The Prognostic Ability of Venous Clinical Severity Score in Iliac Vein Stent Placement

The Venous Clinical Severity Score (VCSS) is a widely used measure of quantifying the severity of chronic venous disease (CVD). Yet, little is known of the prognostic ability of VCSS for predicting reintervention after iliac vein stenting. This study sought to assess whether preoperative VCSS can predict reintervention requiring venography. A registry of 622 patients who underwent iliac vein stenting for chronic proximal venous outflow obstruction secondary to nonthrombotic iliac vein lesions from August 2011 to November 2020 was retrospectively analyzed. VCSS was used to assess symptoms and reintervention requiring venography was used as the primary end point. Univariable and multivariable logistic and Cox proportional hazard regression models were used to determine the odds and hazard ratios of reintervention. Patients (n = 146, 23.5%) of received a reintervention requiring venography. The only component of preoperative VCSS that differed significantly between those who did and did not receive a reintervention was the pain component of VCSS (2.0 vs 1.7; P < .001). Of the 10-parameter VCSS, preoperative pain was the only component that was significantly associated with reintervention in the univariable (odds ratio [OR], 1.58; 95% confidence interval [CI], 1.25-2.02; P < .001), multivariable adjusting for the nine other components (OR, 1.58; 95% CI, 1.24-2.02; P < .001), and multivariable logistic regression analyses adjusting for all VCSS components as well as significant comorbidities (OR, 1.49; 95% CI, 1.15-1.94; P = .003). Similarly, preoperative pain was the only component of preoperative VCSS that was significantly associated with time to reintervention in the univariable (hazard ratio [HR], 1.43; 95% CI, 1.16-1.76, P = .001), multivariable adjusting for all other components of VCSS (HR, = 1.47; 95% CI, 1.18-1.82; P = .001), and multivariable Cox proportional hazards regression model adjusting for all components as well as significant comorbidities (HR, 1.37; 95% CI, 1.09-1.73; P = .007). VCSS composite scores were not associated with odds or hazard ratios of reintervention in either the univariable or multivariable logistic and Cox proportional hazard regression models. Preoperative pain was the only component of VCSS that was significantly associated with reintervention requiring venography, while VCSS composite and all nine other components of VCSS were poor predictors of reintervention.