Abstract
Objective
Endovenous thermal ablation (EVTA) has become increasingly used for treatment of saphenous vein incompetence. However, severe adverse events leading to rehospitalization remain insufficiently characterized in large real-world populations. This study aimed to evaluate 30-day rehospitalization after great saphenous vein (GSV) and small saphenous vein (SSV) interventions in France and compare outcomes between EVTA and surgery.
Methods
We conducted a nationwide observational study using the French National Health Data System (Système National des Données de Santé). Adult patients undergoing GSV or SSV intervention between January 2020 and November 2024 were identified using International Classification of Diseases, 10th Revision and Common Classification of Medical Acts. The primary outcome was all-cause 30-day rehospitalization after discharge. Secondary outcomes included rehospitalization for thromboembolic events, major bleeding, infection, and other procedure-related complications. Multivariable logistic regression analyses were performed to identify factors associated with rehospitalization.
Results
A total of 450,202 patients underwent saphenous vein intervention, including 65,485 SSV and 384,717 GSV procedures. EVTA represented 77.3% of SSV interventions and 83.4% of GSV interventions. Thirty-day rehospitalization occurred in 1.2% of patients after SSV treatment and 4.3% after GSV treatment. Rehospitalizations due to thromboembolic complications were exceptionally rare (0.01% after SSV treatment and 0.03% after GSV treatment), whereas major bleeding and infectious complications were nearly absent. For SSV interventions, treatment modality was not independently associated with rehospitalization after adjustment. For GSV interventions, surgery was associated with a lower risk of 30-day rehospitalization compared with EVTA (adjusted odds ratio, 0.54; 95% confidence interval, 0.41-0.71). Among patients treated with EVTA for GSV incompetence, no difference was observed between endovenous laser ablation and radiofrequency ablation (adjusted odds ratio, 0.97; 95% confidence interval, 0.81-1.16).
Conclusions
In this nationwide French cohort, 30-day rehospitalization after saphenous vein intervention was uncommon, and severe complications requiring rehospitalization were exceptionally rare. EVTA was the predominant treatment modality and demonstrated an excellent safety profile. Rehospitalization appeared to be influenced primarily by patient characteristics rather than major procedure-related complications, supporting the safety of contemporary treatment strategies for both GSV and SSV incompetence.
Keywords: Saphenous vein, Great saphenous vein, Small saphenous vein, Nationwide, Observational study, National health data
Article Highlights.
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Type of Research: Nationwide multicenter retrospective observational study using the French National Health Data System (Système National des Données de Santé)
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Key Findings: In a cohort of 450,202 patients who underwent saphenous vein intervention, 30-day rehospitalization occurred in 1.2% after small saphenous vein treatment and 4.3% after great saphenous vein treatment.
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Take Home Message: This French nationwide analysis showed that 30-day rehospitalization after saphenous vein intervention was uncommon, and severe complications requiring rehospitalization were exceptionally rare.
Saphenous vein incompetence is a frequent driver of symptomatic chronic venous disease and mainly affects the two principal superficial venous systems, the great saphenous vein (GSV) and the small saphenous vein (SSV). Endovenous thermal ablation (EVTA) techniques have increasingly become the treatment of choice over classical surgery, due to their minimally invasive nature compared with open surgery.1 They regroup several techniques including endovenous laser ablation (EVLA) and radiofrequency ablation (RFA).1 Although both EVLA and RFA have demonstrated their efficiency, there is still a need in research to evaluate and estimate more precisely adverse events and complications that can lead to rehospitalization after these interventions. Randomized trials and single-center series are essential to evaluate efficacy, safety, and outcomes following treatment, but they rarely have sufficient sample size to precisely estimate rare severe adverse events leading to rehospitalization.2, 3, 4, 5, 6, 7 Large nationwide administrative datasets provide complementary value by capturing contemporary real-world practice and enabling assessment of rare but clinically meaningful complications. The aim of this nationwide study was to estimate the incidence of all-cause 30-day rehospitalization after venous intervention in France and compare 30-day outcomes between patients who had EVTA and those who had surgery.
