title: Advanced Chronic Venous Insufficiency.
abstract: BACKGROUND
  Intervention for advanced chronic venous insufficiency is considered an appropriate standard of care. However, outcomes vary among patients who present in advanced clinical stages of disease. The main objectives of this study were to determine whether racial disparity exists at initial presentation and response to intervention.
  
  
  METHODS
  A retrospective database was created to include all radiofrequency ablation procedures performed by a single surgeon from January 14, 2009, through May 25, 2011. Demographics, clinical traits, race, procedure, and outcomes were analyzed. Stepwise model selection reduced candidate baseline factors to a final parsimonious model, which was analyzed using analysis of variance.
  
  
  RESULTS
  The database consisted of 300 patients with a predominant female (n = 215, 85%) base and 85 (15%) males, with a mean age distribution of 53 years. The mean body mass index was 30.2. Racial distribution revealed Asian (n = 9, 3.3%), Pacific Islander (n = 1, 0.4%), African American (n = 37, 13.6%), and Caucasian (CAU, n = 225, 82.7%). African Americans presented with more advanced clinical stages than the CAU group-C2: African American 21.6%, CAU 36.7%; C4: African American 35%, CAU 24.3%; and C6: African American 35.1%, CAU 7.5%. African Americans demonstrated a higher preoperative venous clinical severity score (VCSS) than their CAU counterparts. Postprocedural decrease in VCSS score was lower in African Americans than their CAU counterparts.
  
  
  CONCLUSIONS
  African American patients present with more advanced venous insufficiency than CAUs. Postprocedural analysis reveals not only slower ulcer healing times but also higher ulcer recurrence rates.
authors.affiliation: 1 Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Anahita
authors.initials: A
authors.lastname: Dua
authors.affiliation: 2 Division of Vascular Surgery, Department of Surgery, Johns Hopkins Vein Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Heller
mesh_terms: D001741:Black or African American; D001213:Asian; D017115:Catheter Ablation / Q000009:adverse effects; D002908:Chronic Disease; D016208:Databases, Factual; D005260:Female; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D044468:Native Hawaiian or Pacific Islander; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014689:Venous Insufficiency / Q000175:diagnosis / Q000208:ethnology* / Q000601:surgery*; D044465:White People; D014945:Wound Healing
keywords: chronic venous disease; race; vascular disease and race; venous disease