The relationship between CEAP class and Venous Clinical Severity Score (VCSS) change following great saphenous vein ablation (GSVa) is under reported. We further defined this relationship in patients including those with severe chronic venous disease (CVD) and the obese. We reviewed our prospectively collected venous procedural database from January 2007 to October 2010 for patients who had undergone GSVa (± phlebectomies). A CEAP class 5 or 6 designated severe CVD. VCSS were obtained preoperatively and at the 1st, 2nd, and 3rd follow up visits. 265 limbs in 216 patients underwent GSVa. (Table 1) Follow up was done at a mean of 7.5, 102.7, and 242.6 days postoperatively. A significant association between CEAP class and a declining VCSS following GSVa was seen, such that more severe CVD does not improve to the same degree as less severe CVD.(Fig 1) A direct correlation between increasing BMI and higher VCSS by a coefficient of .053 was demonstrated. (p < .001).Table 1Patient DemographicsCEAP 2CEAP 3CEAP 4CEAP 5 and 6p valueNUMBER OF LIMBS1111092916N/AMALE:FEMALE28:8722:8713:165:11.036MEAN AGE49.6752.4954.7953.19.094MEAN BMI28.9229.6032.8235.41.01RFA:EVLT59:5140:6910:1913:3.001PHLEBETOMIES n(%)66 (59%)32 (29%)8 (28%)2 (13%)<.001BMI - Body Mass Index (kg/m2); RFA - Radiofrequency Ablation; EVLT - Endovenous Laser Treatment Open table in a new tab BMI - Body Mass Index (kg/m2); RFA - Radiofrequency Ablation; EVLT - Endovenous Laser Treatment Although all groups improved, the degree of improvement was influenced by BMI and CEAP class. Realistic outcomes must be considered when counseling patients.

Objective: We hypothesize that endovenous laser ablation (EVA) therapy is equally successful in improving venous insufficiency symptoms in patients with or without deep venous insufficiency (DVI).Methods: From January 2005 through August 2007, EVA of the great saphenous vein (GSV) was attempted in 364 patients (460 limbs) with symptomatic GSV reflux. The GSV was successfully cannulated and obliterated in all but 17 limbs. EVA was performed alone in 308 limbs (69.5%) and with phlebectomy or perforator ligation (EVAP) in 135 limbs (30.5%). Venous clinical severity scores (VCSS) were recorded preoperatively and at 30, 90, 180, and 360 days postoperatively. Patients were classified as those with or without DVI based oil duplex imaging valve closure times at the common femoral vein (CFV) and popliteal vein (PV). lit a subset of 181 patients undergoing EVA therapy in the operating room, perioperative thrombosis prophylaxis was administered based on a risk-stratification protocol. Patients were assessed with direct end points (VCSS) and indirect end points (vein occlusion rates).Results: Successful performance of EVA led to complete saphenous vein ablation in 99.8% at 1 month and 95.9% at 1 year. Median VCSS preoperatively was 6 (interquartile range, 5-8), generally decreasing over all time points to 4 (interquartile range, 2-5) beyond 360 days (P < .001). Male gender was independently associated with greater improvement in scores with time (P = .019). Changes in VCSS and duration of vessel occlusion were equivalent regardless of DVI for both isolated EVA and EVAP. For EVAP, the true deep venous thrombosis (DVT) rate was 2.2%, whereas for isolated EVA, the rate was 0% (P = .028); the rate of saphenofemoral thrombus extension was 5.9% for EVAP vs 7.8% for isolated EVA (P = .554). The use of risk-adjusted heparin prophylaxis in patients undergoing EVAP did not have a significant effect on thrombotic complications. There were no differences in true DVT, thrombus extension, or superficial thrombophlebitis between patients with or without DVI. Performance of concomitant phlebectomy, DVI, gender, and age had no effect on the duration of vessel occlusion.Conclusion: EVA produces successful ablation and is associated with sustained improvement in VCSS. These outcomes are independent of the presence of DVI. Finally, the use of a risk-adjusted thrombosis prevention protocol had no effect on the rate of superficial thrombus extension from EVA or EVAP in patients undergoing general anesthesia. (J Vasc Surg 2008;48:1538-45.)

HYPOTHESIS Surgical compression stockings measurably improve venous physiologic mechanisms, and stocking brands do not differ from one another. METHODS Eleven patients, (8 men and 3 women [mean age, 53 years]), were included. Six patients had primary venous insufficiency and 5 patients had secondary venous insufficiency; 5 patients were in CEAP class 4 and 6 were in CEAP class 5. Patients were randomly assigned to a sequence of 4 brands of knee-high, open-toe, 30- to 40-mm Hg stockings. Each patient wore a stocking for a 1-month equilibration period, then a different stocking monthly for 4 months in a row. Air plethysmography examinations were performed with and without stockings before and after each month of wear. Patients filled out a daily stocking record log and a monthly satisfaction survey. Stockings underwent compression testing after use. RESULTS Stockings controlled reflux better than they improved calf muscle pump function. With stockings on, patients in CEAP 4 benefited more than those in CEAP 5 in decreasing reflux, while patients in CEAP 5 benefited more than those in CEAP 4 in improving calf muscle pump function. Changes in residual volume fraction were improved in patients in CEAP 5 wearing stockings but not in patients in CEAP 4. Patients with primary disease had greater volumes of reflux and calf ejection than with secondary disease. There were no hemodynamic differences between stocking brands but there were differences in patient compliance and acceptance. CONCLUSIONS Surgical support stockings seem to be more effective in controlling reflux than in improving calf muscle pump function. All stocking brands function equally as measured by air plethysmography.

PURPOSE:The purpose of this study was to evaluate the clinical presentation, diagnosis, and endovascular treatment of iliocaval compression syndrome (ICS).PATIENTS AND METHODS:During a 3-year period, 18 patients (17 women, 1 man; mean age, 42 years) presented with clinical and imaging findings consistent with ICS. All patients were evaluated with venography and Doppler ultrasound (DUS), 13 of 18 with intravascular pressure measurements, 12 of 18 with intravascular ultrasound, 9 of 18 with air plethysmography (APG), and 4 of 18 with magnetic resonance venography. Seventeen patients were treated with endovascular stenting, one was treated with angioplasty alone, and six received adjunct thrombolysis.RESULTS:Despite the presence of stenosis or occlusion in all cases, APG indicated no iliac vein obstruction (outflow fraction > or = 40%) in nine patients. DUS revealed acute (6) or chronic (7) unilateral iliofemoral deep venous thrombosis in 13 of 18 patients, whereas the results of five of 18 DUS studies were normal. Recanalization and stent placement (n = 17) or angioplasty (n = 1) was achieved in all patients. The average pressure gradient was 5.6 mm Hg preprocedure and 0.6 mm Hg postprocedure. The primary patency rate demonstrated with DUS (n = 17) and venography (n = 7) at 6 months was 89%. The primary patency rate at 12 months was 79%.CONCLUSIONS:ICS often presents as sudden unilateral left lower extremity pain and swelling in young to middle-aged female patients after pregnancy, surgery, or a period of inactivity. Venography, intravascular ultrasound, and magnetic resonance venography demonstrate high sensitivity, whereas APG-outflow fraction demonstrates low sensitivity in the diagnosis of ICS. Endovascular stenting and angioplasty provide safe and effective early and intermediate-term treatment of symptomatic ICS.