Analysis Of Risk Factors Of Recanalization After Endovenous Laser Ablation Of Superficial Varicose Veins Of Lower Extremities

Objective:To explore the risk factors of recanalization after endovenous laser ablation（EVLA）of superficial varicose veins of lower extremities,and to provide evidence-based basis for clinical prevention of recanalization of superficial veins after EVLA.Methods:The clinical and follow-up data of 554 lower limbs treated with EVLA for superficial varicose veins in the Department of Vascular surgery of the affiliated Hospital of Chengde Medical College from September 2017 to September 2019 were collected.The follow-up period was 12 months after operation.According to whether the superficial veins were recanalized during the follow-up period,all the lower limbs were divided into recanalization group and non-recanalization group.Univariate and multivariate Logistic regression analysis was used to analyze the collected data.To study the correlation between sex,age,site of affected limb,clinical severity（CEAP classification）,body mass index（BMI）,smoking,deep venous valve insufficiency,Incompetent perforator vein（IPV）,diameter of great saphenous vein（GSV）,family history of varicose vein,postoperative average daily standing time,postoperative elastic stockings wearing time and so on,with recanalization of superficial veins after EVLA.The receiver operating characteristic curve（ROC）was drawn and the area under the curve（AUC）was calculated to evaluate the predictive value of the regression model.Results:1.According to the inclusion and exclusion criteria,525 lower extremities were actually included in this study.The corresponding patients were followed up for 12 months.48 lower extremities showed superficial veins recanalization,with a recanalization rate of 9.1%.2.The results of univariate analysis showed that there were significant differences in clinical severity((χ²)=6.200,P=0.045),BMI((χ²)=6.136,P=0.013),deep venous valvular insufficiency((χ²)=6.780,P=0.009),IPV((χ²)=9.136,P=0.003),diameter of GSV((χ²)=9.860,P=0.002)and time of wearing elastic socks after operation((χ²)=5.510,P=0.019)between recanalization group and non-recanalization group.3.The results of multivariate Logistic regression analysis showed that BMI≥25.0Kg/m²（OR=2.336,95%CI:1.173-4.650,P=0.016）,complicated withdeepvenousvalvularinsufficiency（OR=2.438,95%CI:1.236-4.809,P=0.010）,complicated with IPV（OR=2.244,95%CI:1.129-4.461,P=0.021）,diameter of GSV≥1.0cm（OR=3.125,95%CI:1.517-6.441,P=0.002）and time of wearing elastic sockslessthan3monthsafteroperation（OR=2.227,95%CI:1.106-4.482,P=0.025）are independent risk factors for recanalization of superficial veins after EVLA,and the difference was statistically significant.4.AUC is 0.755（95%CI:0.688-0.822,P=0.000）,indicating that the regression model has a certain predictive value for recanalization of superficial veins after EVLA.Conclusion:BMI≥25.0Kg/m²,complicated with deep venous valvular insufficiency,complicated with IPV,diameter of GSV≥1.0cm and time of wearing elastic socks less than 3 months after operation are independent risk factors for recanalization of superficial veins after EVLA.During the perioperative period,the patient’s condition should be evaluated in detail,the risk factors should be found in time,and the individualized treatment plan should be made according to the risk factors,which can reduce the recanalization rate of superficial veins after operation.