Methods
Study design and population
Data were collected through the French National Health Data System (SNDS, Système National des Données de Santé), which integrates information from multiple sources, including the national hospital discharge database (Programme de médicalisation des systèmes d'information), the health insurance reimbursement database (Système national d'information inter-régimes de l'Assurance Maladie), and the national death registry (Centre d'épidémiologie sur les causes médicales de décès). The SNDS covers 99% of the French population, includes all regions in France and every hospitalization in any private or public hospital.8 For this study, two distinct study populations were selected depending on the anatomical region of venous intervention, being the SSV and the GSV, respectively. Eligible patients were identified using procedure codes defined according to the Common Classification of Medical Acts (Table I). All adult patients 18 years or older, admitted in any private or public hospital in France for SSV or GSV intervention using EVTA or surgery between January 1, 2020, and November 30, 2024 were included. Patients were categorized by procedure performed according to Common Classification of Medical Acts codes as EVTA and Open Surgery (ligation and stripping). For patients who underwent EVTA on the GSV intervention, either EVLA or RFA could be performed, and subgroup analysis were therefore performed.
Table I.
Definition of variables including procedures, comorbidities, and outcomes
| Variables | Classification and codes | Data source from the French National Health Insurance Information System |
|---|---|---|
| Vascular intervention on the small saphenous vein (SSV) | CCAM codes:
|
Index stay |
| Vascular intervention on the great saphenous vein (GSV) | CCAM codes:
|
Index stay |
| Ulcer | ICD-10: I83.0, I83.2, L97 | Index stay |
| Venous thromboembolism | ICD-10: I26, I80, I82 | Rehospitalization |
| Major bleeding | ICD-10: T81.0-T81.2, I60-I62, D62, J94.2, H11.3, H31.3, H35.6, H43.1, N02, N95, R04, R31, R58, K25.0, K25.2, K25.4, K25.6, K26.0, K26.2, K26.4, K26.6, K27.0, K27.2, K27.4, K27.6, K28.0, K28.2, K28.4, K28.6, K29.0, K62.5, K92.0, K92.1, K92.2, S06.3-S06.6 | Rehospitalization |
| Infection/sepsis | ICD-10: T81.4, T81.8, T81.9, A40, A41, L02, L03, N39.0 | Rehospitalization |
| Other specific complications |
|
Rehospitalization |
| Obesity | ICD-10: E66 | Index stay |
| Diabetes | ICD-10: E10-E14 | Index stay |
| Dyslipidemia | ICD-10: E78 | Index stay |
| Arterial hypertension | ICD-10: I10-I13, I15 | Index stay |
| Congestive heart failure | ICD-10: I09.9, I11.0, I13.0, I13.2, I25.5, I42.0, I42.5, I42.6, I42.7, I42.8, I42.9, I42.5, I42.9, I43, I50, P29.0 | Index stay |
| Myocardial infarction | ICD-10: I21, I22, I252 | Index stay |
| Chronic pulmonary disease | ICD-10: I278, I279, J40-J47, J60-J67, J684, J701, J703 | Index stay |
| Chronic renal disease | ICD-10: I120, I131, N032-N037, N052-N057, N18-N19, N250, Z49.0-Z49.2, Z94.0, Z99.2 | Index stay |
| Chronic liver disease | ICD-10: B18, K700-K703, K709, K713-K715, K717, K73-K74, K760 | Index stay |
| Past history of cerebrovascular disease | ICD-10: G45, G46, H34.0, I60-I69 | Index stay |
| Cancer | ICD-10: C00-C26, C30-C34, C37-C41, C45-C58, C60-C76, C77-C80, C97 | Index stay |
| Metastatic cancer | ICD-10: C77-C80 | Index stay |
CCAM, Common Classification of Medical Acts; ICD-10, International Classification of Diseases, 10th Revision.
The protocol was approved by the Institutional Review Board of the University Hospital of Nice (Registry No. 2025-R005-16).
