Clinical outcomes following treatment for small saphenous vein insufficiency: An AVLS PRO venous registry study.

Abstract

Background: Compared to the great saphenous vein, there is a relative paucity of data in the literature focused on treating the small saphenous vein (SSV). Our goal was to evaluate and analyze national registry data related to the diagnosis and treatment of the SSV and identify practice patterns and clinical outcomes.

Method: Subjects undergoing SSV interventions between April 2014 and March 2023 were identified in the AVLS PRO Venous Registry. Data points included Clinical, Etiological, Anatomical, Pathological (CEAP) classifications; Venous Clinical Severity Score (VCSS), Venous Quality of Life (VVSymQ®) instrument scores, Heaviness, Aching, Swelling, Throbbing, Itching (HASTI) symptoms, and Short Form Health Survey (SF-36.) Duplex ultrasound findings included vein diameter, length, and the overall recanalization rate.

Result: A total of 92,175 SSV interventions were identified. Over two-thirds of subjects presented with a CEAP classification of C3 (31%) and C4 (C4 40%). Clinical results demonstrated significant improvement immediately after treatment in the first month and maintained beneficial results at 1 year or longer (p < 0.001.) This improvement was reflected in the significant decrease in VCSS scores (6 ± 3.4 to 5 ± 2.9; p < 0.0001), VVSymQ (9.5 ± 6.0 to 5.9 ± 4.4; p < 0.0001), and HASTI (9.4 ± 5.9 to 6.6 ± 5.2; p < 0.0001). The recanalization rate at any follow-up was 3%; 48% of those occurring within the first year. Predictors associated with recanalization were larger vein diameter (mean 4.0 mm, 95% CI 3.9-4.1, p < 0.0001) and shorter SSV length (mean 15.27 mm, 95 % CI 14.4-16.1, p < 0.0001).

Conclusion: Treatment of SSV insufficiency improved clinical outcomes by both patient and physician-derived outcome measures. Only 3% of SSV demonstrated recanalization, and nearly half occurred within the first year following the procedure. Predictors of recanalization included larger pre-procedure vein diameters and treatment of a shorter length of SSV.