Race/ethnicity and outcomes of venous ablation procedures

To evaluate the effectiveness and safety of endovenous ablation across racial and ethnic groups by comparing rates of endovenous heat-induced thrombosis (EHIT) and recanalization.

We retrospectively analyzed 13,335 endothermal ablation procedures (radiofrequency or laser) performed from 2012 to 2022 at a single outpatient center. Patient demographics, including self-identified race/ethnicity (such as Asian, Black, Hispanic, and White), were recorded. Postprocedural duplex ultrasound study was conducted at 3 to 7 days, 3 to 6 months, and then every 6 to 12 months. EHIT (classes 1-4) and recanalization of the treated vein were identified on follow-up imaging. Outcomes were compared across racial/ethnic groups using univariable and multivariable logistic regression.

Among 13,335 ablations (8187 radiofrequency and 5148 laser) in 3218 patients, 67.1% were performed in women. Mean follow-up was 25.8 ± 12.9 months (range, 3-72 months). EHIT incidence was highest in Black patients (3.0%), followed by Asian (2.6%), White (1.7%), and Hispanic (1.4%) patients; the difference between Black and White patients was significant (P < .001), whereas other pairwise comparisons were not. Procedural success (no EHIT or recanalization) was high and comparable across groups: 96.1% in Asians, 95.2% in Blacks, 96.1% in Hispanics, and 96.2% in Whites. On multivariable analysis, Black race was associated with higher EHIT risk (odds ratio, 1.92; P < .001), and Asian race with higher recanalization risk (odds ratio, 1.65; P = .045). Additional predictors of recanalization included advanced disease (Clinical, Etiologic, Anatomic, and Pathophysiologic class 6; P < .05), whereas the ablation of the great, anterior, or small saphenous veins was protective compared with perforator veins (all P < .001). Predictors of EHIT included older age (P < .0001) and previous recanalization (P < .0001), whereas laser ablation was associated with a significantly lower EHIT risk compared with radiofrequency (P < .0001). Baseline disease severity also varied: Black patients were more likely to present with advanced disease (Clinical, Etiologic, Anatomic, and Pathophysiologic class, 5-6) than Hispanic and Asian patients (P < .0001).

Endovenous ablation is a safe and effective treatment for chronic venous insufficiency across different racial/ethnic groups, with overall success rates of 95% to 96%. However, racial differences were observed in complication rates and baseline severity: Black patients had higher EHIT risk and more advanced disease at presentation, whereas Asian patients had a slightly higher risk of recanalization. These findings highlight the need for tailored postablation surveillance and improved early access to care to address differences in minority populations.