Varicose veins—Who should be referred?

2015 ◽  
Vol 30 (2_suppl) ◽  
pp. 4-8 ◽  
Author(s):  
Sarah Onida ◽  
Alun H Davies ◽  
Ian Franklin
Keyword(s):  
Quality Of Life ◽  
Secondary Care ◽  
Varicose Veins ◽  
Venous Disease ◽  
Evidence Based ◽  
Negative Effects ◽  
Referral Criteria ◽  
Assessment And Treatment ◽  
The Uk

Varicose veins are a common, progressive condition in the UK, with significant negative effects on patients’ quality of life. Despite their prevalence, access to secondary care for the assessment and treatment of varicose veins can be variable throughout the country. The National Institute of Health and Care Excellence guidelines developed in 2013 provide evidence-based guidance on the referral, assessment, and management of the patient with venous disease. In this article, we review the development of the guidelines for the management of varicose veins over the last 15 years, highlighting the latest changes in referral criteria.

Venous Disease: The New International Challenge

1996 ◽  
Vol 11 (1) ◽  
pp. 6-9 ◽  
Author(s):  
N. Bosanquet ◽  
P. Franks
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Venous Insufficiency ◽  
Varicose Veins ◽  
Health Care Expenditure ◽  
Current Treatment ◽  
Venous Disease ◽  
Venous Diseases ◽  
The Uk

This paper reviews data on the socio-economic aspects of venous disease and venous insufficiency. It will cover data on the burden of disease and the effects of venous insufficiency on quality of life. It will also cover varicose veins, chronic venous insufficiency and venous ulcers of the leg. The use of the WHO International Classification of Diseases allows for comparisons across countries, with costs expressed not only in local currency, but also in terms of ECUs and as a percentage of health care costs. The paper presents estimates on the costs of venous disease in the UK, France and Germany. Using standard diagnoses, costs are estimated to amount to 1.5–2.0% of total health care expenditure in these three countries. This is divided between inpatient, outpatient and community nursing programmes. Prescribing costs for venous diseases range from 0.26% of the total in the UK to 5.38% in France, with Germany in the middle of the range at 2.87%. The paper also summarizes costs in terms of reduced quality of life and loss of work-time. In Germany venous diseases contributed significantly to total disability, accounting for 1.2% of invalidity days in the late 1980s. As a result of dissatisfaction with current treatment programmes there have been moves towards new ones. The paper sets out the evidence on innovations in care through investment programmes aimed at reducing costs and improving efficacy. Current developments in Britain, Germany and France are set out, summarizing likely costs and benefits.

scholarly journals Ultrasound-guided foam sclerotherapy for chronic venous disease with ulcer. A prospective multiple outcome cohort study

2020 ◽  
Vol 19 ◽  
Author(s):  
Guilherme Camargo Gonçalves de Abreu ◽  
Otacílio de Camargo Jr. ◽  
Márcia Fayad Marcondes de Abreu ◽  
José Luis Braga de Aquino
Keyword(s):  
Quality Of Life ◽  
Cohort Study ◽  
Disease Severity ◽  
Varicose Veins ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Leg Ulcers ◽  
Ultrasound Guided ◽  
Foam Sclerotherapy

Abstract Background Chronic Venous Disease (CVD) is the main cause of chronic leg ulcers. Varicose veins are the most frequent cause of venous leg ulcers (VLU). 50.9% of Brazilian women have varicose veins and ulcer prevalence is as high as 4%. Ultrasound-guided foam sclerotherapy (UGFS) is a low-cost treatment option for varicose veins. Objectives To analyze UGFS outcomes in patients with VLU. Methods Prospective consecutive single center cohort study. Patients with great saphenous vein (GSV) reflux and VLU were treated and followed-up for 180 days. The following were studied: quality of life (QoL), disease severity, healing, and elimination of GSV reflux. The Aberdeen questionnaire, a venous clinical severity score, and Duplex scanning (DS) results were analyzed. Results 22 patients aged 35 to 70 years were treated. There was improvement in quality of life, disease severity reduced, and ulcer diameter reduced (p < 0.001; ANOVA). 77.27% of VLU healed completely (95%CI: 59.76-94.78%). The dimensions of 20/22 VLU reduced (90.91%; 95%CI: 78.9-100%). GSV reflux was eliminated in 63.64% (95%CI: 43.54-83.74%). Men had greater QoL benefit and women had more complications. There were no severe complications. The VLU that had healed completely at the end of the study were smaller at baseline than those that did not completely heal. The GSV that were completely occluded at the end of the study were smaller at baseline than those that were not completely occluded (p < 0.05; Mann-Whitney). Conclusion The results suggest that most patients benefited from UGFS.