Data collection
The index procedure was defined as the date of the venous intervention, and follow-up began at discharge from the index stay. Comorbidities were identified using the World Health Organization International Classification of Diseases, 10th Revision codes from primary and associated discharge diagnoses (Table I). Clinical characteristics included: presence of lower limb ulcer, diabetes, arterial hypertension, dyslipidemia, obesity, congestive heart failure, metastatic cancer; pulmonary, renal or liver disease and, history of—myocardial infarction, venous thromboembolism, cerebrovascular disease, or cancer (Table I). The primary outcome was all-cause rehospitalization within 30 days of index discharge. Postoperative complications potentially related to venous intervention were investigated and included venous thromboembolic complications, major bleeding, infection/sepsis (Table I). Other specific complications regrouped cardiac, cerebrovascular, and respiratory complications, nonhemorrhagic/noninfectious surgical complications, arterial, or lymphatic complications (Table I).
Statistical analysis
Descriptive statistics were used to summarize baseline characteristics and outcomes across both datasets, with categorical variables reported as frequencies (percentages) and continuous variables presented as means (±SD) or medians after testing for normality through the Shapiro test. Intergroup comparisons for categorical data were performed using Pearson χ2 or Fisher exact tests. For continuous variables, differences between treatment groups were assessed using the Mann-Whitney U (Wilcoxon rank-sum) test. Multivariable logistic regression models were used for both cohorts to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for 30-day rehospitalization using the Wald method. In the primary analysis, the models adjusted for treatment type, age, sex, calendar year (using 2020 as the reference), and baseline comorbidities. To further explore treatment-specific dynamics in the datasets, separate regression models were fitted for each one of the four cohorts independently. All statistical tests were two-sided, and the threshold for significance was set at α = .05.
Results
SSV intervention
A total of 65,485 adults underwent SSV intervention during the study period, including 50,590 EVTA procedures (77.3%) and 14,895 surgical procedures (22.7%) (Table II). Mean age was 57.1 ± 14.5 years; 35.5% of patients were male, and 784 (1.2%) had lower limb ulcer. All-cause 30-day rehospitalization occurred in 817 patients (1.2%). Rehospitalization was observed in 731 patients undergoing EVTA (1.4%) and 86 patients with surgery (0.6%), P < .001. Rehospitalization for thromboembolic complications was exceptional, with seven events after EVTA and none after surgery. No rehospitalization for major bleeding or sepsis was observed. Other specific complications were observed in 37 patients (0.1%) after EVTA and 6 (0.001%) after surgery, P = .169. No significant difference on the incidence of postoperative complications was observed between patients with and without lower limb ulcer. In multivariable analysis, procedure type was not a significant predictor of 30-day rehospitalization (surgery vs EVTA; OR, 0.68; 95% CI, 0.28-1.64).
Table II.
