Great Saphenous Vein Pressure after Ablation in Patients with Symptomatic Reflux.

OBJECTIVES: 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). METHODS: 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. RESULTS: 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). CONCLUSION: 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.