A Comparison of Below-Knee Versus Above-Knee Treatment of Varicose Veins

Varicose veins have a significant impact on quality of life and can commonly occur in the thigh and calves. However, there has been no large-scale investigation examining the relationship between anatomic distribution and outcomes after varicose vein treatment. This study sought to compare below-the-knee versus (BTK) and above-the-knee (ATK) varicose vein treatment outcomes. Employing the Vascular Quality Initiative Varicose Vein Registry, 53,528 patients undergoing varicose vein ablation for either BTK or ATK lesions were identified. Outcomes were assessed using patient-reported outcomes (PROs) and the Venous Clinical Severity Score (VCSS). Continuous variables were compared using t-test and categorical variables were analyzed using χ2. Multivariate logistic regression was used to determine the odds of improvement after intervention. The multivariate model controlled for age, gender, race, previous varicose vein treatment, preoperative VCSS composite score, and history of DVT. Between those receiving BTK and ATK treatment, there was no difference in preoperative VCSS composite score (7.2 vs 7.2; P = .148). However, PROs preoperatively showed that BTK treatment was associated with consistently less severe reported symptoms including heaviness (1.9 vs 2.0; P < .001), achiness (2.2 vs 2.4; P < .001), swelling (2.0 vs 2.1; P < .001), throbbing (1.4 vs 1.6; P < .001), appearance (1.1 vs 1.2; P < .001), and work impact (1.7 vs 1.8; P < .001). Yet, after treatment, those receiving BTK treatment for varicosities exhibited less improvement (3.0 vs 3.5; P < .001) and higher postoperative VCSS composite score (4.4 vs 3.9; P < .001). PROs showed similar results. After intervention, patients with BTK interventions reported greater heaviness (0.7 vs 0.6; P < .001), achiness (0.9 vs 0.8; P < .001), swelling (0.9 vs 0.8; P < .001), and work impact (0.7 vs 0.6; P < .001). Multivariate analysis adjusting for covariates also showed that ATK treatments were associated with greater improvement in VCSS composite scores after intervention (odds ratio, 1.4; 95% confidence interval, 1.3-1.5). Treatment region has a significant impact on both patient-reported outcomes and VCSS composite scores after varicose vein interventions. Preoperatively, there was no difference in VCSS composite scores but significant differences in PROs with patients receiving BTK treatment exhibiting less severe symptoms. Yet, the association appeared to reverse postoperatively with those receiving BTK treatments exhibiting worse PROs, worse VCSS composites scores, and less improvement in VCSS composite scores. Therefore, BTK interventions pose a unique challenge compared with ATK interventions in ensuring commensurate clinical improvement after treatment.