Endovenous thermal ablation (EVTA) is a prevalent treatment option for patients with severe venous disease. However, the decision to intervene for patients with less severe disease (CEAP [clinical, etiology, anatomy, pathophysiology] C2 and C3) is less clear and becomes further complicated for patients with 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 database to evaluate outcomes after EVTA in obese patients with CEAP C2 and C3 venous insufficiency. Using the Society for Vascular Surgery Vascular Quality Initiative database, we retrospectively analyzed the initial procedure of all patients with a CEAP clinical class of C2 or C3 who underwent EVTA from January 2015 to December 2021. Patients were grouped by obesity, defined as a body mass index of ≥30 kg/m. The primary outcome was the change in venous clinical severity score (VCSS) from the procedure to the patient's initial follow-up. The secondary outcomes included the change in patient-reported outcomes at follow-up via the HASTI (heaviness, achiness, swelling, throbbing, itching) score, incidence of follow-up complications, and recanalization of treated veins. The change in the VCSS and HASTI score were analyzed using Student tests, and complications and recanalization were assessed using the Fisher exact test. Significant outcomes were confirmed by multiple variable logistic regression. The remaining significant variables were then analyzed, with obesity categorized using the World Health Organization classification system to analyze how increasing obesity levels affect outcomes. There were 8146 limbs that met the inclusion criteria, of which 5183 (63.6%) were classified as nonobese and 2963 (36.4%) as obese. Obesity showed no impact on improvement in the VCSS (−3.29 vs −3.35; = .408). Obesity was found to be associated with a larger improvement in overall symptoms, as evidence by a greater improvement in the HASTI score (−7.24 vs −6.62; < .001). Obese limbs showed a higher incidence of superficial phlebitis (1.5% vs 0.7%; = .001), but no difference was found in recanalization or any other complication. These data suggest that obese patients with CEAP clinical class C2 or C3 experience greater improvement in their perceived symptoms after EVTA with little difference in clinical improvement and complications compared with nonobese patients. Although obesity has been associated with increased severity of venous disease symptoms, obese patients are able to derive significant relief after treatment during the short term and may experience greater relief of symptoms than nonobese patients when treated at more mild disease presentations.

中文翻译：

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患有 CEAP（临床、病因学、解剖学、病理生理学）C2 和 C3 疾病的肥胖患者在静脉内热消融后症状改善明显

静脉内热消融（EVTA）是严重静脉疾病患者的普遍治疗选择。然而，对疾病不太严重的患者（CEAP [临床、病因学、解剖学、病理生理学] C2 和 C3）进行干预的决定不太明确，并且对于肥胖患者来说变得更加复杂，肥胖是一种已知会增加静脉疾病症状严重程度的病理学。因此，本研究的目的是利用血管外科学会血管质量倡议数据库来评估患有 CEAP C2 和 C3 静脉功能不全的肥胖患者 EVTA 后的结果。使用血管外科学会血管质量倡议数据库，我们回顾性分析了 2015 年 1 月至 2021 年 12 月期间接受 EVTA 的所有 CEAP 临床分类为 C2 或 C3 的患者的初始手术。患者按肥胖（定义为体重）进行分组指数≥30 kg/m。主要结果是从手术到患者初次随访期间静脉临床严重程度评分（VCSS）的变化。次要结局包括患者通过 HASTI（沉重、疼痛、肿胀、抽动、瘙痒）评分随访时报告的结局变化、随访并发症的发生率以及治疗静脉的再通。使用Student检验分析VCSS和HASTI评分的变化，并使用Fisher精确检验评估并发症和再通。多变量逻辑回归证实了显着的结果。然后分析其余的重要变量，使用世界卫生组织分类系统对肥胖进行分类，以分析肥胖水平的增加如何影响结果。符合纳入标准的肢体有 8146 条，其中 5183 条（63.6%）被归类为非肥胖，2963 条（36.4%）被归类为肥胖。肥胖对 VCSS 的改善没有影响（−3.29 vs -3.35；= .408）。肥胖被发现与整体症状的更大改善相关，HASTI 评分的更大改善就是证据（-7.24 与 -6.62；< .001）。肥胖肢体的浅静脉炎发生率较高（1.5% vs 0.7%；= .001），但在血管再通或任何其他并发症方面没有发现差异。这些数据表明，与非肥胖患者相比，CEAP 临床分类为 C2 或 C3 的肥胖患者在 EVTA 后其感知症状有更大改善，但临床改善和并发症几乎没有差异。尽管肥胖与静脉疾病症状的严重程度增加有关，但肥胖患者在治疗后短期内能够得到显着缓解，并且在病情较轻的情况下接受治疗时，与非肥胖患者相比，症状可能会得到更大程度的缓解。