Symptom patterns and quality of life (QoL) in CEAP clinical class 0 (C0sEpAsPr) are not thoroughly evaluated compared to C2s patients. We conducted a propensity score matching study to evaluate symptom characteristics, QoL, and treatment effects between C0s and C2 patients.¹ ²

This was a registry-based observational study from Mar. 1. 2019 to Sep. 31. 2021 (National IRB No. 2019-2827-003). A total of 2059 limbs of C0s and 942 limbs of C2s that had truncal great saphenous vein (GSV) reflux were prospectively enrolled. Chronic Venous Disease (CVD) symptoms were classified into five: leg heaviness, calf cramping, itching sensation, pain, and numbness. 33.2% (n=683 of C0s limbs) and 61.6% (n=580 of C2s limbs) of patients underwent endovenous surgery (sclerotherapy, endovenous laser ablation, radiofrequency ablation, cyanoacrylate embolization) with or without concomitant phlebectomy. After propensity score matching based on sex, age, and types of endovenous procedure, the present study analyzed 449 limbs of C0s and 449 C2s. The primary objective was to evaluate whether there was a difference in the distribution of preoperative CVD symptoms between the two groups (Chi-square test). As secondary outcomes, perioperative VAS pain score, the required number of concomitant phlebectomy, postoperative CVD symptom improvement, changes in symptom severity (0 - 5 points), the Venous Clinical Severity Score (VCSS), and the ChronIc Venous Insufficiency Quality of Life Questionnaire (CIVIQ-14) were evaluated by performing a three-month postoperative data analysis. There were 558 (62.2%) females with 51.9±13.5 years.

After adjusting the data, preoperative symptom distribution was not different in both groups for Leg heaviness (73.9% vs. 75.1%), Calf cramping (70.2% vs. 68.6%), Pain (29.8% vs. 29.2%), and Numbness (57.5% vs. 56.8%). Itching was more prevalent in C2 limbs (18.3% vs. 24.5% p=0.028). Preoperative patient-reported symptom severity scores (0-5 points) were similar in both groups (2.73±1.67 vs. 2.63±1.5, p=ns. Non-parametric Mann-Whitney U test); however, VCSS (1.62±0.97 vs. 3.39±1.22, p<0.001) and CIVIQ-14 (26.6±9.5 vs. 28.5±17.1, p=0.03) were significantly higher in having C2 limbs. Even though endovenous surgery is being used as the primary modality, the mean number of required concomitant phlebectomy (0.18±0.58 vs. 2.12±2.59, p<0.001), perioperative VAS pain scores (4.0±2.4 vs. 4.4±2.4, p=0.04), and mean procedure time (21.3±10.8 vs. 31.3±20.2, p<0.001) were significantly higher in C2 group. Three months after the endovenous surgery, all types of symptoms were significantly improved in both groups (82.7% vs.84.9% for leg heaviness, 89.3% vs. 93.7% for cramping, 71.6% vs. 69.5% for pain, 94.5% vs. 98.5% for itching, 85.0% vs. 85.2% for Numbness, All McNemar test). Although CIVIQ-14 and VCSS were higher in C2 preoperatively, they improved significantly in both groups and remained similar in the repeated measured general linear model. Patient-reported satisfaction score (0-10) was similar in both groups (8.15±1.8 vs. 8.2±1.9, p=ns).

Although the C0s limbs showed lower VCSS scores, the preoperative CVD symptom patterns and patient-reported symptom severity scores in C0s patients were comparable to those in C2s groups. All CVD symptoms, Patient-reported symptom severity, and CIVIQ-14 were significantly improved after the treatment of pathologic venous reflux. In selected cases of C0s, endovenous treatment may be helpful to reduce CVD symptoms and enhance QoL.

1.Lurie, Fedor, et al. "The 2020 update of the CEAP classification system and reporting standards." Journal of Vascular Surgery: Venous and Lymphatic Disorders 8.3 (2020): 342-352. 2022 2.De Maeseneer, Marianne G., et al. "European Society for Vascular Surgery (ESVS) 2022 clinical practice guidelines on the management of chronic venous disease of the lower limbs." European Journal of Vascular and Endovascular Surgery (2022).