Great Saphenous Vein Pressure after Ablation in Patients with Symptomatic Reflux

We sought to determine the impact of GSV ablation on below-the-knee pre- and post- saphenous vein pressures using the novel VeinPress Device. Venous pressures were correlated to clinical outcomes using the venous clinical severity score (VCSS).

Patients with symptomatic GSV insufficiency undergoing planned GSV ablation were prospectively enrolled into the study at a single tertiary center. GSV pressure, while standing, was measured at the ankle level utilizing the VeinPress device (Compremium, Switzerland) pre- and post- GSV ablation. Patient demographics, comorbidities, periprocedural complications, BMI and VCSS were obtained. GSV pressure was compared pre- and post- ablation. Based on median BMI, a subgroup analysis was performed on patients separated into BMI > 31 versus BMI ≤ 31.

A total of 31 patients (average age 68 years old, 45% female) underwent GSV ablation with 100% technical success. The mean VCSS pre-ablation was 7.64 ± 3.5 (n=31) which significantly decreased after ablation to 5.0 ± 2.9 (n=27) (P<0.001). The mean baseline GSV pressure at the ankle (83.8 ± 28 mmHg (n= 31)) significantly decreased post-ablation to (76.5 ± 18 (n=27) (P=0.05)). There was poor correlation between change in GSV pressure and delta VCSS (r=0.24, p=0.239). There was a significant mean difference in post-procedure GSV pressure for patients with BMI >31 (Hodges-Lehman estimate: -13.9 mmHg [95% CI:-39.4 to -3.8]; P=0.006). A significant difference was not identified for BMI ≤31 (Hodges-Lehman estimate: -1.9 mmHg [ 95% CI: -16.5 to 15], P=0.724). Pre-ablation GSV pressures did not differ significantly when comparing ≤31 versus >31 BMI groups (74.6 ± 29 vs 93.7 ± 24, P=0.1). There was no difference in pre-ablation VCSS scores in BMI ≤31 (8.3 ± 4.2) and BMI >31 (6.9 ± 2.3) (P=0.472). There was no significant correlation between baseline GSV pressure and C classification (r = 0.022, P = 0.9).

Amongst patients with symptomatic GSV reflux, ablation resulted in a decrease in ankle region GSV pressure. This effect was most pronounced in patients with a BMI >31. GSV pressure did not demonstrate a correlation with venous clinical severity score.