Venous leg ulcers are a marker of worse long-term survival in patients treated for chronic venous insufficiency

Abstract

Introduction

This study assessed the relationship between venous leg ulcers (VLUs) and overall survival among patients treated for chronic venous insufficiency.

Methods

Patients with CEAP C2-C6 disease who underwent superficial venous interventions at a single center from May 2016-April 2024 were identified from the Vascular Quality Initiative Varicose Vein Registry. Demographics, comorbidities, and venous disease severity were recorded at the index database procedure. Mortality was recorded from the electronic health record and Social Security Death Index. Patient characteristics and all-cause mortality were compared between VLU (C5-C6) and non-VLU (C2-C4) cohorts.

Results

Among 7084 patients, 8.9% (n = 632) had a VLU history. Compared with non-VLU patients, those with a VLU history were older (p < .001) and disproportionately male (p < .001), Black/African American (p < .001), and Medicaid-insured (p = .009). They had greater body mass indices (p < .001), revised venous clinical severity scores (rVCSS) (p < .001), HASTI scores (p = .015), and work/activity limitations (p < .001). Prior venous thromboembolism (p < .001), anticoagulation use (p < .001), previous varicose vein (VV) treatment (p = .042), and deep venous reflux (DVR) (p < .001) were also more common. Mortality was higher among VLU patients than non-VLU patients (3.6% vs 0.7%, p < .001) over a similar mean follow-up (2.8 vs 3.0 years, p = .070). VLU history was associated with worse survival (HR 5.03, 95% CI [2.96-8.53], p < .001), in addition to older age (p < .001), male sex (p = .003), White race (p = .003), no prior VV treatment (p = .026), anticoagulation use (p < .001), higher rVCSS (p < .001), and DVR (p = .016). After adjusting for these latter variables, VLU history remained independently associated with mortality (adjusted HR 2.01, 95% CI [1.00-4.01], p = .049). Compared with C2, only C6 –not C3-C5 –was associated with increased mortality after multivariable adjustment (adjusted HR 3.40, 95% CI [1.08, 10.69], p = .036).

Conclusion

Among patients undergoing superficial venous interventions, VLUs were associated with a two-fold hazard of all-cause death. The mechanism driving their increased mortality warrants further study.

Keywords

venous leg ulcer mortality chronic venous insufficiency CEAP classification superficial venous interventions

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