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Schmedt CG, Dikic S, Demhasaj S, Küspert T. Diagnostik und Therapie der Stammveneninsuffizienz. GEFÄSSCHIRURGIE 2015. [DOI: 10.1007/s00772-015-0097-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Wittens C, Davies AH, Bækgaard N, Broholm R, Cavezzi A, Chastanet S, de Wolf M, Eggen C, Giannoukas A, Gohel M, Kakkos S, Lawson J, Noppeney T, Onida S, Pittaluga P, Thomis S, Toonder I, Vuylsteke M, Kolh P, de Borst GJ, Chakfé N, Debus S, Hinchliffe R, Koncar I, Lindholt J, de Ceniga MV, Vermassen F, Verzini F, De Maeseneer MG, Blomgren L, Hartung O, Kalodiki E, Korten E, Lugli M, Naylor R, Nicolini P, Rosales A. Editor's Choice - Management of Chronic Venous Disease: Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2015; 49:678-737. [PMID: 25920631 DOI: 10.1016/j.ejvs.2015.02.007] [Citation(s) in RCA: 505] [Impact Index Per Article: 56.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Cheng WH, Patel H, Lee WJ, Lin FJ, Pickard AS. Positive Outcomes of Varicose Vein Surgery: The Patient Perspective. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2014; 8:329-37. [PMID: 25344103 DOI: 10.1007/s40271-014-0092-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patient-reported outcomes are increasingly recognized as important to understanding outcomes of medical interventions such as varicose vein surgery (VVS). Our aim was to compare positive outcomes of VVS as defined by several patient-reported measures, and to identify baseline characteristics associated with positive outcomes of VVS. METHODS A secondary analysis of the UK Patient-Reported Outcome Measures database was conducted on patients undergoing VVS, in the period 2009-2011 who completed the generic EQ-5D (index and visual analog scale [VAS] summary scores) and disease-specific Aberdeen varicose vein questionnaire (AVVQ). Surgical outcome was defined as positive if pre/post change scores exceeded half a standard deviation of mean baseline scores. Logistic regression models were used to identify significant predictors of positive outcomes, including age, gender, and baseline health. RESULTS Of 9,113 patients analyzed (71% females, 57% aged >50 years), positive outcomes were identified in 62% using the AVVQ, 43% based on EQ-5D index scores, and 24% according to EQ-VAS; 10% improved on all three measures. Patients with poorer baseline functioning (AVVQ scores ≥ 11) were more likely to have a positive outcome based on the EQ-5D index (odds ratio [OR] 1.23, 95% confidence interval [CI] 1.11-1.36) and EQ-VAS (OR 1.30, 95% CI 1.14-1.47). CONCLUSIONS Defining surgery as successful will clearly depend on how health-related quality of life (HRQL) is operationalized and the criteria used to identify meaningful change. Across a range of criteria, a consistently greater proportion of patients had positive outcomes in terms of VV-related functioning (via AVVQ) compared with those who improved in terms of generic health (via EQ-index), or self-rated health (EQ-VAS).
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Affiliation(s)
- Wei-Han Cheng
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, 833, S. Wood Street, M/C 886, Chicago, IL, 60612, USA
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Darvall KAL, Bate GR, Bradbury AW. Patient-reported outcomes 5–8 years after ultrasound-guided foam sclerotherapy for varicose veins. Br J Surg 2014; 101:1098-104. [DOI: 10.1002/bjs.9581] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Revised: 01/10/2014] [Accepted: 05/02/2014] [Indexed: 11/11/2022]
Abstract
Abstract
Background
The aim was to determine the long-term (5–8 years) outcomes of ultrasound-guided foam sclerotherapy (UGFS) for varicose veins using health-related quality of life (HRQL), patient-reported outcomes (PROMs), patient satisfaction and retreatment rates.
Methods
Consecutive patients undergoing UGFS between April 2004 and May 2007 were invited for review at least 5 years after treatment. Patients completed generic (Short Form 12) and disease-specific (Aberdeen Varicose Vein Symptom Severity Score, AVSS) HRQL instruments, and questionnaires enquiring about lower limb symptoms, lifestyle factors and satisfaction with treatment. Data on retreatments were recorded prospectively.
