Effect of obesity on endovenous ablation outcomes in the Vascular Quality Initiative

Obesity is a known risk factor for chronic venous insufficiency in both incidence and disease severity. Limited previous work suggests that obesity is associated with worse outcomes after endovenous ablation. We analyzed patients who received truncal endovenous ablation with or without concomitant phlebectomy to better understand the relationship between obesity and postoperative outcomes.

We evaluated short- and long-term clinical and patient-reported outcomes among patients who underwent truncal endovenous ablation with and without phlebectomy in the Vascular Quality Initiative Varicose Vein Registry with body mass index (BMI) as the primary explanatory variable. Our primary outcome measures were improvement in revised Venous Clinical Severity Score (rVCSS) and total symptom score. Secondary outcomes included complications and recanalization of target vein. Pre- and postprocedural comparisons were performed using bivariate statistics, and multivariable logistic regression models were used to assess for confounding.

From January 2015 to October 2025, we identified 10,494 adult patients (12,955 limbs) who underwent truncal endovenous ablation with either laser or radiofrequency ablation. Patients were 68.6% female, with a mean BMI of 29.9 kg/m². A total of 51.2% of patients underwent concomitant phlebectomy. Median follow-up was 60 days (interquartile range, 16-133). Patients with higher BMI had higher preoperative rVCSS and total symptoms scores. The predicted probability of improvement in rVCSS and total symptom score was >92% for patients undergoing endovenous ablation with phlebectomy. BMI was not associated with increased rates of procedure-related complications or long-term follow-up complications [adjusted odds ratio (aOR), 1.12; 95% confidence interval (CI), 0.89-1.41; P = .34; aOR, 1.00; 95% CI, 0.92-1.08; P = .98, respectively for five-point change in BMI]. In patients receiving ablation alone, BMI was associated with increased risk of recanalization (aOR for five-point change in BMI, 1.26; 95% CI, 1.06-1.5; P = .009) CONCLUSIONS: Despite patients with higher BMI having worse preoperative disease, patients sustain very high rates of improvement across the BMI spectrum. Further, higher BMI was not associated with increased rates of complications. The addition of phlebectomy in patients with higher BMI may improve outcomes and reduce likelihood of recanalization. Given the difficulty of achieving meaningful weight loss, delaying venous procedures until weight loss is achieved may prevent patients from receiving indicated and effective treatment.