Characteristics and outcomes of patients who underwent small saphenous vein (SSV) intervention in France
| Variables | Total population, N = 65,485 | Endovenous thermal ablation (EVTA), N = 50,590 | Surgery, N = 14,895 | P value |
|---|---|---|---|---|
| General characteristics | ||||
| Age, years | 57.1 ± 14.5 | 57.5 ± 14.6 | 56.1 ± 14.2 | <.001 |
| Sex, male | 23,271 (35.5) | 16,990 (33.6) | 6281 (42.2) | <.001 |
| Clinical characteristics | ||||
| Lower limb ulcer | 784 (1.2) | 553 (1.1) | 231 (1.6) | <.001 |
| Diabetes | 3973 (6.1) | 3088 (6.1) | 885 (5.9) | .466 |
| Arterial hypertension | 628 (1.0) | 487 (1.0) | 141 (0.9) | .860 |
| Dyslipidemia | 6 (0.0) | 3 (0.0) | 3 (0.0) | .135 |
| Obesity | 66 (0.1) | 54 (0.1) | 12 (0.1) | .376 |
| Past history of myocardial infarction | 558 (0.9) | 441 (0.9) | 117 (0.8) | .314 |
| Past history of venous thromboembolism | 647 (1.0) | 491 (1.0) | 157 (1.1) | .354 |
| Congestive heart failure | 367 (0.6) | 308 (0.6) | 59 (0.4) | .002 |
| Past history of cerebrovascular disease | 1039 (1.6) | 809 (1.6) | 230 (1.5) | .637 |
| Past history of cancer | 6112 (9.3) | 4825 (9.5) | 1287 (8.6) | <.001 |
| Metastatic cancer | 36 (0.1) | 25 (0.0) | 11 (0.1) | .263 |
| Chronic pulmonary disease | 456 (0.7) | 356 (0.7) | 100 (0.7) | .667 |
| Renal disease | 310 (0.5) | 240 (0.5) | 70 (0.5) | .945 |
| Liver disease | 438 (0.7) | 344 (0.7) | 94 (0.6) | .520 |
| 30-day outcomes | ||||
| All-cause rehospitalization | 817 (1.2) | 731 (1.4) | 86 (0.6) | <.001 |
| Thromboembolic complication | 7 (0.01) | 7 (0.01) | 0 (0.0) | .363 |
| Bleeding | 0 (0.0) | 0 (0.0) | 0 (0.0) | 1 |
| Infection | 0 (0.0) | 0 (0.0) | 0 (0.0) | 1 |
| Other specific complications | 43 (0.1) | 37 (0.1) | 6 (0.001) | .169 |
| Other causes – none of the above | 768 (1.2) | 688 (1.4) | 80 (0.5) | <.001 |
Values are expressed as means ± SD or n (%).
GSV intervention
A total of 384,717 adults underwent GSV intervention during the study period, including 320,929 thermal ablation (EVLA/RFA) procedures (83.4%) and 63,788 surgical procedures (16.6%; Table III). Mean age was 55.7 ± 14.8 years; 38.7% of patients were male, and 5475 (1.4%) had lower limb ulcer. All-cause 30-day rehospitalizations occurred in 16,474 patients (4.3%). Readmissions were observed in 14,568 patients (4.5%) who had thermal ablation and 1906 patients (3.0%) who had surgical procedure, P < .001. Readmission for thromboembolic complications occurred in 130 patients after thermal ablation (0.04%) and 10 patients with surgery (0.02%). Only 15 patients were observed to be admitted for major bleeding, 11 after the ablation and 4 after surgery interventions were performed (P = .295). No readmission for sepsis was observed. Other specific complications were observed in 460 patients (0.1%) after thermal ablation and 52 (0.1%) after surgery, P < .001. Patients with lower limb ulcer had a higher rate of venous thromboembolism (0.2% vs 0.1%; P < .001), and readmission for bleeding (0.1% vs <0.1%; P = .041), whereas no difference was observed for the other complications. In the multivariable analysis, type of intervention was associated with the risk of 30-day readmissions (surgery vs EVTA; OR, 0.54; 95% CI, 0.41-0.71).
Table III.
