Treatment of foot varicose veins: A study of 119 consecutive patients

2017 ◽  
Vol 33 (4) ◽  
pp. 267-272
Author(s):  
Luiz Fernando Albernaz ◽  
Daiane Taís Schlindwein Albernaz ◽  
Fernanda Rita Machado Zignani ◽  
Yung-Wei Chi
Keyword(s):  
Quality Of Life ◽  
Varicose Vein ◽  
Varicose Veins ◽  
Lymphatic Drainage ◽  
Clinical Severity ◽  
Compression Stockings ◽  
Single Procedure ◽  
Venous Clinical Severity Score ◽  
Deep Vein

Objective To analyze the outcomes of 119 (188 feet) patients undergoing foot varicose vein phlebectomy with and without sclerotherapy between 2013 and 2015. Methods Legs and feet were treated in one single procedure. Clinical and ultrasound assessments were carried out at 7, 30, and 90 days for visualization of the sapheno-femoral and sapheno-popliteal junctions and the deep vein system. Results Mean age was 50 ± 12 years (25–79 years); 67 patients were female (56.3%). Median venous clinical severity score was 4 (range 2–5) before and 1 (range 0–2) at 90 days ( p < 0.001). Edema and transient paresthesia were the most frequent complications (13 (10.92%) and 11 (9.24%) patients, respectively). All complications were resolved at 90 days except one case of edema (resolved after 150 days with compression stockings and lymphatic drainage manual therapy). Conclusions Symptomatic foot varicose vein intervention was safe and effective. Further studies should focus on assessment of vein-specific quality of life questionnaires.

Patient-reported symptoms are independent of disease severity in patients with primary varicose veins

Vascular ◽  
2011 ◽  
Vol 19 (5) ◽  
pp. 262-268 ◽  
Author(s):  
A M Conway ◽  
I M Nordon ◽  
R J Hinchliffe ◽  
M M Thompson ◽  
I M Loftus
Keyword(s):  
Quality Of Life ◽  
Disease Severity ◽  
Varicose Vein ◽  
Clinical Severity ◽  
Patient Pathway ◽  
Venous Clinical Severity Score ◽  
Patient Reported ◽  
Pathologic Classification ◽  
Group A

The objective of this paper is to explore patterns of incompetence and disease distribution in patients with chronic venous disorders and to correlate this with CEAP (Clinical, Etiologic, Anatomic and Pathologic) classification and presenting symptoms to determine which features of chronic venous disorder (CVD) could be used to guide a patient pathway for referral and treatment. Consecutive patients attending a one-stop venous clinic at a university teaching hospital were recruited over a 12-month period. Patients were clinically assessed, assigned CEAP scores, duplex-scanned and categorized. Data were analyzed to identify associations between symptomatology and disease. Four hundred twenty-four limbs were divided into groups A (C2–3) (339) and B (C4–6) (85). The number of men, mean patient age, varicose vein diameter and quality-of-life score (Aberdeen Varicose Vein Questionnaire – AVVS) were significantly higher in group B ( P < 0.01). Ache occurred more commonly in group A and in women ( P < 0.01). Ache and pain were seen more frequently with saphenofemoral junction reflux ( P < 0.05). Group A women were more likely to be offered surgical intervention while men were managed conservatively ( P < 0.05). In conclusion, CVD symptoms are independent of disease severity assessed by CEAP score. Advanced disease is associated with larger venous diameters, older age and corresponds to a poorer quality of life. Objective markers such as CEAP, Venous Clinical Severity Score and AVVS should be used in determining a patient pathway for referral and treatment of CVD.

Comparison of disease-specific quality of life tools in patients with chronic venous disease

2013 ◽  
Vol 29 (10) ◽  
pp. 648-653 ◽  
Author(s):  
Mong-Loon Kuet ◽  
Tristan RA Lane ◽  
Muzaffar A Anwar ◽  
Alun H Davies
Keyword(s):  
Quality Of Life ◽  
Varicose Vein ◽  
Strong Correlation ◽  
Clinical Severity ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Life Questionnaire ◽  
The Relationship ◽  
Disease Specific