Results
A total of 391 limbs in 285 patients were included (81·2 per cent response rate) at a median of 71 (i.q.r. 67–78) months following first UGFS treatment. Originally 72·1 per cent had symptomatic, uncomplicated varicose veins, 21·9 per cent had undergone surgery previously, 87·2 per cent had treatment of great saphenous veins and 19·9 per cent treatment of short saphenous veins. Disease-specific HRQL scores improved significantly at long-term follow-up, with 88·5 per cent having an improved AVSS compared with baseline. Regarding lower limb symptoms and lifestyle improvement, 62·7–93·8 per cent of patients had their pretreatment expectations met or exceeded. Overall, 82·0 per cent were very satisfied with their treatment and only 3·3 per cent were dissatisfied; 91·0 per cent would recommend the treatment to others. Some 15·3 per cent of limbs required retreatment by 5 years (Kaplan–Meier analysis).
Conclusion
UGFS has durable results as reported by PROMs to at least 5 years. Only 15·3 per cent of limbs required retreatment for recurrence during follow-up.
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Affiliation(s)
- K A L Darvall
- Birmingham University Department of Vascular Surgery, Flat 5 Netherwood House, Solihull Hospital, Lode Lane, Solihull B91 2JL, UK
| | - G R Bate
- Birmingham University Department of Vascular Surgery, Flat 5 Netherwood House, Solihull Hospital, Lode Lane, Solihull B91 2JL, UK
| | - A W Bradbury
- Birmingham University Department of Vascular Surgery, Flat 5 Netherwood House, Solihull Hospital, Lode Lane, Solihull B91 2JL, UK
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Rasmussen L, Lawaetz M, Bjoern L, Blemings A, Eklof B. Randomized clinical trial comparing endovenous laser ablation and stripping of the great saphenous vein with clinical and duplex outcome after 5 years. J Vasc Surg 2013; 58:421-6. [DOI: 10.1016/j.jvs.2012.12.048] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 12/03/2012] [Accepted: 12/13/2012] [Indexed: 10/26/2022]
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Darvall KAL, Bate GR, Adam DJ, Bradbury AW. Generic health-related quality of life is significantly worse in varicose vein patients with lower limb symptoms independent of CEAP clinical grade. Eur J Vasc Endovasc Surg 2012; 44:341-4. [PMID: 22831872 DOI: 10.1016/j.ejvs.2012.06.022] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Accepted: 06/25/2012] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To determine the relationship between lower limb symptoms and generic health-related quality of life (HRQL) in patients with varicose veins (VV). METHODS 284 patients on the waiting list for VV treatment completed the Short Form-12 (SF12) and a questionnaire asking about the presence of lower limb symptoms commonly attributed to venous disease (pain or ache, itching, tingling, cramp, restless legs, a feeling of swelling, and heaviness). RESULTS Median age was 57 years (interquartile range 45-67); 100 (35%) were male, and 182 (64%) had CEAP clinical grade 2 or 3 disease. Jonckheere-Terpstra test for trend revealed that both physical (P < .0005) and mental (P = .001) HRQL worsened as the reported number of symptoms increased. Patients reporting tingling (P = .016, Mann-Whitney U test), cramp (P = .001), restless legs (P < .0005), swelling (P < .0005), and heaviness (P < .0005) had a significantly worse physical HRQL than those who did not. Mental HRQL was also significantly worse in patients with tingling (P = .010), cramp (P = .008), restless legs (P = .040), swelling (P = .001), and heaviness (P = .035). These significant relationships remained, and pain was also correlated with worse physical HRQL (P = .011), when linear regression was performed to control for CEAP clinical grade, age and sex. CONCLUSIONS Physical and mental HRQL is significantly worse in VV patients with lower limb symptoms irrespective of the clinical stage of disease. This observation confirms that VV are not primarily a cosmetic problem and that NHS rationing of treatment to those with CEAP C4-6 disease excludes many patients who would benefit from intervention in terms of HRQL. Generic HRQL instruments also allow comparison with interventions for other chronic conditions.
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Affiliation(s)
- K A L Darvall
- Birmingham University, Department of Vascular Surgery, Heart of England NHS Trust, Birmingham, UK.
