p=0.001), but no difference was found for recanalization or any other complication.

CONCLUSIONS: These data suggest obese patients in CEAP clinical classes C2 and C3 experience greater improvement in their perceived symptoms following EVTA with little difference in clinical improvement and complications compared to non-obese patients. Although obesity has been associated with increased severity of venous disease symptoms, obese patients are able to derive significant relief following treatment over the short-term and may garner greater relief of symptoms than non-obese patients when treated at more mild disease presentations.