Predictors of treatment failure in elderly patients with advanced chronic venous insufficiency

Objective This study evaluated factors associated with treatment failure in elderly patients with advanced chronic venous insufficiency, focusing on mobility limitation, baseline compression feasibility, CEAP C6 disease, venous anatomy/mechanism, and functional/dependent venous insufficiency. Methods This retrospective cohort study included patients aged ≥65 years with CEAP C3–C6 chronic venous disease managed at a tertiary university hospital between 2022 and 2025. Clinical, functional, social, and duplex ultrasound data were obtained from medical records and supplemented by structured telephone follow-up when required. The primary analysis compared treatment success with treatment failure at 6 months. Secondary analyses examined outcomes by management strategy and venous insufficiency mechanism. Multivariable logistic regression identified independent factors associated with failure, and Kaplan–Meier analysis compared freedom from failure between anatomical and functional/dependent venous insufficiency. Results Among 288 patients, 228 (79.2%) achieved treatment success and 60 (20.8%) experienced failure. Failure was more common after conservative management than after venous intervention ( P = 0.023). Functional/dependent venous insufficiency, defined as CVI-like edema or symptoms without demonstrable reflux or obstruction on duplex ultrasound and associated with impaired mobility or prolonged dependency, was present in 48 patients (16.7%) and was associated with lower clinical improvement (45.8% vs 79.2%), more persistent edema (58.3% vs 24.2%), and higher failure (45.8% vs 15.8%) than anatomical venous insufficiency. Freedom from failure was lower in the functional/dependent group (log-rank P < 0.001). Independent factors associated with failure were mobility limitation (OR, 3.76; 95% CI, 1.86–7.61), baseline need for assisted compression (OR, 3.14; 95% CI, 1.60–6.17), CEAP C6 disease (OR, 2.64; 95% CI, 1.27–5.49), and functional/dependent venous insufficiency (OR, 3.08; 95% CI, 1.49–6.37). Venous intervention was associated with lower odds of failure (OR, 0.46; 95% CI, 0.22–0.97). Conclusions Treatment failure affected one in five elderly patients. Mobility limitation, baseline compression feasibility, CEAP C6 disease, and functional/dependent venous insufficiency were more strongly associated with outcome than age alone. Assessment should include mobility, ability to use compression, CEAP class, and duplex-defined venous mechanism when planning treatment in elderly patients with advanced CVI.