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Carradice D, Mazari FAK, Samuel N, Allgar V, Hatfield J, Chetter IC. Modelling the effect of venous disease on quality of life. Br J Surg 2011; 98:1089-98. [DOI: 10.1002/bjs.7500] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2011] [Indexed: 11/08/2022]
Abstract
Abstract
Background
A clear understanding of the relationship between venous reflux, clinical venous disease and the effects on quality of life (QoL) remains elusive. This study aimed to explore the impact of venous disease, and assess any incremental direct effect of progressive disease on health-related QoL, with the ultimate aim to model venous morbidity.
Methods
Consecutive patients with venous disease were assessed for inclusion in the study. Patients with isolated, unilateral, single superficial axial incompetence diagnosed on duplex imaging were included. Clinical grading was performed with the Clinical Etiologic Anatomic Pathophysiologic (CEAP) classification and Venous Clinical Severity Score (VCSS). Patients completed generic (Short Form 36, SF-36®; EuroQol 5D, EQ-5D™) and disease-specific (Aberdeen Varicose Vein Questionnaire, AVVQ) QoL instruments. Multivariable regression modelling was performed, taking account of demographic and anatomical factors, to explore the effect of clinical severity on QoL impairment.
Results
Some 456 patients with C2–6 venous disease were included, along with control data for 105 people with C0–1 disease. Increasing clinical grade corresponded strongly with deterioration in disease-specific QoL (P < 0·001). This could be stratified into three distinguishable groups: C0–1, C2–4 and C5–6 (P < 0·001 to P = 0·006). Increasing clinical grade also corresponded with deterioration in the physical domains of SF-36® (P < 0·001 to P = 0·016), along with EQ-5D™ index utility (quality-adjusted life year) scores (P < 0·001).
Conclusion
Demonstrable morbidity was seen, even with uncomplicated venous disease. The physical impairment seen with venous ulceration was comparable with that seen in congestive cardiac failure and chronic lung disease.
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Affiliation(s)
- D Carradice
- Academic Vascular Surgical Unit, University of Hull and Hull York Medical School, Hull, UK
| | - F A K Mazari
- Academic Vascular Surgical Unit, University of Hull and Hull York Medical School, Hull, UK
| | - N Samuel
- Academic Vascular Surgical Unit, University of Hull and Hull York Medical School, Hull, UK
| | - V Allgar
- Department of Statistics, Hull York Medical School, Hull, UK
| | - J Hatfield
- Academic Vascular Surgical Unit, University of Hull and Hull York Medical School, Hull, UK
| | - I C Chetter
- Academic Vascular Surgical Unit, University of Hull and Hull York Medical School, Hull, UK
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Gloviczki P, Comerota AJ, Dalsing MC, Eklof BG, Gillespie DL, Gloviczki ML, Lohr JM, McLafferty RB, Meissner MH, Murad MH, Padberg FT, Pappas PJ, Passman MA, Raffetto JD, Vasquez MA, Wakefield TW. The care of patients with varicose veins and associated chronic venous diseases: Clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg 2011; 53:2S-48S. [PMID: 21536172 DOI: 10.1016/j.jvs.2011.01.079] [Citation(s) in RCA: 838] [Impact Index Per Article: 64.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 01/12/2011] [Accepted: 01/15/2011] [Indexed: 12/20/2022]
Affiliation(s)
- Peter Gloviczki
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
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Kutlu A, Yılmaz E, Çeçen D, Eser E, Özbakkaloğlu A. The Turkish Validity and Reliability of the Venous Insufficiency Epidemiological and Economic Study-Quality of Life/Symptoms Scales. Angiology 2011; 62:329-37. [DOI: 10.1177/0003319710394159] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of the study was to test Turkish validity and reliability of Venous Insufficiency Epidemiological and Economic Study-Quality of Life/Symptoms (VEINES-QoL/Sym) in patients with chronic venous insufficiency (CVI). A total of 118 patients with CVI hospitalized in 3 different hospitals were enrolled in this study. VEINES-QoL/Sym, translated to Turkish with a standard methodology, was applied to the patients and was evaluated for acceptability, reliability, validity, and responsiveness. Cronbach α (including if item deleted) values were used for the reliability analysis. Construct and criterion validity approaches were used for validity analysis. Cronbach α values are .86 for the VEINES-QOL and .81 for the VEINES-Sym. No problematic items were observed for the scale. The VEINES-QoL/Sym was significantly sensitive to clinical, etiology, anatomy, and pathophysiology (CEAP) classification, indicating good criterion validity. Significant correlation was found between scores of SF-36 and VEINESQoL (r = .43-.66). Turkish version of the VEINES-QOL/Sym was found reliable and valid for Turkish patients with CVI.