Characteristics and outcomes of patients who underwent great saphenous vein (GSV) intervention in France
| Variables | Total population, N = 384,717 | Endovenous thermal ablation (EVTA), N = 320,929 | Surgery, N = 63,788 | P value |
|---|---|---|---|---|
| General characteristics | ||||
| Age, years | 55.7 (14.8) | 55.8 (14.9) | 55.2 (14.5) | <.001 |
| Sex, male | 148,869 (38.7) | 119,494 (37.2) | 29,375 (46.1) | <.001 |
| Clinical characteristics | ||||
| Lower limb ulcer | 5475 (1.4) | 4536 (1.4) | 939 (1.5) | .253 |
| Diabetes | 27,687 (7.2) | 22,892 (7.1) | 4795 (7.5) | <.001 |
| Arterial hypertension | 3775 (1.0) | 3163 (1.0) | 612 (1.0) | .541 |
| Dyslipidemia | 44 (0.0) | 36 (0.0) | 8 (0.0) | .775 |
| Obesity | 500 (0.1) | 424 (0.1) | 76 (0.1) | .406 |
| Past history of myocardial infarction | 3194 (0.8) | 2646 (0.8) | 548 (0.9) | .379 |
| Past history of venous thromboembolism | 3234 (0.8) | 2652 (0.8) | 582 (0.9) | .03 |
| Congestive heart failure | 2119 (0.6) | 1767 (0.6) | 352 (0.6) | .969 |
| Past history of cerebrovascular disease | 6222 (1.6) | 5179 (1.6) | 1043 (1.6) | .696 |
| Past history of cancer | 34,070 (8.9) | 28,527 (8.9) | 5543 (8.7) | .106 |
| Metastatic cancer | 211 (0.1) | 148 (0.0) | 63 (0.1) | <.001 |
| Chronic pulmonary disease | 2563 (0.7) | 2129 (0.7) | 434 (0.7) | .63 |
| Renal disease | 1935 (0.5) | 1598 (0.5) | 337 (0.5) | .322 |
| Liver disease | 2672 (0.7) | 2176 (0.7) | 496 (0.8) | .006 |
| 30-day outcomes | ||||
| All-cause rehospitalization | 16,474 (4.3) | 14,568 (4.5) | 1906 (3.0) | <.001 |
| Thromboembolic complication | 140 (0.03) | 130 (0.04) | 10 (0.02) | .003 |
| Bleeding | 15 (0.004) | 11 (0.003) | 4 (0.0) | .295 |
| Infection | 0 (0.0) | 0 (0.0) | 0 (0.006) | 1 |
| Other specific complications | 512 (0.1) | 460 (0.1) | 52 (0.1) | <.001 |
| Other causes–none of the above | 15,819 (4.1) | 13,978 (4.4) | 1841 (2.9) | <.001 |
Values are expressed as means ± SD or n (%).
In total, 320,929 patients had thermal ablation for GSV intervention, among which 200,008 had EVLA procedures (62.3%) and 120,921 surgical procedures (37.7%) (Table IV). Mean age was 55.8 ± 14.9 years, and 37.2% of patients were male. All-cause 30-day rehospitalizations occurred in 14,568 patients (4.5%). Readmissions were observed in 9183 patients undergoing EVLA (4.6%) and 5385 patients undergoing RFA (4.5%), P = .069.
Table IV.
Characteristics and outcomes of patients who underwent great vein intervention in France
| Variables | Total population, N = 320,929 | Endovenous laser ablation (EVLA), N = 200,008 | Radiofrequency ablation (RFA), N = 120,921 | P value |
|---|---|---|---|---|
| General characteristics | ||||
| Age, years | 55.8 (14.9) | 55.9 (14.9) | 55.6 (14.8) | <.001 |
| Sex, male | 119,494 (37.2) | 73,865 (36.9) | 45,629 (37.7) | <.001 |
| Comorbidities | ||||
| Lower limb ulcer | 4536 (1.4) | 2072 (1.0) | 2464 (2.0) | <.001 |
| Diabetes | 22,892 (7.1) | 13,810 (6.9) | 9082 (7.5) | <.001 |
| Arterial hypertension | 3163 (1.0) | 2004 (1.0) | 1159 (1.0) | .227 |
| Dyslipidemia | 36 (0.01) | 15 (0.007) | 21 (0.02) | .011 |
| Obesity | 424 (0.1) | 258 (0.1) | 166 (0.1) | .531 |
| Past history of myocardial infarction | 2646 (0.8) | 1650 (0.8) | 996 (0.8) | .969 |
| Past history of venous thromboembolism | 2652 (0.8) | 1442 (0.7) | 1210 (1.0) | <.001 |
| Congestive heart failure | 1767 (0.6) | 1115 (0.6) | 652 (0.5) | .498 |
| Past history of cerebrovascular disease | 5179 (1.6) | 3249 (1.6) | 1930 (1.6) | .537 |
| Past history of cancer | 28,527 (8.9) | 17,924 (9.0) | 10,603 (8.8) | .062 |
| Metastatic cancer | 148 (0.0) | 99 (0.05) | 49 (0.04) | .251 |
| Chronic pulmonary disease | 2129 (0.7) | 1293 (0.6) | 836 (0.7) | .129 |
| Renal disease | 1598 (0.5) | 997 (0.5) | 601 (0.5) | .955 |
| Liver disease | 2176 (0.7) | 1322 (0.7) | 854 (0.7) | .13 |
| 30-day outcomes | ||||
| All-cause readmission | 14,568 (4.5) | 9183 (4.6) | 5385 (4.5) | .069 |
| Thromboembolic complication | 130 (0.0) | 62 (0.03) | 68 (0.1) | <.001 |
| Bleeding | 11 (0.003) | 5 (0.002) | 6 (0.004) | .248 |
| Infection | 0 (0.0) | 0 (0.0) | 0 (0.0) | 1 |
| Other specific complications | 460 (0.1) | 312 (0.2) | 148 (0.1) | .015 |
| Other causes–none of the above | 13,978 (4.4) | 8809 (4.4) | 5169 (4.3) | .081 |
Categorical data are shown as number (%).
