Frequency of Inappropriate Endovenous Truncal Ablation Therapy within the VQI Varicose Vein Registry.

Document Type

Article

Publication Date

3-25-2026

Institution/Department

Surgery

Journal Title

J Vasc Surg Venous Lymphat Disord

Abstract

OBJECTIVE: Chronic venous disease is a pervasive problem, with a spectrum of severity and an equally diverse range of potential treatment settings and proceduralists. The adoption of endovenous ablation (EVA) techniques has facilitated growth in office-based and ambulatory procedures. Concurrently, the impact of external factors including market compensation and insurance policies is known to influence procedural patterns away from evidence-based therapy. Utilizing the VQI Varicose Vein Registry (VQI-VVR), we aimed to investigate trends in EVA therapies and ascertain trends in compliance with appropriate use criteria. We hypothesized that variation would exist in venous disease treatment patterns, and that treatment location and insurance status would influence the likelihood of nonconformity with these guidelines.

METHODS: We identified patients undergoing truncal vein EVA procedures from participating VQI centers between January 2015 and September 2022. Procedures limited to perforator ablation, remnant or recanalized veins, or stab phlebectomy alone were excluded, as well as procedures performed on patients failing to meet VQI-VVR inclusion criteria. The primary objective was to evaluate practice variation and identify factors associated with non-compliance with 2020 AVF/SVS/AVLS/SIR Appropriate Use Criteria (AUC). Secondary objectives compared outcomes between patients treated in accordance with versus outside of guideline recommendations.

RESULTS: A total of 32,558 procedures were analyzed and stratified into appropriateness subgroups. Procedures in which all treated veins were guideline appropriate interventions comprised 90.1% of the cohort. Interventions with at least one treatment designated as rarely appropriate or never appropriate guideline therapy comprised 1.8% and 1.3% of the cohort respectively. Comparative analysis between appropriate and the inappropriate (i.e., rarely appropriate, and never appropriate) treatment revealed prior varicose vein intervention (OR: 2.4 [2.0-2.9]; p < 0.0001) and non-white race (OR: 2.1 [1.7-4.2]; p < 0.0001) was associated with receiving a never appropriate treatment. Office-based settings (OR: 2.7 [1.9-4.0]; p< 0.0001) and bilateral interventions (OR: 1.9 [1.2-2.9]; p=0.003) were associated with never appropriate treatment. Increasing the number of veins treated was positively associated with inappropriate treatment (3 [1,2] vs. 3 [2,4]; p< 0.0001 and 2 [1,2] vs. 2 [2,4]; p< 0.0001). Most patients were privately insured (70%), however there was no association between insurance status and off-guideline therapy. Center-level analysis revealed that 38% of all inappropriate procedures occurred at four centers.

CONCLUSIONS: Analysis of the VQI-VVR registry demonstrates a low incidence of inappropriate EVA procedures. These findings underscore the importance of continued education and quality improvement efforts to ensure adherence to evidence-based guidelines for venous ablation.

ISSN

2213-3348

First Page

102493

Last Page

102493

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