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Affiliation(s)
- Adalet Kutlu
- Nursing Department, Celal Bayar University, Manisa Health Sciences College, Manisa, Turkey,
| | - Emel Yılmaz
- Nursing Department, Celal Bayar University, Manisa Health Sciences College, Manisa, Turkey
| | - Dilek Çeçen
- Nursing Department, Celal Bayar University, Manisa Health Sciences College, Manisa, Turkey
| | - Erhan Eser
- Public Health Department, Celal Bayar University, Medical School, Manisa, Turkey
| | - Alper Özbakkaloğlu
- Cardiovascular Surgery Department, Celal Bayar University, Medical School, Manisa, Turkey
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Duplex Ultrasound Outcomes Following Ultrasound-Guided Foam Sclerotherapy of Symptomatic Primary Great Saphenous Varicose Veins. Eur J Vasc Endovasc Surg 2010; 40:534-9. [DOI: 10.1016/j.ejvs.2010.06.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Accepted: 06/20/2010] [Indexed: 11/20/2022]
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Photoplethysmographic Venous Refilling Times Following Ultrasound Guided Foam Sclerotherapy for Symptomatic Superficial Venous Reflux: Relationship with Clinical Outcomes. Eur J Vasc Endovasc Surg 2010; 40:267-72. [DOI: 10.1016/j.ejvs.2010.02.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Accepted: 02/23/2010] [Indexed: 11/17/2022]
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12
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Rasmussen L, Bjoern L, Lawaetz M, Lawaetz B, Blemings A, Eklöf B. Randomised Clinical Trial Comparing Endovenous Laser Ablation with Stripping of the Great Saphenous Vein: Clinical Outcome and Recurrence After 2Years. Eur J Vasc Endovasc Surg 2010; 39:630-5. [PMID: 20064730 DOI: 10.1016/j.ejvs.2009.11.040] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2009] [Accepted: 11/26/2009] [Indexed: 11/24/2022]
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Darvall KAL, Sam RC, Bate GR, Silverman SH, Adam DJ, Bradbury AW. Changes in health-related quality of life after ultrasound-guided foam sclerotherapy for great and small saphenous varicose veins. J Vasc Surg 2010; 51:913-20. [PMID: 20347688 DOI: 10.1016/j.jvs.2009.11.045] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Revised: 10/19/2009] [Accepted: 11/07/2009] [Indexed: 11/30/2022]
Abstract
BACKGROUND Health-related quality of life (HRQOL) improves after superficial venous surgery for varicose veins, but the effect of ultrasound-guided foam sclerotherapy on HRQOL is unknown. The aim of this study was to determine changes in HRQOL after ultrasound-guided foam sclerotherapy for varicose veins. METHODS Consecutive patients undergoing ultrasound-guided foam sclerotherapy for varicose veins were sent the Short Form 12 (SF-12) questionnaire, a generic measure of HRQOL, and the Aberdeen Varicose Vein Symptom Score (AVSS) questionnaire, a disease-specific measure of HRQOL, 1 week before treatment and 1, 6, and 12 months after treatment. RESULTS The study enrolled 296 patients (34% male; 395 treated legs) with a median age of 57 years (range, 22-89 years). Of these, 24% had had previous superficial venous surgery, and 66% were CEAP C(2-3) (uncomplicated varicose veins). Questionnaire completion rates were 82%, 73%, and 69% at 1, 6, and 12 months after treatment. The median Physical Component Summary score of the SF-12 (higher score indicates better HRQOL) improved from 47.6 pretreatment to 49.4 at 1 month (P < .008, Wilcoxon signed rank test), to 51.9 at 6 months (P < .0005), and to 52.9 at 12 months (P < .0005). The median AVSS (lower score indicates better HRQOL) improved from 19.0 pretreatment to 16.5 at 1 month (P < .0005), to 8.7 at 6 months (P < .0005), and to 8.6 at 12 months (P < .0005). CONCLUSIONS Ultrasound-guided foam sclerotherapy for great and small saphenous varicose veins leads to significant improvements in generic and disease-specific HRQOL for at least 12 months after treatment.