Readmission for thromboembolic complications occurred in 62 patients after EVLA and 68 patients (0.1%) who had RFA. Only 11 patients (0.003%) were observed to be admitted for major bleeding, 5 after EVLA, and 6 after RFA interventions. No readmission for sepsis was observed. Other specific complications were observed in 312 patients (0.2%) after EVLA and 148 patients (0.1%) after RFA, P = .015. In multivariable analysis, type of intervention was not significantly associated with 30-day readmission (RFA vs EVLA; OR, 0.97; 95% CI, 0.81-1.16; P = .741).
Discussion
This nationwide study including more than 450,000 saphenous vein interventions performed in France between 2020 and 2024 provides a contemporary assessment of 30-day rehospitalization after treatment of chronic venous disease. The results showed that early rehospitalization following saphenous vein treatment was uncommon overall. Besides, rehospitalizations directly attributable to major procedural complications, particularly venous thromboembolism, major bleeding, or infection, were exceptionally rare. For SSV intervention, procedure type was not associated with 30-day rehospitalization; but for GSV, EVTA was associated with the risk of 30-day rehospitalization. No significant difference was observed when comparing EVLA and RFA.
The progressive predominance of EVTA observed in our cohort reflects the major evolution in the management of chronic venous disease over the last decade. Current European guidelines recommend endovenous techniques as first-line treatment for patients with saphenous incompetence because of their high occlusion rates, reduced postoperative pain, faster recovery, and lower morbidity compared with conventional surgery.1 In the present study, more than 80% of GSV interventions and more than three-quarters of SSV interventions were performed using endovenous thermal techniques, illustrating the widespread adoption of these recommendations in routine practice.
An important finding of our study is the very low incidence of severe complications requiring rehospitalization. Thromboembolic events occurred in only 0.01% of patients after SSV treatment and 0.03% after GSV treatment. Similarly, rehospitalizations for major bleeding and infectious complications were almost nonexistent. Note that 30-day complications were identified when they resulted in hospital readmission. Therefore, complications managed exclusively in the outpatient setting were not captured, potentially leading to an underestimation of the incidence. Nevertheless, the most clinically significant complications were captured. In France, routine postoperative duplex ultrasound guidance is commonly performed following EVTA in accordance with national clinical practice and the recommendations of the 2022 European Society for Vascular Surgery guidelines.1 However, the SNDS database does not contain information on postoperative imaging or adherence to these recommendations at the individual patient level.