Objectives This work was presented as a poster in the American Venous Forum 25th Annual Meeting; 28 February 2013; Phoenix, Arizona, USA. Quality of life (QoL) is an important outcome measure in the treatment for chronic venous disease. The Aberdeen Varicose Vein Questionnaire (AVVQ) and the ChronIc Venous Insufficiency quality of life Questionnaire (CIVIQ-14) are two validated disease-specific QoL questionnaires in current use. The aim of this study is to evaluate the relationship between the AVVQ and the CIVIQ-14 to enable better comparison between studies and to compare these disease-specific QoL tools with generic QoL and clinician-driven tools. Methods Adults attending our institution for management of their varicose veins completed the AVVQ, CIVIQ-14 and EuroQol-5D (EQ-5D). Clinical data, CEAP classification and the Venous Clinical Severity Score (VCSS) were collected. The relationship between the AVVQ and CIVIQ-14 scores was analysed using Spearman’s correlation. The AVVQ and CIVIQ-14 scores were also analysed with a generic QoL tool (EQ-5D) and a clinician-driven tool, the VCSS. Results One hundred patients, mean age 57.5 (44 males; 56 females), participated in the study. The median AVVQ score was 21.9 (range 0–74) and the median CIVIQ-14 score was 30 (range 0–89). A strong correlation was demonstrated between the AVVQ and CIVIQ-14 scores ( r = 0.8; p < 0.0001). Strong correlation was maintained for patients with C1-3 disease ( r = 0.7; p < 0.0001) and C4-6 disease ( r = 0.8; p < 0.0001). The VCSS correlated strongly with the AVVQ and CIVIQ-14 scores ( r = 0.7; p < 0.0001 and r = 0.7; p < 0.0001, respectively). Both the AVVQ and CIVIQ-14 scores correlated well with the EQ-5D score ( r = −0.5; p < 0.0001 and r = −0.7; p < 0.0001, respectively). Conclusions This study demonstrates that there is good correlation between two widely used varicose vein specific QoL tools (AVVQ and CIVIQ-14) across the whole spectrum of disease severity. Strong correlation exists between these disease-specific QoL tools and generic and clinician-driven tools. Our findings confirm valid comparisons between studies using either disease-specific QoL tool.

A prospective observational cohort study of concomitant versus sequential phlebectomy for tributary varicosities following axial mechanochemical ablation

2019 ◽  
Vol 34 (9) ◽  
pp. 627-635 ◽  
Author(s):  
Abduraheem Mohamed ◽  
Clement Leung ◽  
Louise Hitchman ◽  
Tom Wallace ◽  
George Smith ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Varicose Veins ◽  
Patient Choice ◽  
Clinical Severity ◽  
Concomitant Treatment ◽  
Mechanochemical Ablation ◽  
Severity Scores ◽  
Secondary Procedures ◽  
One Year

Introduction Endovenous mechanochemical ablation (MOCA) is an increasingly popular non-thermal non-tumescent technique used to treat axial reflux in patients with superficial venous incompetence. However, the optimal management of varicose tributaries following this technique is unknown and may impact on patient outcomes. This study compares MOCA with concomitant phlebectomy (MOCAP) versus ablation with sequential phlebectomy if required (MOCAS). Methods Patients with symptomatic Comprehensive Classification System for Chronic Venous Disorders (CEAP C2–C6) unilateral axial reflux were studied. Patient choice determined whether concomitant treatment of varicosities was carried out. The primary outcome was the Aberdeen Varicose Veins Questionnaire (AVVQ) at one year. Secondary outcomes included: Venous Clinical Severity Scores (VCSS), EuroQol 5-Domain quality of life scores, complications, procedure duration, procedural and post-operative pain scores and need for secondary procedures. Outcomes were assessed at baseline and then one week, six weeks, six months and one year post intervention. Results Fifty patients underwent MOCAP and 33 patients MOCAS. The two groups were comparable at baseline. MOCAP was associated with lower (better) AVVQ scores at six weeks (3.4 (0.5–6.0) vs. 6.1 (1.8–12.1); P = 0.009) and at six months (1.6 (0.0–4.5) vs. 3.34 (1.8–8.4); P = 0.009) but by one year the difference was no longer statistically significant (1.81 (0.0–4.5) vs. 3.81 (0.2–5.3); P = 0.099). MOCAP was associated with longer procedural duration (45 min (36–56) vs. 30 min (25–37); P < 0.001) and higher maximal periprocedural pain (31 (21–59) vs. 18 (7–25); P = 0.001). VCSS at all time points were lower in favour of MOCAP (0 (0–1) vs. 1 (0–3); P < 0.001). MOCAP was associated with fewer episodes of clinically significant thrombophlebitis (6 of 50 (12%) vs. 10 of 33 (30%); P = 0.039) and lower numbers of secondary procedures (2 (4%) vs. 6 (18%); P = 0.032). Conclusion Concomitant treatment of tributary varicosities following MOCA improves quality of life and clinical severity, while reducing rates of re-intervention and post-operative thrombophlebitis compared to sequential treatment. The penalty is a modest increase in procedural duration and discomfort. Further evidence from longer-term follow-up is needed.

