Surgical treatment of varicose veins of the lower extremities and the current comorbid background

Introduction. Varicose veins of the lower extremities are a common pathology affecting about 25–33% of the adult population. The treatment of this disease requires studying the influence of comorbidities on the choice of surgical treatment tactics for varicose veins.

Aim. To assess the degree of influence of comorbid conditions on decision-making regarding the method of surgical intervention and to develop an algorithm for a personalized treatment approach.

Materials and methods. A retrospective analysis of 500 medical records of patients who underwent surgical treatment for varicose veins was conducted using multivariate statistical analysis and machine learning methods to identify significant correlations. To assess long-term results, a prospective observation of 100 patients was additionally conducted for one year after surgery.

Results. The results of the study showed that the presence of cardiovascular diseases increases the risk of postoperative complications by 23%, which requires correction of surgical tactics. A significant association between diabetes mellitus and increased duration of postoperative wound healing was revealed (p < 0.01). The analysis of long-term results showed that patients with comorbidities have a higher risk of varicose vein recurrence, especially in the presence of obesity and diabetes mellitus.

Discussion. The results demonstrate the necessity of differentiated approach to the choice of surgical tactics taking into account the individual profile of the patient’s comorbidity.

Conclusions. The developed prognostic algorithm and the proposed recommendations can serve as a basis for the creation of clinical guidelines aimed at improving the efficacy and safety of surgical treatment of varicose veins in patients with comorbidities.

1. Pannier-Fischer F, Rabe E. Epidemiology of chronic venous disorders. Hautatzt. 2003;54(11):1037–1044. https://doi.org/10.1007/s00105-003-0616-0.

2. Zolotukhin IA, Seliverstov EI, Shevtsov YN, Avakiants IP, Nikishkov AS, Tatarintsev AM, Kirienko AI. Prevalence and Risk Factors for Chronic Venous Disease in the General Russian Population. Eur J Vasc Endovasc Surg. 2017;54(6):752–758. https://doi.org/10.1016/j.ejvs.2017.08.033.

3. Gloviczki P, Comerota AJ, Dalsing MC, Eklof BG, Gillespie DL, Gloviczki ML et al. The care of patients with varicose veins and associated chronic venous diseases: Clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 2011;53(5 Suppl):2S–48S. https://doi.org/10.1016/j.jvs.2011.01.079.

4. Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012;380(9836):37–43. https://doi.org/10.1016/S0140-6736(12)60240-2.

5. Piazza G, Goldhaber SZ. Venous thromboembolism and atherothrombosis: an integrated approach. Circulation. 2010;121(19):2146–2150. https://doi.org/10.1161/CIRCULATIONAHA.110.951236.

6. Clark A, Harvey I, Fowkes FG. Epidemiology and risk factors for varicose veins among older people: cross-sectional population study in the UK. Phlebology. 2010;25(5):236–240. https://doi.org/10.1258/phleb.2009.009045.

7. Onida S, Davies AH. Predicted burden of venous disease. Phlebology. 2016;31(1 Suppl):74–79. https://doi.org/10.1177/0268355516628359.

8. Wittens C, Davies AH, Bækgaard N, Broholm R, Cavezzi A, Chastanet S, de Wolf M et al. Editor’s Choice – Management of Chronic Venous Disease: Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2015;49(6):678–737. https://doi.org/10.1016/j.ejvs.2019.11.027.

9. Kakkos SK, Gohel M, Baekgaard N, Bauersachs R, Bellmunt-Montoya S, Black SA et al. Editor’s Choice – European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on the Management of Venous Thrombosis. Eur J Vasc Endovasc Surg. 2021;61(1):9–82. https://doi.org/10.1016/j.ejvs.2020.09.023.

10. Lurie F, Passman M, Meisner M, Dalsing M, Masuda E, Welch H et al. The 2020 update of the CEAP classification system and reporting standards. J Vasc Surg Venous Lymphat Disord. 2020;8(3):342–352. https://doi.org/10.1016/j.jvsv.2019.12.075.

11. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity inlongitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–383. https://doi.org/10.1016/0021-9681(87)90171-8.

12. Launois R, Reboul-Marty J, Henry B. Construction and validation of a quality oflife questionnaire in chronic lower limb venous insufficiency (CIVIQ). Qual Life Res. 1996;5(6):539–554. https://doi.org/10.1007/BF00439228.

13. Vuylsteke ME, Mordon SR. Endovenous laser ablation: a review of mechanisms of action. Ann Vasc Surg. 2012;26(3):424–433. https://doi.org/10.1016/j.avsg.2011.05.037.

14. Rasmussen LH, Lawaetz M, Bjoern L, Vennits A, Eklof B. Randomized clinical trial comparing endovenous laser ablation, radiofrequency ablation, foam sclerotherapy and surgical stripping for great saphenous varicose veins. Br J Surg. 2011;98(8):1079–1087. https://doi.org/10.1002/bjs.7555.

15. van der Velden SK, Biemans AA, De Maeseneer MG, Kockaert MA, Cuypers PW, Hollestein LM et al. Five-year results of a randomized clinical trial of conventional surgery, endovenous laser ablation and ultrasound-guided foam sclerotherapy in patients with great saphenous varicose veins. Br J Surg. 2015;102(10):1184–1194. https://doi.org/10.1002/bjs.9867.

16. Rabe E, Guex JJ, Puskas A, Scuderi A, Fernandez Quesada F; VCP Coordinators. Epidemiology of chronic venous disorders in geographically diverse populations: results from the Vein Consult Program. Int Angiol. 2012;31(2):105–115. Available at: https://pubmed.ncbi.nlm.nih.gov/22466974/.

17. Lehtola A, Asko-Seljavaara S, Laurikka J, Perhoniemi V. Laskimoiden kroonisen vajaatoiminnan ja säärihaavan kirurginen hoito [Surgical treatment of chronic venous insufficiency and varicose ulcer]. Duodecim. 1997;113(20):2077–2088. Available at: https://www.duodecimlehti.fi/duo70460.

18. Meissner MH. What is the medical rationale for the treatment of varicose veins? Phlebology. 2012;27 Suppl 1:27–33. https://doi.org/10.1258/phleb.2012.012s17.

19. Baraldi C, Bissacco D. Safety and Efficacy of Combining Saphenous Endovenous Laser Ablation and Varicose Veins Foam Sclerotherapy: An Analysis on 5500 Procedures in Patients With Advance Chronic Venous Disease (C3-C6). Vasc Endovascular Surg. 2024;58(1):60–64. https://doi.org/10.1177/15385744231188804.

20. Lurie F, Passman M, Meisner M, Dalsing M, Masuda E, Welch H et al. The 2020 update of the CEAP classification system and reporting standards. J Vasc Surg Venous Lymphat Disord. 2020;8(3):342–352. https://doi.org/10.1016/j.jvsv.2019.12.075.