Early cardiac doppler findings and venous hemodynamic burden after combined superficial venous treatment for primary lower extremity varicose veins: an exploratory retrospective cohort study

This study was designed to explore early postoperative cardiac Doppler findings, venous structural and hemodynamic burden in patients with primary lower extremity varicose veins (LEVVs) undergoing a combined superficial venous treatment pathway. A retrospective descriptive statistical analysis was performed on preoperative and postoperative one-week postoperative transthoracic echocardiographic Doppler data from 69 patients with primary LEVVs. All patients underwent endovenous laser ablation (EVLA) of the incompetent great saphenous vein with adjunctive treatment of tributaries when indicated, including ultrasound-guided foam sclerotherapy, followed by standardized postoperative compression. Preoperative venous reflux volume, great saphenous vein (GSV) diameter and the extent of tributaries were quantified. Potential associations between venous hemodynamic measures and ventricular Doppler parameters were explored. Benjamini-Hochberg false discovery rate (FDR) was applied to evaluate multiple outcomes and subgroup comparisons. In the overall paired analysis, postoperative decreases in tricuspid E-wave velocity, tricuspid E/e' and an increase in tricuspid systolic annular velocity were nominally significant (raw P = 0.048, 0.027 and 0.031), but these findings did not remain significant after within-table FDR correction (adjusted P = 0.288, 0.279 and 0.279, respectively). Age-stratified and CEAP-stratified cardiac findings were likewise not significant after adjustment (all adjusted P ≥ 0.246). In contrast, venous severity metrics remained robust after FDR correction, including GSV diameter and shrinkage measures (adjusted P = 0.005-0.007), number of involved tributaries (adjusted P = 0.007), preoperative TAMEAN, CSA, reflux volume across CEAP classes (adjusted P = 0.027, 0.008 and 0.024, respectively). No statistically significant linear correlation was observed between preoperative reflux volume and resting cardiac Doppler parameters. Venous structural and reflux burdens correlate significantly with CEAP severity. Early cardiac Doppler changes after the combined superficial venous treatment pathway were small, nominal, and not significant after FDR correction. These findings should be interpreted as exploratory and hypothesis-generating rather than evidence that EVLA alone improves in right ventricular diastolic function.