Cost-effectiveness analysis: role and implications

2013 ◽  
Vol 28 (1_suppl) ◽  
pp. 135-140 ◽  
Author(s):  
G Marsden ◽  
D Wonderling
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Cost Effectiveness ◽  
Varicose Vein ◽  
Varicose Veins ◽  
Health Gain ◽  
Cost Effectiveness Analysis ◽  
Effectiveness Analysis ◽  
The Cost

Background: Cost-effectiveness analysis (CEA) is often misperceived to be a cost-cutting exercise. The intention of CEA is not to identify and implement cheap technologies, but rather those which offer maximum health gain, subject to available funds. Such analysis is crucial for decision making in health care, as tight budget constraints mean spending in one area of healthcare displaces spending elsewhere. Therefore in order to achieve the greatest health gain for the overall population, treatments must be selected which provide the greatest health gain within the available funds. Summary: The relevance of CEA in health care systems is explained, using varicose vein treatment in the UK NHS as an example. Treatment for varicose veins is often not commissioned to at a local level, most likely because it is misperceived to be a cosmetic problem. However, this view does not take into account the impact of quality of life. CEA balances costs against a quantitative measure of health related quality of life, and could therefore be used to determine whether it is cost-effective to provide varicose vein treatment. The current literature on the cost-effectiveness of varicose vein treatment is reviewed, and an overview of cost-effectiveness principles is provided. Concepts such as economic modelling, incremental cost-effectiveness ratios (ICERs), net monetary benefit (NMB) and sensitivity analysis are explained, using examples relevant to varicose veins where appropriate. Conclusion: This article explains how, far from cutting costs and sacrificing patient health, CEA provides a useful tool to maximise the health of the population in the face of ever tightening budget constraints. CEA could be used to compare the cost-effectiveness of the various treatment options for varicose veins, and efficiencies realised.

A review on hetus of varicose veins

2019 ◽  
Vol 7 (4) ◽  
Author(s):  
Shruti Mani ◽  
M. V. Mokashi
Keyword(s):  
Quality Of Life ◽  
Varicose Vein ◽  
Varicose Veins ◽  
Early Stage ◽  
Signs And Symptoms ◽  
Physiological Changes ◽  
Prolonged Standing ◽  
Life Style Changes

The life style changes, obesity, occupational pattern of prolonged standing and pregnancy are considered to be significantly contributing to this situation known as Varicose veins wherein veins become enlarged and twisted. Incidence of varicose vein is more in people belonging to the occupation that involved prolonged standing. Varicose vein can be co-related to Sirajgranthi as described in Ayurvedic texts. Ayurved formulations are said to be effective in the management of Sirajgranthi (Varicose veins)Sirajgranthi, treated at an early stage or allows proper maintenance of signs and symptoms reduces the complications and support a better quality of life. In this article we have tried to analyse the anatomical and physiological changes due to long term standing.

A medial approach for open redo groin surgery for varicose vein recurrence

Phlebologie ◽  
2013 ◽  
Vol 42 (05) ◽  
pp. 247-252 ◽  
Author(s):  
O. Nelzén
Keyword(s):  
Varicose Vein ◽  
Operating Time ◽  
Duplex Ultrasound ◽  
Clinical Severity ◽  
Wound Infections ◽  
Medial Approach ◽  
Venous Clinical Severity Score ◽  
One Year ◽  
The One

