Propensity Score Matched Analysis of Quality of Life Improvement after Endovenous Ablation for Isolated Below knee Segmental Versus Thigh to Calf Great Saphenous Vein Reflux.

Abstract

Symptomatic isolated below knee (BK) reflux in the great saphenous vein is under represented in current guidelines. This study compared outcomes after endovenous ablation in patients with isolated BK segmental reflux (BK group) vs. thigh to calf continuous reflux (TC group), focusing on patient reported outcomes in early stage chronic venous disease (CVD). This was a retrospective propensity score matched analysis of a prospectively maintained Venous Reflux Originated Severity Score registry. Patients enrolled between January 2022 and December 2024 with at least one typical CVD symptom and truncal reflux > 1 second (Clinical-Etiological-Anatomical-Pathophysiological [CEAP] clinical C0s - C3) were included. Exclusion criteria were age > 75 years, previous interventions, deep vein thrombosis, active ulceration, and incomplete follow up. Intervention was endovenous (laser, radiofrequency, cyanoacrylate, or foam) ablation. A 1:1 nearest neighbour match on sex and baseline symptom severity yielded 115 pairs. Sample size was calculated to detect a two point difference in Chronic Venous Insufficiency Questionnaire-14 (CIVIQ-14) with 80% power. The primary outcome was improvement in CIVIQ-14 at three months; secondary outcomes were changes in symptom severity, Venous Clinical Severity Score (VCSS), and patient satisfaction. Multivariable regression explored predictors of quality of life (QoL) improvement. At three months, no major complications occurred; minor complications were similar (BK 4.0% vs. TC 5.0%; p = .72). Symptom improvement rates were comparable (BK 83.4% vs. TC 85.9%; p = .42). Both groups improved in CIVIQ-14, VCSS, and symptom scores (all p < .001). VCSS reduction was greater in the TC group (3.11 to 0.62; Δ -2.49) than the BK group (2.08 to 0.81; Δ -1.27; interaction p < .001, ANCOVA), whereas CIVIQ-14 gains were comparable (p = .13). Patient reported satisfaction did not differ. Baseline CIVIQ-14 best predicted QoL improvement (B = 0.768, p < .001). In early stage CVD, disease specific QoL may improve following ablation regardless of reflux extent. These findings support the clinical relevance of treating isolated BK reflux in carefully selected patients.