The diagnosis and management of metastatic bone disease in general practice

2021 ◽  
pp. 175573802110103
Author(s):  
Natalie Cheyne ◽  
David Nichols ◽  
Amit Kumar
Keyword(s):  
Quality Of Life ◽  
General Practice ◽  
Cancer Treatment ◽  
Bone Disease ◽  
Secondary Care ◽  
Early Recognition ◽  
Survival Rates ◽  
Metastatic Bone Disease ◽  
The Uk

As cancer treatment improves and survival rates continue to increase, clinicians are seeing increasing numbers of patients with metastatic bone disease (MBD). This term describes cancer that has originated in another organ and subsequently spread to the bone. It is a condition that can severely impact the quality of life for an individual and the treatment is often not curative. This article aims to cover the management of MBD, from early recognition to secondary care interventions. The care of individuals with MBD is evolving in the UK, with the development of specialist regional referral pathways to facilitate prompt and timely management.

scholarly journals VenaSeal for vertical veno-venous reflux elimination in patients with chronic venous disease

2021 ◽  
Vol 18 (1) ◽  
pp. 48-54
Author(s):  
S. M. Belentsov
Keyword(s):  
Quality Of Life ◽  
Varicose Veins ◽  
Pain Syndrome ◽  
Chronic Venous Disease ◽  
Long Term Results ◽  
Venous Disease ◽  
Open Label ◽  
Saphenous Veins

Introduction. Chronic venous disease significantly reduces quality of life and often leads to complications. The only way to eliminate hemodynamically significant blood flow disorders is the surgical method, incl. its latest modification is the VenaSeal.Objective of the study. To study the immediate and long-term results of the use of VenaSeal adhesive technology to obliterate the incompetent major saphenous veins, as well as the potential benefits in special groups of patients based on three-year experience in using VenaSeal Glue Procedure.Materials and methods. Over a 3-year period, we have treated 104 patients with VenaSeal. The average age was 59.6 ± 14.97 years, the CEAP class was 3.2 ± 1.09. 101 patients had varicose veins, in three cases - post-thrombotic. The intervention was performed on 117 incompetent main veins: GSV – 107, SSV – 10.Results and discussion. Clinical evaluation and ultrasound imaging of veins immediately after the intervention of vein occlusion throughout the intervention. There was no pronounced pain syndrome after surgery. Complications occurred in 3 patients in the form of chemical phlebitis. Long-term results up to 3 years were studied clinically and using ultrasound in 72 patients (76 veins): recanalization was noted in 2 GSV (2.6%), which in one case was accompanied by the formation of a recurrent varicose veins. To study the effect of VenaSeal on the quality of life in a comparative aspect, a non-randomized, single-center, open-label study was carried out; it included patients, incl. with GSV occlusion using RFA and EVLT. In the group of patients after VenaSeal, the quality of life indicators were better values. In addition, the absence of the need for elastic compression made the surgical treatment of patients with chronic venous disease and concomitant lesions of the peripheral arterial bed. In groups of elderly and senile patients, patients with weeping eczema, with obesity, additional advantages were found in the form of a decrease in the invasiveness of the intervention and the possibility of correcting reflux as a hemodynamic basis for the development of trophic disorders with the aim of their faster and more effective relief.Conclusions. Non-thermal obliteration of incompetent major saphenous veins using VenaSeal in varicose veins and post-thrombotic disease is highly effective: the immediate results assessed with clinical methods and using ultrasound duplex scanning confirmed the occlusion of the target vein in all cases. The study of long-term results revealed recanalization of two veins out of 76, which accounted for 2.6%.

Relationships between duplex findings and quality of life in long-term follow-up of patients treated for chronic venous disease

2016 ◽  
Vol 31 (1_suppl) ◽  
pp. 88-98 ◽  
Author(s):  
Ying Huang ◽  
Peter Gloviczki
Keyword(s):  
Quality Of Life ◽  
Clinical Studies ◽  
Varicose Veins ◽  
Long Term Results ◽  
Venous Disease ◽  
Venous Surgery ◽  
Long Term Follow Up

Objective Relationships between duplex findings and data on health-related quality of life (QoL) to assess long-term results of treatment of varicose veins and chronic venous insufficiency (CVI) are not well known. The goal of this review was to correlate duplex findings and QoL assessments in clinical studies with long-term follow-up. Methods A review of the English language literature on PUBMED revealed 17 clinical studies, including 9 randomized controlled trials (RCTs), 6 prospective, and 2 retrospective studies that included patients with at least 5-year follow-up after endovenous laser ablation (EVLA), radiofrequency ablation (RFA), ultrasound-guided foam sclerotherapy (UGFS), and traditional superficial venous surgery. Results At 5 years, great saphenous vein (GSV) occlusion rate on duplex ultrasound ranged from 66% to 82% for EVLA, from 62% to 92% for RFA, from 41% to 58% for UGFS and from 54% to 85% for surgery. Freedom from GSV reflux rates were 82% and 84%, respectively for EVLA and surgery, and ranged between 84% and 95% for RFA. Significant improvements were observed in several domains of generic QoL and in most domains of venous disease-specific QoL, irrespective of the treatment. In at least one RCT, CIVIQ scores correlated well with abnormal duplex findings in patients who underwent treatment with UGFS. In another RCT, long-term AVVQ was significantly better after surgery as compared with UGFS similar to results of duplex findings. Conclusions Analysis of the available literature confirmed that all four techniques were effective in the abolishment of reflux or obliteration of the GSV. Moreover, well-designed RCTs with large sample size are needed to produce robust long-term data on clinical outcome after treatment of varicose veins and CVI and to better understand the relationships between duplex-derived data and QoL assessments.