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Affiliation(s)
- Katy A L Darvall
- Birmingham University Department of Vascular Surgery, Heart of England NHS Trust, Birmingham, United Kingdom.
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Darvall KAL, Bate GR, Adam DJ, Bradbury AW. Recovery after ultrasound-guided foam sclerotherapy compared with conventional surgery for varicose veins. Br J Surg 2009; 96:1262-7. [DOI: 10.1002/bjs.6754] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Abstract
Background
The advantages of minimally invasive alternatives such as ultrasound-guided foam sclerotherapy (UGFS) over conventional surgery for the treatment of varicose veins include lower morbidity and faster recovery times. The aim was to compare morbidity, analgesia use, and time to return to driving and work following UGFS with those reported after conventional surgery for varicose veins.
Methods
Patients who had UGFS or surgery for varicose veins were sent a questionnaire 4 weeks after treatment.
Results
A total of 332 (84·9 per cent) of 391 patients who had UGFS and 53 (56 per cent) of 94 who had surgery returned a questionnaire. The groups were similar in terms of age, sex, and the proportion who had treatment of bilateral or recurrent veins. Patients who had surgery were more likely to have significant bruising (44 versus 7·2 per cent; P < 0·001) and pain (17 versus 5·5 per cent; P = 0·001). After UGFS, 43·2 per cent of patients returned to work within 24 h compared with none who had surgery (P < 0·001). Patients who had UGFS were more likely to return to driving within 4 days (P = 0·014).
Conclusion
UGFS was associated with less pain and analgesia requirement, time off work and quicker return to driving.
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Affiliation(s)
- K A L Darvall
- Department of Vascular Surgery, Birmingham University, Heart of England NHS Trust, Birmingham, UK
| | - G R Bate
- Department of Vascular Surgery, Birmingham University, Heart of England NHS Trust, Birmingham, UK
| | - D J Adam
- Department of Vascular Surgery, Birmingham University, Heart of England NHS Trust, Birmingham, UK
| | - A W Bradbury
- Department of Vascular Surgery, Birmingham University, Heart of England NHS Trust, Birmingham, UK
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Wall ML, Dealey C, Davies RSM, Simms MH. Local versus general anaesthesia for varicose veins surgery: a prospective non-randomized controlled trial. Phlebology 2009; 24:61-6. [DOI: 10.1258/phleb.2008.008029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective To compare the acceptability and outcome of primary varicose vein (VV) surgery (saphenofemoral or saphenopopliteal ligation/excision) under local anaesthesia (LA) with that of general anaesthesia (GA). Methods A non-randomized controlled trial of consecutive patients treated between April 2004 and March 2006 was performed. After complete informed consent individual patients were asked to select their preferred form of anaesthesia (LA or GA). Preoperative disease status and co-morbidities were recorded. Outcomes were assessed perioperatively and at six weeks and six months postoperatively using patient scoring systems including the Aberdeen varicose veins severity score (AVVSS). Results Seventy-two (LA 46[62%] and GA 26[38%]) patients participated; median (range) age was 48 (21–74) years versus 36 (21–59) years ( P = 0.0164), respectively. All procedures were performed as day cases. Median postoperative pain scores for LA and GA did not differ at 12 hours (4 versus 4; P = 0.48) and four days (5 versus 6; P = 0.44). Median improvement in the AVVSS at six weeks and six months for LA and GA cohorts were 5.7 versus 6.1 ( P = 0.875) and 6.5 versus 8.3 ( P = 0.131), respectively. Overall patient satisfaction did not show any intergroup difference at six weeks. Conclusions Surgical treatment of VV under LA can be performed safely with comparable results to GA in self-selected patients.