SummaryAims: To describe the technique of a medial approach for redo groin surgery for varicose vein recurrence and to report the one year prospective results for this procedure.Method: The standardised technique employed is described. Prospective one year data regarding the effectiveness of this procedure was taken from a one year audit performed 2009–2010 at Skaraborg Hospital. Details regarding this patient cohort and the surgery performed were registered. The outcome was measured by using venous clinical severity score (VCSS) and the disease specific quality of life was measured with the Aberdeen varicose vein questionnaire (AVVQ). Venous duplex ultrasound scanning (DUS) was performed preoperatively, after 4–6 weeks and after one year.Results: Out of 255 venous operations 34 regarded redo groin surgery and these were assessed. Females dominated 25/34 and the median age was 55 years (range 26–80). All patients had a probable stump according to DUS. CEAP C3-C4 dominated 28 patients/ legs and C5-C6 in 4 legs. The median operating time was 69 minutes (range 35–120) and the operating time was significantly correlated to the number of incisions (p<0.001). The complication rate was 15 %, including 2 wound infections but no DVT or lymph leakage. Both the VCSS and the AVVQ scores were significantly improved after one year (p<0.001). After one year DUS detected recurrence in the groin was observed in 19 %, mostly neovascularisation.Conclusion: Redo groin surgery by a standardised medial approach is a safe and not an especially technically demanding technique that can be performed reasonably rapidly. The one year results are promising and the early DUS recurrence rate seems low.

Postoperative quality of life, satisfaction, and skin condition after varicose vein surgery

Phlebologie ◽  
2016 ◽  
Vol 45 (06) ◽  
pp. 363-369
Author(s):  
G. Bruning ◽  
A. Langenbruch ◽  
M. Augustin ◽  
W. Kath
Keyword(s):  
Quality Of Life ◽  
Varicose Veins ◽  
Skin Condition ◽  
Skin Care ◽  
Surgical Removal ◽  
Compression Stocking ◽  
Free Text ◽  
Compression Stockings ◽  
Skin Moisture

SummaryCompression is performed postoperatively with the intention of minimising side effects, such as bleeding and haematoma in the area of operation, as well as postoperative oedema and pain. Compression stocking manufacturing has incorporated the addition of skin care products into the yarn material in recent years. However, the benefits of these products remain controversial. In addition, the length of the compression stocking is disputed in terms of its effectiveness. This effectiveness was investigated in the present study.Before surgery, 160 patients with indication of surgical removal of varicose veins were randomly divided into four groups with different types of compression stockings in each case. In each group, 40 patients received a knee-length stocking (length A–D), thigh-length stocking (length A–G), knee-length stocking with Aloe vera or thigh-length stocking with AV. At time 0 (before surgery), one week and 8 weeks after surgery, skin moisture was measured as an objective parameter, quality of life was determined using the Freiburger questionnaire of quality of life in veinous disease (FLQA-vs), benefit to patients was evaluated using the patient benefit index (PBI-v) and further subjective parameters were investigated with a free-text questionnaire. After surgery, the extent of haematoma was determined using the point count method.After surgery, at both post-operative times, the FLQA-vs decreased significantly (corresponding to a better quality of life), and the PBI-v increased. In the group with Aloe, pruritus was significantly lower, comfort and skin moisture were increased, and skin condition was significantly improved. The extent of haematoma decreased regardless of the length of the stockings.A benefit of AV as a skin care additive was observed. This finding was objectively confirmed based on the skin moisture. The multifactorial quality of life was not affected by the skin care additive. Thigh-length compression stockings did not provide a measurable benefit.

Treatment Options, Clinical Outcome (Quality of Life) and Cost Benefit (Quality-adjusted Life Year) in Varicose Vein Treatment

2012 ◽  
Vol 27 (1_suppl) ◽  
pp. 16-22 ◽  
Author(s):  
D Kelleher ◽  
T R A Lane ◽  
I J Franklin ◽  
A H Davies
Keyword(s):  
Quality Of Life ◽  
Clinical Outcome ◽  
Varicose Vein ◽  
Varicose Veins ◽  
Treatment Options ◽  
Cost Benefit ◽  
Assessment Tools ◽  
Life Assessment ◽  
Extensive Literature

Varicose veins are an extremely common condition causing morbidity; however, with current financial pressures, treatment of such benign diseases is controversial. Many procedures allow the treatment of varicose veins with minimal cost and extensive literature supporting differing approaches. Here we explore the underlying evidence base for treatment options, the effect on clinical outcome and the cost-benefit economics associated with varicose vein treatment. The method of defining clinical outcome with quality-of-life assessment tools is also investigated to explain concepts of treatment success beyond abolition of reflux.

scholarly journals A One-Year Audit of Varicose Vein Surgery at a Vascular Surgical Unit with a Long-Term Duplex and Quality of Life Follow-Up