Translation and validation of the Dutch VEINES-QOL/Sym in varicose vein patients

2013 ◽  
Vol 29 (4) ◽  
pp. 227-235 ◽  
Author(s):  
S K Van Der Velden ◽  
A A M Biemans ◽  
T Nijsten ◽  
A Sommer
Keyword(s):  
Quality Of Life ◽  
Varicose Veins ◽  
Short Form ◽  
Ceiling Effect ◽  
Underlying Structure ◽  
Venous Disease ◽  
Quality Of Life Research ◽  
Sf 36 ◽  
The Individual

Objectives To translate from English to Dutch and evaluate the psychometric properties of the VEnous INsufficiency Epidemiological and Economic Studies (VEINES) questionnaire, divided in symptom (VEINES-Sym) and quality of life (VEINES-QOL) subscales. Methods Standard forward-backward translation method was used to translate the 26 items of the VEINES-QOL/Sym. Eligible patients had to complete a standardized questionnaire. Demographic, venous disease characteristics, clinical venous signs, CEAP (clinical, aetiological, anatomical and pathological elements) classification and ultrasound findings were also noted. If item's scores were in an extreme category in more than 70% of patients a floor or ceiling effect was present. Feasibility of the individual items was considered poor if 5% or more of the responses were missing. The validity was tested by comparing the VEINES-QOL/Sym scores to the Short Form 36 (SF-36) scores and across the different ‘CEAP’ categories. Confirmatory factor analysis was used to assess the underlying structure of the VEINES-QOL/Sym. Results Sixty-six patients were included (response rate of 72%). None of the 26 items missed <10% of responses, but two showed ceiling effect. Both the VEINES-QOL and VEINES-Sym showed an excellent internal consistency (Cronbach's alpha of 0.88 and 0.81, respectively). The VEINES-QOL demonstrated a good construct validity for the physical component of the SF-36, but not for the mental component (rho = 0.62 and 0.22, respectively), as expected. The VEINES-Sym correlated poorly to both SF-36's components. According to the confirmatory principle axis factoring, only three out of 25 items did not load sufficiently on the factor. Conclusions The Dutch VEINES-QOL/Sym can be used for health-related quality of life research in varicose veins patients and the evaluation of therapies.

scholarly journals Overactive bladder syndrome in the ageing population

2011 ◽  
Vol 25 (1) ◽  
pp. 12
Author(s):  
Steven Mark Finney ◽  
Ian Eardley
Keyword(s):  
Quality Of Life ◽  
Overactive Bladder ◽  
Pharmacological Treatment ◽  
Older Age ◽  
Ageing Population ◽  
Overactive Bladder Syndrome ◽  
Age Group ◽  
Negative Effects ◽  
Assessment And Treatment

Overactive bladder syndrome (OAB) is a common problem in the older age group that can seriously effect quality of life. It raises challenges in the assessment and treatment of the patient with attention needed to be given to the presence of co-existent disease, cognition, patient motivation and the potential negative effects of pharmacological treatment. Though with the correct approach a substantial amount patients should derive some benefit.

Misophonia: An Evidence-Based Case Report

2020 ◽  
Vol 29 (4) ◽  
pp. 685-690
Author(s):  
C. S. Vanaja ◽  
Miriam Soni Abigail
Keyword(s):  
Quality Of Life ◽  
Case Report ◽  
Case History ◽  
Pure Tone ◽  
Physiological Responses ◽  
Evidence Based ◽  
Management Option ◽  
Pure Tone Audiogram

Purpose Misophonia is a sound tolerance disorder condition in certain sounds that trigger intense emotional or physiological responses. While some persons may experience misophonia, a few patients suffer from misophonia. However, there is a dearth of literature on audiological assessment and management of persons with misophonia. The purpose of this report is to discuss the assessment of misophonia and highlight the management option that helped a patient with misophonia. Method A case study of a 26-year-old woman with the complaint of decreased tolerance to specific sounds affecting quality of life is reported. Audiological assessment differentiated misophonia from hyperacusis. Management included retraining counseling as well as desensitization and habituation therapy based on the principles described by P. J. Jastreboff and Jastreboff (2014). A misophonia questionnaire was administered at regular intervals to monitor the effectiveness of therapy. Results A detailed case history and audiological evaluations including pure-tone audiogram and Johnson Hyperacusis Index revealed the presence of misophonia. The patient benefitted from intervention, and the scores of the misophonia questionnaire indicated a decrease in the severity of the problem. Conclusions It is important to differentially diagnose misophonia and hyperacusis in persons with sound tolerance disorders. Retraining counseling as well as desensitization and habituation therapy can help patients who suffer from misophonia.

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