Journal of vascular surgery. Venous and lymphatic disorders · 2026
Combined treatment of deep and superficial venous reflux accelerates ulcer healing and improves symptoms: A real-world retrospective study.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Zheng Wei, Gu Zongheng, Zhao Hui, Yan Changbao, Zhang Jie, Zhao Liang, Wu Yingfeng
Аннотация
BACKGROUND: The optimal surgical strategy for treating chronic venous disease with concomitant deep and superficial reflux but without iliac/proximal obstruction remains unclear. This study aimed to compare clinical symptoms, health-related quality-of-life, and ulcer outcomes between superficial venous surgery alone and combined deep-superficial surgery (performed concurrently or in stages).
METHODS: In this single-center retrospective cohort, 229 patients were grouped by treatment and received superficial-only (n = 138), concurrent deep + superficial (n = 49), or staged deep + superficial (n = 42) interventions. Outcomes were Venous Clinical Severity Score (VCSS), Chronic Venous Insufficiency Questionnaire-20 (CIVIQ-20) at baseline and follow-up (1, 3, and 6 months, and last follow-up), ulcer outcomes (n = 59) assessed by healing rates and Kaplan-Meier time-to-healing analysis, duplex valve competence after deep intervention, and complications. Analyses used Welch one-way analysis of variance with Games-Howell post hoc and log-rank testing.
RESULTS: Baseline characteristics were comparable (baseline VCSS 8.6±3.3, 9.6±4.0, and 9.0±3.9; P = .32). Between-group differences in VCSS were significant at 1 month (P = .012), 6 months (P < .001), and last follow-up (P = .017). Staged treatment reduced VCSS vs superficial-only at 1 month (mean difference [MD], -1.47; Padj = .008); both concurrent and staged strategies showed lower VCSS vs superficial-only at 6 months (MD, -0.98 and -1.01; Padj = .003 and .001) and last follow-up (MD, -0.76 and -0.68; Padj = .025 and .033). The CIVIQ-20 at the last-follow-up was lower with concurrent and staged strategies vs superficial-only (MD, -2.83 [Padj < .001]; MD, -2.40 [Padj = .010]). Internal valvuloplasty (n = 77) demonstrated lower VCSS at 1 to 6 months and last follow-up vs superficial-only (all Padj ≤ .026) and a lower CIVIQ-20 score. Among 59 active ulcers, 89.8% healed overall; healing proportions did not differ (P = .310), but time to healing differed by Kaplan-Meier analysis (log-rank P = .038). Duplex after deep intervention showed reflux normalization (<0.5 seconds) in 94.5% to 98.9% at 1 to 6 months; complications were minor, with no symptomatic deep vein thrombosis/pulmonary embolism or major bleeding.
CONCLUSIONS: In patients with chronic venous disease with concomitant deep and superficial reflux but no iliac obstruction, adding deep reflux correction (concurrent or staged) was associated with greater and more durable symptom relief and better quality of life than superficial-only surgery, with high duplex-confirmed competence and low complication rates; ulcer healing time may be accelerated.
METHODS: In this single-center retrospective cohort, 229 patients were grouped by treatment and received superficial-only (n = 138), concurrent deep + superficial (n = 49), or staged deep + superficial (n = 42) interventions. Outcomes were Venous Clinical Severity Score (VCSS), Chronic Venous Insufficiency Questionnaire-20 (CIVIQ-20) at baseline and follow-up (1, 3, and 6 months, and last follow-up), ulcer outcomes (n = 59) assessed by healing rates and Kaplan-Meier time-to-healing analysis, duplex valve competence after deep intervention, and complications. Analyses used Welch one-way analysis of variance with Games-Howell post hoc and log-rank testing.
RESULTS: Baseline characteristics were comparable (baseline VCSS 8.6±3.3, 9.6±4.0, and 9.0±3.9; P = .32). Between-group differences in VCSS were significant at 1 month (P = .012), 6 months (P < .001), and last follow-up (P = .017). Staged treatment reduced VCSS vs superficial-only at 1 month (mean difference [MD], -1.47; Padj = .008); both concurrent and staged strategies showed lower VCSS vs superficial-only at 6 months (MD, -0.98 and -1.01; Padj = .003 and .001) and last follow-up (MD, -0.76 and -0.68; Padj = .025 and .033). The CIVIQ-20 at the last-follow-up was lower with concurrent and staged strategies vs superficial-only (MD, -2.83 [Padj < .001]; MD, -2.40 [Padj = .010]). Internal valvuloplasty (n = 77) demonstrated lower VCSS at 1 to 6 months and last follow-up vs superficial-only (all Padj ≤ .026) and a lower CIVIQ-20 score. Among 59 active ulcers, 89.8% healed overall; healing proportions did not differ (P = .310), but time to healing differed by Kaplan-Meier analysis (log-rank P = .038). Duplex after deep intervention showed reflux normalization (<0.5 seconds) in 94.5% to 98.9% at 1 to 6 months; complications were minor, with no symptomatic deep vein thrombosis/pulmonary embolism or major bleeding.
CONCLUSIONS: In patients with chronic venous disease with concomitant deep and superficial reflux but no iliac obstruction, adding deep reflux correction (concurrent or staged) was associated with greater and more durable symptom relief and better quality of life than superficial-only surgery, with high duplex-confirmed competence and low complication rates; ulcer healing time may be accelerated.