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Affiliation(s)
- M L Wall
- Department of Vascular Surgery, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - C Dealey
- Department of Vascular Surgery, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - R S M Davies
- Department of Vascular Surgery, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - M H Simms
- Department of Vascular Surgery, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
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Abstract
This article examines the practice of standard varicose vein surgery including sapheno-femoral and sapheno-popliteal ligation, perforator surgery and surgery for recurrent varicose veins. The technique of exposure of the sapheno-femoral junction and the sapheno-popliteal junction is outlined and advice given on avoidance of complications for both. The evidence regarding methods of closure over the ligated sapheno-femoral junction is examined as is the requirement for stripping and the use of different types of stripper. The requirement to strip the small saphenous vein and the extent of dissection necessary in the popliteal fossa is also examined. Complications of standard varicose vein surgery are outlined. The frequency of wound infection, nerve injury, vascular injury and venous thromboembolism are listed and strategies to avoid these complications are examined.
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A Prospective Study of Incidence of Saphenous Nerve Injury after Total Great Saphenous Vein Stripping. Dermatol Surg 2008. [DOI: 10.1097/00042728-200810000-00005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Winterborn RJ, Corbett CRR. Treatment of varicose veins: the present and the future--a questionnaire survey. Ann R Coll Surg Engl 2008; 90:561-4. [PMID: 18701012 DOI: 10.1308/003588408x318228] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The treatment options for varicose veins have increased over the last few years. Despite a lack of randomised trials comparing the various modalities, many surgeons are changing their practice. The aim of this study was to assess the current practice of surgeons in Great Britain and Ireland. MATERIALS AND METHODS A postal questionnaire survey was sent to surgical members of the Vascular Society of Great Britain and Ireland and the Venous Forum of The Royal Society of Medicine. Of 561 questionnaires sent, 349 were returned completed (62%). RESULTS The types of varicose vein treatments offered by each surgeon varied widely in both NHS and private practice. The vast majority (96%) offered conventional surgery (CS) on the NHS. Foam sclerotherapy (FS) endovenous laser (EVL) and radiofrequency ablation (RF) were more likely to be offered in private practice than in NHS practice. Overall, 38% of respondents for NHS practice and 45% of respondents for private practice offered two or more modalities. Of the respondents who were not yet performing FS, EVL, or RF, 19% were considering or had undertaken training in FS, 26% in EVL and 9% in RF. When asked to consider future practice, 70% surgeons felt that surgery would remain the most commonly used treatment. This was followed by FS (17%), EVL (11%) and RF (2%). CONCLUSIONS Over one-third of respondents are now offering more than one treatment modality for the treatment of varicose veins. Whilst there is movement towards endovascular treatments, the problem of cost has yet to be solved. At present, surgery remains the most popular modality in both the NHS and private practice; however, improved outcomes and patient preference may lead to a change in practice.
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Affiliation(s)
- R J Winterborn
- Department of General Surgery, Bristol Royal Infirmary, Bristol, UK
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Flu HC, Breslau PJ, Hamming JF, Lardenoye JW. A prospective study of incidence of saphenous nerve injury after total great saphenous vein stripping. Dermatol Surg 2008; 34:1333-9. [PMID: 18616536 DOI: 10.1111/j.1524-4725.2008.34285.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Total stripping of the great saphenous vein (GSV) is a validated surgical strategy of treating patients with primary varicose veins (PVV). An often cited, but not well documented and studied, complication of total stripping is postoperative damage of the saphenous nerve (SN). OBJECTIVE The objective was to evaluate the incidence of SN damage and to assess the therapeutic efficacy after total stripping of the GSV. MATERIALS AND METHODS Patients undergoing total stripping of the GSV because of PVV in the entire lower limb were enrolled. Pre- and postoperative neurologic examination was performed to identify potential sensory neurologic deficits. RESULTS Total stripping of the GSV in 69 limbs occurred because of pain (9%) or a tired feeling in the limbs (77%) or for cosmetic reasons (14%). The overall incidence of postoperative sensory neurologic deficits was 7 and 6%, respectively, after 6-week follow-up and both 3% after 3-month follow-up. In 99% of the patients, total stripping of the GSV resulted in reduction of the primary signs and symptoms. CONCLUSION The incidence of SN damage after total stripping of the GSV is low. Thus, total stripping of the GSV resulted in improvement of the primary complaint in almost all patients. Total stripping of the GSV is an effective surgical strategy in treating PVV.
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Affiliation(s)
- Hans C Flu
- Department of Vascular Surgery, HagaHospital, The Hague, The Netherlands.