2021 ◽  
pp. 1-8
Author(s):  
Olle Nelzén ◽  
Olle Nelzén ◽  
Ingvor Fransson
Keyword(s):  
Quality Of Life ◽  
Varicose Vein ◽  
Open Surgery ◽  
Varicose Veins ◽  
Long Term Results ◽  
Primary Surgery ◽  
One Year

Objective: With the introduction of endovenous treatments, open varicose veins surgery was discarded due to a claimed high risk of neovascularisation. A one-year audit was set up to look at results from performing mainly open surgery. Methods: All varicose vein interventions were registered and prospectively followed with colour Duplex assessments after 4-6 weeks, 1 and >5 years. In addition, Aberdeen Varicose Vein Questionnaire (AVVQ) was used in addition to Varicose Vein Severity Score (VCSS) to assess patients’ quality of life (QoL) and the disease severity. Results: During the year, 236 patients/252 legs were operated and 28% were re-do procedures. Median age was 55 years (16-87) and 70% were females. Duplex at 4-6 weeks showed a primary success rate of 91%. Neovascularisation was noted in 8% one year after primary surgery. The long-term assessment was done after a median of 69 months (39-75) and 67% of all legs were examined. After primary surgery 16% showed neovascularisation compared with and 27% after re-do procedures. VCSS improved significantly from 6 (range 1-22) to 2 at the long-term follow-up (p<0.001). The AVVQ score improved from 20 (range 3-55) down to 10 (p<0.001). Conclusion: The risk for neovascularisation seems to have been overestimated and good long-term results can be achieved following modern open surgery. The major problem is to avoid varicose vein recurrence since results from re-do procedures seem less favourable long term.

Need for adjunctive procedures following cyanoacrylate closure of incompetent great, small and accessory saphenous veins without the use of postprocedure compression: Three-month data from a postmarket evaluation of the VenaSeal System (the WAVES Study)

2018 ◽  
Vol 34 (4) ◽  
pp. 231-237 ◽  
Author(s):  
Kathleen Gibson ◽  
Renee Minjarez ◽  
Krissa Gunderson ◽  
Brian Ferris
Keyword(s):  
Saphenous Vein ◽  
Varicose Vein ◽  
Severity Score ◽  
Rating Scale ◽  
Great Saphenous Vein ◽  
Clinical Severity ◽  
Compression Stockings ◽  
Saphenous Veins ◽  
Clinical Severity Score ◽  
Venous Clinical Severity Score

Purpose Studies examining cyanoacrylate closure of saphenous veins with the VenaSeal™ System have not allowed concomitant procedures for tributaries at the time of the index procedure. Outside of clinical trials, however, concomitant procedures are frequently performed in conjunction with endovenous ablation. We report on the frequency of need for saphenous tributary treatment three months after cyanoacrylate closure of the treatment of great saphenous vein, small saphenous vein, and/or accessory saphenous vein. Methods Fifty subjects with symptomatic great saphenous vein, small saphenous vein, and/or accessory saphenous vein incompetence were treated with no postprocedure compression stockings. Concomitant procedures were not allowed. Treating physicians predicted the type and nature of any concomitant procedures that they would usually perform at the time of ablation, if not limited by the constraints of the study. Evaluations were performed at one week, one and three months and included duplex ultrasound, numeric pain rating scale, revised venous clinical severity score, the Aberdeen Varicose Vein Questionnaire, and time to return to work and normal activities. At the three-month visit, the need for and type of adjunctive procedures were recorded. Results Complete closure at three months was achieved in 70 (99%) of the treated veins (48 great saphenous veins, 14 accessory saphenous veins, eight small saphenous veins). Revised venous clinical severity score improved from 6.4 ± 2.2 to 1.8 ± 1.5 (P < .001) and Aberdeen Varicose Vein Questionnaire from 17.3 ± 7.9 to 6.5 ± 7.2 (P < .0001). Sixty-six percent of patients underwent tributary treatment at three months. The percentage of patients who required adjunctive treatments at three months was lower than had been predicted by the treating physicians (65% versus 96%, p=.0002). Conclusions Closure rates were high in the absence of the use of compression stockings or side branch treatment. Improvement in quality of life was significant, and the need for and extent of concomitant procedures was significantly less than had been predicted by the treating physicians.

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