Combined treatment of deep and superficial venous reflux accelerates ulcer healing and improves symptoms: A real-world retrospective study

Background The optimal surgical strategy for chronic venous disease (CVD) with concomitant deep and superficial reflux but without iliac/proximal obstruction remains unclear. This study aimed to compare clinical symptoms, health-related quality of life, and ulcer outcomes between superficial venous surgery alone and combined deep–superficial surgery (performed concurrently or in stages). Methods In this single-center retrospective cohort, 229 patients were grouped by treatment received: superficial-only (n=138), concurrent deep+superficial (n=49), and staged deep+superficial (n=42). Outcomes were VCSS, CIVIQ-20 at baseline and follow-up (1, 3, and 6 months, and last follow-up), ulcer outcomes (n=59) assessed by healing rates and Kaplan–Meier time-to-healing, duplex valve competence after deep intervention, and complications. Analyses used Welch one-way ANOVA with Games–Howell post hoc and log-rank testing. Results Baseline characteristics were comparable (baseline VCSS 8.6±3.3, 9.6±4.0, 9.0±3.9; P=0.32). Between-group differences in VCSS were significant at 1 month (P=0.012), 6 months (P