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20
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Lozano F. Calidad de vida relacionada con la cirugía vascular. ANGIOLOGIA 2008. [DOI: 10.1016/s0003-3170(08)06001-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Miccoli P, Minuto MN, Paggini R, Rucci P, Oppo A, Donatini G, Golia F, Novelli L, Carlini M, Dell'Osso L. The impact of thyroidectomy on psychiatric symptoms and quality of life. J Endocrinol Invest 2007; 30:853-9. [PMID: 18075288 DOI: 10.1007/bf03349227] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Existing trials investigated the impact of medical treatment of thyroid disorders on health-related quality of life (QOL) and psychiatric symptoms. The aim of this prospective study is to analyze the impact of thyroid surgery on QOL and severity of psychiatric symptoms. MATERIALS AND METHODS Forty-seven patients undergoing thyroid surgery (TS) were assessed before thyroidectomy (T0) and 37 also after surgery, >or=6 months after euthyroidism was achieved (T1). QOL and psychiatric symptoms were evaluated at T0 and T1 using the Medical Outcomes Study Short Form Survey (SF-36) and the Symptom Checklist-90 (SCL-90-R). Scores at T0 were compared with those of patients undergoing surgery for non-thyroidal disease and the SF-36 scores were also compared with the normative Italian sample. Changes in QOL and psychiatric symptoms between T0 and T1 were also examined. RESULTS Health-related QOL in TS patients before surgery was poorer than in the comparison group on the SF-36 mental component summary measure and social functioning. Mental health improved significantly after surgery but social functioning remained markedly impaired. A significant reduction in the severity of psychiatric symptoms was observed. DISCUSSION Our results indicate that even long after euthyroidism is achieved after surgery, patients show a significant improvement of mental health and a reduction of psychiatric symptoms. Nevertheless, patients continue to have a poorer QOL compared to the Italian normative sample.
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Affiliation(s)
- P Miccoli
- Department of Surgery, University of Pisa, 56100 Pisa, Italy
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Sam RC, Darvall KAL, Adam DJ, Silverman SH, Bradbury AW. A comparison of the changes in generic quality of life after superficial venous surgery with those after laparoscopic cholecystectomy. J Vasc Surg 2006; 44:606-10. [PMID: 16950442 DOI: 10.1016/j.jvs.2006.03.048] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2006] [Accepted: 03/29/2006] [Indexed: 11/27/2022]
Abstract
BACKGROUND Superficial venous surgery (SVS) results in a significant improvement in generic health-related quality of life (HRQL). However, it is unclear how this improvement compares with that observed after other commonly performed general and vascular operations. The aim of this study was to compare the changes in generic HRQL observed before and after SVS for CEAP clinical grade 2 to 4 venous disease with those observed before and after elective laparoscopic cholecystectomy (ELC) for biliary colic. METHODS The Short Form 12 questionnaire was mailed to patients before and 3, 6, and 12 months after SVS (n = 143) and ELC (n = 60). The responses were used to calculate physical (PCS) and mental (MCS) component summary scores at each time point. A higher score indicates a better HRQL. RESULTS Before surgery and 3 and 12 months after surgery, patients in the ELC group had a significantly lower PCS than those in the SVS group (40.2 vs 49.5, 48.9 vs 53.1, and 45.4 vs 53.8; P < .001, P = .033, and P < .001, respectively; Mann-Whitney U test). However, the change in PCS observed over the first 12 postoperative months was not significantly different between the SVS and ELC groups. Patients in the ELC group had a significantly lower MCS than those in the SVS group before surgery (45.9 vs 50.8; P = .002; Mann-Whitney U test), but not after surgery. There was no difference between the two groups in terms of postoperative change in MCS. CONCLUSIONS SVS is associated with a statistically significant and clinically meaningful improvement in generic HRQL that is similar to that observed after ELC. These novel data lend further support to the clinical benefit of SVS and will help health care purchasers make decisions regarding the prioritization of vascular and general surgical services.
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Affiliation(s)
- Rachel C Sam
- Birmingham University Department of Vascular Surgery, Heart of England National Health Service Foundation Trust, Birmingham, United Kingdom.
