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Total symptom score was higher for patients without deep reflux both pre (median, 14, [IQR,(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)] vs median 13.5 [IQR, 9.5-18.0]; P ¼ .005) and postprocedurally (median, 4 [IQR,(1)(2)(3)(4)(5)(6)(7)(8)(9) vs median 3.25 [IQR, 1-7]; P < .001) but no difference was seen in change in symptom score (median, 8 [IQR,(4)(5)(6)(7)(8)(9)(10)(11)(12)(13) vs median 9 [IQR, 4-13]; P ¼ .172). Patients with deep reflux had substantially higher rates of complications (10.4% vs 3.0%; P < .001) with a particular increase in proximal thrombus extension (3.1% vs 1.1%; P < .001). After controlling for confounding, this estimate of effect size for any complication increased (OR, 5.72; 95% CI, 2.21-14.81; P < .001).Conclusions: No significant difference is seen in total symptom improvement when patients undergo truncal endovenous ablation with concomitant deep venous reflux, although a greater improvement was seen in VCSS score in these patients. Patients with deep venous reflux had a significantly increased rate of complications independent of confounding variables and should be counseled appropriately before the decision for treatment.

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