SAN DIEGO – Great saphenous vein diameter is a poor surrogate marker for assessing the impact of superficial venous incompetence on a patient's quality of life, results from a study of 91 patients showed.
The finding runs counter to the current practice of some health insurance carriers that use great saphenous vein (GSV) diameter to determine coverage for treatment of axial venous insufficiency.
"It is inappropriate to use GSV diameter as a sole criterion for determining medical necessity for the treatment of GSV reflux," Dr. Kathleen Gibson said at the annual meeting of the American Venous Forum. "Further investigation should be undertaken to look for more appropriate surrogate markers to guide treatment decisions."
Dr. Gibson and her associates collected data from the charts of 91 patients who were prospectively enrolled in two varicose vein trials that examined changes in quality-of-life measures with different varicose vein treatments. It was the first study of its kind, said Dr. Gibson, a vascular surgeon at Lake Washington Vascular in Bellevue, Wash.
The current analysis looked for correlations between GSV diameter and quality-of-life measures prior to any vein treatment.
GSV diameter was measured on duplex ultrasound within 5 cm of the saphenofemoral junction, while the patient was standing. Clinicians also determined Venous Clinical Severity Score (VCSS), and patients completed the Chronic Venous Insufficiency Questionnaire 2 (CIVIQ-2), the Venous Insufficiency Epidemiological and Economic Study-Quality of Life (VEINES-QOL) questionnaire, and the VEINES Symptoms (VEINES-SYM) questionnaire prior to treatment.
Values for VCSS range from 0 to 30, with 30 being the most severe. Scores on the CIVIQ-2 range from 0 to 100, with 100 being the most severe. Higher scores on both the 25-item VEINES-QOL and the 10-item VEINES-SYM indicate better outcomes.
The mean age of patients was 45 years, 72 were women, and the mean GSV diameter was 6.77 mm.
Dr. Gibson reported that the mean VCSS value was 6.4 (range 2-12). The mean CIVIQ-2 score was 42.5 (range 20-85), the mean VEINES-QOL score was 82.7 (range 35-188), and the VEINES-SYM scores had a mean value of 40.5 (range 12-60).
Before vein treatment, there was a moderate correlation between VCSS and QOL measures, she said, and a strong correlation between VCSS and patient-derived quality-of-life measures, which were both significant (P less than .01).
Scatter plot analysis and Pearson correlation coefficients revealed a poor correlation between GSV diameter and VCSS, and no correlation between GSV diameter and any of the following: CIVIQ-2, VEINES-SYM, or VEINES-QOL.
"The only statistically significant findings we had for correlation were a weak correlation between height and body mass index and GSV diameter," Dr. Gibson said. "There was no statistical significance with the weak correlation we saw with VCSS and GSV diameter, and no correlation with any of the quality-of-life surveys. For reflux time, there was a trend toward a weak correlation inversely with height and BMI."
Dr. Gibson said that she had no relevant financial disclosures.