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Blomgren L, Johansson G, Bergqvist D. Quality of Life after Surgery for Varicose Veins and the Impact of Preoperative Duplex: Results Based on a Randomized Trial. Ann Vasc Surg 2006; 20:30-4. [PMID: 16378147 DOI: 10.1007/s10016-005-9285-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In a prospective randomized study, we found that the addition of a preoperative duplex scan before varicose vein (VV) surgery reduced recurrences and reoperations after 2 years. The aim of the present study was to investigate whether this correlates with an improved quality of life (QoL). We studied 293 patients scheduled for VV surgery with or without preoperative duplex. QoL was assessed preoperatively at 1 month, 1 year, and 2 years with the Short Form-36 (SF-36). Scores were compared with matched reference groups from the Swedish population. The 237 complete responders (81%) had a mean age of 47 (range 22-73) years, 169 (71%) were women, and 43 (18%) had skin changes. Both groups of VV patients scored significantly worse than the reference group in the domain Bodily Pain preoperatively (p < 0.001) and better after 1 year (p = 0.04), with no difference found after 2 years. There was no significant difference in QoL between the duplex and control groups at any time. We conclude that preoperative duplex before VV surgery did not significantly improve QoL after 2 years in spite of improved surgical results. VV surgery per se improved QoL as measured with the SF-36.
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Affiliation(s)
- Lena Blomgren
- Department of Surgery, Capio St. Göran's Hospital, Stockholm, SE-112 81 Sweden.
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Subramonia S, Lees T. Sensory abnormalities and bruising after long saphenous vein stripping: impact on short-term quality of life. J Vasc Surg 2005; 42:510-4. [PMID: 16171598 DOI: 10.1016/j.jvs.2005.05.021] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2005] [Accepted: 05/10/2005] [Indexed: 11/28/2022]
Abstract
BACKGROUND We assessed the impact of postoperative sensory abnormalities and bruising after long saphenous vein (LSV) stripping on short-term quality of life (QOL). METHODS Seventy patients with LSV incompetence were recruited before surgery. Surgery involved saphenofemoral disconnection, stripping of the LSV in the thigh, and multiple stab avulsions in all patients. Sensory abnormalities (subjective and objective) and bruising were recorded at two follow-up visits (mean, 8 and 47 days). The bruised area was traced manually, and the surface area was estimated by placing the tracing on a square chart. A QOL assessment was performed before surgery and repeated during the second visit by using the Aberdeen Varicose Veins Questionnaire. Minitab version 13.32 was used for statistical analysis. RESULTS Eight patients either did not complete follow-up or were excluded from the final analysis. Final analysis was performed on 63 limbs in 62 patients (27 men and 35 women; age, 19-75 years). The overall incidence of postoperative sensory abnormality was 40% (25/63 limbs). This included numbness or decreased sensation in 36.5% (23/63), paresthesia in 8% (5/63), and dysesthesia in 1.6% (1/63). Irrespective of the presence of sensory abnormalities, QOL scores improved after surgery (mean change in QOL score, -7.58 and -7.52; SE, 1.1 and 1.3 in those with and without sensory abnormalities, respectively). There was no significant difference either in the degree of improvement in the QOL score (P = .972; t test) or in the proportion of patients with an improved score (P = .69; Fisher exact test) between the groups with and without sensory abnormalities. Postoperative bruising at first follow-up ranged from 28 to 1419 cm(2) (mean, 500.7 cm(2); median, 438 cm(2)). Both groups--those who bruised less than the median value (438 cm(2)) and those who bruised more than the median value--showed improved postoperative QOL scores (mean change in QOL score, -7.64 and -7.46; SE, 1.3 and 1.3, respectively). There was no significant difference either in the degree of improvement in the QOL score (P = .924; t test) or in the proportion of patients with an improved score (P = .422; Fisher exact test). All patients with persistent bruising at the second follow-up (26%) also showed an improvement in the QOL score (mean change in QOL score, -10.29). CONCLUSIONS Conventional surgery for varicose veins with stripping of the LSV is associated with significant morbidity of sensory abnormalities and bruising. However, this does not adversely affect postoperative improvement in short-term QOL.
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Affiliation(s)
- Sriram Subramonia
- Northern Vascular Centre, Freeman Hospital, Newcastle Upon Tyne, UK.
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