These results are consistent with previous randomized trials and meta-analyses reporting excellent safety profiles for both surgery and EVTA, although such studies were generally underpowered to accurately estimate rare adverse events.3,9 A systematic review including five randomized controlled trials and 44 cohort studies reported that deep venous thrombosis was a very rare complication (0%-1.2%).3 Another systematic review included 29 studies of patients who underwent EVTA and found that the incidence of postoperative venous thrombotic events was 0.78% for RFA and 0.87% for EVLA at 1 month (OR, 1.46; 95% CI, 0.77-2.74; P = .24).9
For SSV interventions, crude rehospitalization rates were higher after EVTA than surgery; however, treatment modality was no longer associated with rehospitalization after adjustment for baseline characteristics. This finding suggests that patient-related factors rather than the procedure itself are the primary drivers of early postoperative hospitalization. Previous systematic reviews have shown that endovenous thermal techniques achieve at least equivalent, and often superior, efficacy compared with surgery for SSV incompetence while maintaining low complication rates.3
In contrast, for GSV interventions, surgery was associated with a lower adjusted risk of 30-day rehospitalization compared with thermal ablation. Although statistically significant, this finding should be interpreted cautiously. The absolute difference in readmission rates remained modest, and the observational retrospective design of the study raises the possibility of residual confounding factors. Furthermore, the SNDS database does not allow us to reliably determine whether these readmissions were causally related to the index procedure. Patients selected for endovenous treatment may differ from surgical patients in ways not fully captured by administrative databases, including disease severity, anatomical complexity, symptom burden, or ambulatory management pathways. Importantly, the higher rate of rehospitalization observed after EVTA was not explained by major thromboembolic, bleeding, or infectious complications, suggesting that other causes may account for the observed difference.
Among patients treated with thermal ablation of the GSV, no significant difference in rehospitalization risk was observed between EVLA and RFA after adjustment. This finding is in agreement with recent evidence demonstrating comparable effectiveness and safety profiles between both techniques. A recent meta-analysis including 29 studies reported similar occlusion rates and thrombotic complication rates after EVLA and RFA, with only minor differences in risk of burns and ecchymosis and postprocedural pain.9 The present nationwide analysis extends these observations by showing that the choice between EVLA and RFA does not appear to influence the risk of severe complications requiring rehospitalization.
The strengths of this study include its nationwide design, inclusion of virtually all venous interventions performed in France, and sufficient statistical power to evaluate rare complications. Nevertheless, several limitations should be acknowledged. First, the use of administrative data precludes access to important clinical variables such as Clinical-Etiology-Anatomy-Pathophysiology classification, symptom severity, procedural details, and medical treatment. Besides, only complications resulting in rehospitalization could be captured; therefore, minor adverse events managed in outpatient settings were not recorded. Finally, residual confounding factors cannot be excluded despite multivariable adjustment.
Conclusions
In this nationwide French cohort, 30-day rehospitalization following saphenous vein intervention was uncommon, and severe complications requiring rehospitalization were exceptionally rare. EVTA represented the predominant treatment modality and demonstrated a very favorable outcome. Rehospitalization appeared to be influenced primarily by patient characteristics rather than major procedure-related complications. These findings provide contemporary real-world evidence supporting the safety of current treatment strategies for both GSV and SSV incompetence.
Author Contributions
Conception and design: FL, AC, AG, JS, OC, JR
Analysis and interpretation: FL, AC, AG, JS, OC, JR
Data collection: AC, JR
Writing the article: FL, AC, AG, JR
Critical revision of the article: FL, AC, JS, OC, JR
Final approval of the article: FL, AC, AG, JS, OC, JR
Statistical analysis: AC, JR
Obtained funding: Not applicable
Overall responsibility: FL
Funding
This work was supported by the French government through the 3IA Côte d’Azur Investments in the Future project, managed under reference number ANR-23-IACL-0001 and through the National Research Agency (ANR), with reference number ANR-22-CE45-0023-01.
Declaration of generative AI and AI-assisted technologies in the writing process
During the preparation of this work, the authors used Chat-GPT (OpenAI) to assist with language editing. After using this tool, the authors reviewed and edited the content as needed and take full responsibility for the content of the publication.
Footnotes
FL and AC contributed equally to this article and share co-first authorship.
The editors and reviewers of this article have no relevant financial relationships to disclose per the Journal Policy that requires reviewers to decline review of any manuscript for which they may have a conflict of interest.
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