Discussion
bleeding, skin burns, foam sclerosing, DVT, active ulcer, saphenous nerve injury, varicose veins, CEAP, postoperative DVT, SVT
SVT, BLEEDING, RECURRENCE, ADVERSE EVENTS, DISEASE, VARICOSE VEIN, INDURATION, VARICOSE VEINS, INDURATION, POSTOPERATIVE DEEP VEIN THROMBOSIS, DVT
With a growing awareness that SVT can lead to DVT or even more serious consequences, the treatment of SVT has been paid more attention though it is a benign disease. Researchers started to explore the anticoagulant therapy of SVT. The journal Chest recommends using a daily dose of 2.5 mg fondaparinux for anticoagulation therapy to treat SVT [From initial traditional surgery to endovascular ablation and foam sclerotherapy, surgery has always been primary treatment approach for varicose veins [In our study, data of 593 VV patients who underwent DS were retrospectively reviewed. Among them, 59 patients with SVT and 118 patients without SVT were finally matched. Perioperative clinical outcomes and follow-up outcomes were compared between two groups. As far as we can tell, it was the first cohort to explore the impact of SVT on the efficacy of DS for VV. Therefore, the results of our study provide strong evidence regarding the safety and efficacy of DS for VV patients with SVT.PSM was performed from a large volume of data preexisted to balance the baseline characteristics between SVT and non-SVT group. As a retrospective cohort study, the raw baseline data of the two groups were unevenly distributed in age, VCSS score and CEAP grade. Previous studies have indicated that SVT is more prevalent among the elderly population. And worse VCSS score, as well as higher CEAP grade in SVT group may be attributed to the aggravation of venous symptoms by SVT and the residual pigmentation of local skin after the acute phase [Both SVT and non-SVT patients demonstrated similar clinical characteristics and distribution after matching, which suggested less likelihood of selection bias in studying the outcomes. In our propensity score matched cohort, patients in SVT group had a higher number of surgical incisions compared to patients in non-SVT group. This can be attributed to surgeons tend to make an incision on the surface of SVT in shank for embolectomy for SVT cases. Though embolectomy was performed during surgery, it will not extend operation time, making operation time of two groups comparable. Most incisions were located in shallow skin and less than 2 cm, and these incisions generally healed quickly and resulted in a short recovery time.Perioperative outcomes indicate the safety and efficacy of DS for VV patients with SVT. The perioperative outcomes were acceptable in both SVT and non-SVT patients. No significant difference in the incidence of technical failure was showed in our research, as well as major perioperative adverse events. The occurrence of major adverse events such as skin burns, saphenous nerve injury, and postoperative deep vein thrombosis (DVT) was low and could be effectively managed with conservative therapy. Additionally, no bleeding requiring intervention occurred, which further suggested the safety of DS for both groups.In our study, we focused on the high incidence of postoperative subcutaneous induration in both groups (38.98% in the non-SVT and 42.37% in the SVT). Induration along the trunk of GSV in this research, as in previous studies, has a high incidence rate in endovenous ablation, but mostly dissolved within 4 weeks (i.e. at the first review after discharge) [Moreover, although no significant difference in incidence of postoperative DVT was find in our research between the two groups, two patients still experienced postoperative DVT. By reviewing the surgical records, we speculated that this could be attributed to the excessive use of foam sclerosing agents during the operation [During the long-term follow-up, both groups showed a great decrease in VCSS score. VV clinical recurrence was observed in 7 (11.86%) patients with SVT and 17 (14.41%) patients without SVT, which suggested satisfactory long-term efficacy. SVT recurrence occurred in 3 (5.08%) patients with SVT and 4 (3.39%) patients without SVT during follow-up, and all cases were cured after treated with topical Hirudoid. Importantly, no patients suffered DVT during follow-up which also demonstrated the long-term safety of DS in VV patients with SVT.Several limitations in the study should be addressed. First, being a retrospective study, we cannot eliminate all possible biases through PSM. For instance, the majority of patients included in our study had CEAP grades ranging from C2 to C5, while the more serious patients with active ulcer have not been adequately analyzed. Therefore, further research is required to investigate the safety and efficacy of DS for those patients with active ulcer (C6). Second, considering particles of SVT of thigh can be propagated into the deep venous system in endovenous ablation, only patients with SVT below knee were included in our study. Third, not all patients underwent lower extremity ultrasonography during follow-up, which means that there is a possibility that some cases of asymptomatic isolated DVT were not documented. At last, our study is a single center study, and the clinical outcomes observed may not be generally applicable. Different medical centers have different methods of varicose vein surgery, which can lead to different clinical outcomes. Hence, prospective multicenter research should be further carried out in the future.