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Mirakhmedova S, Amirkhanov A, Seliverstov E, Efremova O, Zolotukhin I. Daily Duration of Compression Treatment in Chronic Venous Disease Patients: A Systematic Review. J Pers Med 2023; 13:1316. [PMID: 37763085 PMCID: PMC10533179 DOI: 10.3390/jpm13091316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 08/20/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023] Open
Abstract
Background: There are no data on the daily regimen of compression therapy in patients with chronic venous disease. This systematic review aimed to establish the optimal daily duration of compression treatment. Methods: A systematic search of CENTRAL and MEDLINE was performed to identify RCTs, non-RCTs, reviews, systematic reviews, meta-analyses, and guidelines evaluating the use of compression regimens in the treatment of varicose veins. Results: Thirty-two RCTs, three non-RCTs, four observational studies, and two crossover trials reporting the duration and regimes of compression treatment fulfilled the inclusion criteria. The daily duration of compression was reported in patients after invasive treatment, for venous ulcer treatment, in patients with venous symptoms. The quality of the studies varied. We could not conduct a meta-analysis due to the heterogeneity of the research data and their quality. Twenty-three studies reported results of compression usage after invasive procedures. Eight studies reported daily duration regimens in patients with venous ulcers. Nine studies reported the impact of compression on venous symptoms and/or edema or limb volume change. One study was conducted to assess if compression improves QoL in venous patients. While there was a clear difference found in the daily duration depending on the clinical scenario, no data in support of exact regimens were found. Conclusions: There are no reliable data supporting exact daily regimens of compression treatment in various cohorts of CVD patients.
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Affiliation(s)
| | | | | | | | - Igor Zolotukhin
- Department of Surgery, Pirogov Russian National Research Medical University, Moscow 117997, Russia; (S.M.); (A.A.); (E.S.); (O.E.)
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Feldo M, Wójciak M, Dresler S, Sowa P, Płachno BJ, Samborski D, Sowa I. Effect of Diosmin on Selected Parameters of Oxygen Homeostasis. Int J Mol Sci 2023; 24:12917. [PMID: 37629098 PMCID: PMC10454919 DOI: 10.3390/ijms241612917] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
Chronic venous disease (CVD) is a condition characterized by functional disturbances in the microcirculation of the superficial and deep veins, affecting up to 30% of the global population. Diosmin, a phlebotropic drug, is commonly used in the treatment of CVD, and its beneficial effects have been described in numerous clinical studies. However, the precise molecular mechanism underlying the activity of diosmin is not yet fully understood. Therefore, the objective of our study was to investigate whether diosmin has an impact on oxygen management, as cardiovascular diseases are often associated with hypoxia. In our study, patients were administered a daily dosage of 2 × 600 mg of diosmin for 3 months, and we evaluated several factors associated with oxygen management, angiogenesis, and inflammation using biochemical assays. Our findings indicate that diosmin reduced the levels of fibroblast growth factors (FGF) and vascular endothelial growth factor (VEGF-C), while increasing endostatin and angiostatin levels, suggesting a potential influence on angiogenesis regulation. Furthermore, diosmin exhibited anti-inflammatory properties by suppressing the levels of tumor necrosis factor-alpha (TNF-α), interleukin 1-beta (IL-1β), and interleukin 6 (IL-6), while promoting the production of interleukin 12 (IL-12). Additionally, diosmin significantly decreased the levels of hypoxia-inducible factor (HIF), anion gap (AG), and lactate, indicating its potential influence on the hypoxia-inducible factor pathway. These findings suggest that diosmin may play a crucial role in modulating oxygen management and inflammation in the context of chronic venous disease.
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Affiliation(s)
- Marcin Feldo
- Department of Vascular Surgery, Medical University of Lublin, Staszica 11 St., 20-081 Lublin, Poland
| | - Magdalena Wójciak
- Department of Analytical Chemistry, Medical University of Lublin, Chodźki 4a, 20-093 Lublin, Poland; (M.W.); (S.D.)
| | - Sławomir Dresler
- Department of Analytical Chemistry, Medical University of Lublin, Chodźki 4a, 20-093 Lublin, Poland; (M.W.); (S.D.)
- Department of Plant Physiology and Biophysics, Institute of Biological Sciences, Maria Curie-Skłodowska University, Akademicka 19, 20-033 Lublin, Poland
| | - Paweł Sowa
- Department of Otorhinolaryngology and Oncological Laryngology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 40-055 Katowice, Poland;
| | - Bartosz J. Płachno
- Department of Plant Cytology and Embryology, Institute of Botany, Faculty of Biology, Jagiellonian University in Kraków, 9 Gronostajowa St., 30-387 Cracow, Poland;
| | - Dariusz Samborski
- Department of Conservative Dentistry and Endodontics, Medical University, Chodźki 6, 20-093 Lublin, Poland;
| | - Ireneusz Sowa
- Department of Analytical Chemistry, Medical University of Lublin, Chodźki 4a, 20-093 Lublin, Poland; (M.W.); (S.D.)
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Bootun R, Burrows M, Chowdhury MM, Stather PW, Al-Jundi W. The risk of harm whilst waiting for varicose veins procedure. Phlebology 2023; 38:22-27. [PMID: 36441941 PMCID: PMC9713534 DOI: 10.1177/02683555221141824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Varicose veins (VV) negatively impact quality of life (QoL) and have risks of major complications including bleeding, ulceration and phlebitis. During the COVID-19 pandemic, the VSGBI (Vascular Society of Great Britain and Ireland) and GIRFT (Get It Right First Time) classified VVs as lowest priority for intervention. OBJECTIVE This study aims to determine harm caused and the impact on the QoL on patients waiting for their VVs procedures for more than 1 year. METHODS This was a prospective study conducted at the Norfolk and Norwich University Hospital (NNUH). Patients with VVs awaiting intervention for >1 year were included in the study. Patients with CEAP C6 disease were considered to be too high risk to be invited for treatment during the Covid-19 pandemic. Patients were sent QoL questionnaires and underwent a telephone consultation to assess harm. Both generic (EQ-VAS and EQ-5D) and disease-specific (AVVQ and CIVIQ-14) instruments were utilised. There were no control groups available for comparison. RESULTS 275 patients were identified (37.1% male) with median time on waiting list of 60 weeks (IQR 56-65). 19 patients (6.9%) came to major harm, including phlebitis (3.6%), bleeding (1.8%) and ulceration (1.8%). Fifty-two patients (18.9%) had minor harm, including worsening pain (12.7%) and swelling (6.2%). 6.9% reported psychological harm. Rising CEAP stage was also associated with worsening level of harm in patients with C5-6 disease (p < 0.0001). Only 8.7% stated they would decline surgery during the pandemic. 104 QoL questionnaires were returned. Median EQ-VAS and EQ-5D was 75 (IQR: 60-85) and 0.685 (0.566-0.761), respectively. Median AVVQ score was 23.2 (14.9-31.0) and CIVIQ-14 score was 33 (21-44).ConclusionsThis study highlights the impact of delaying VVs surgery during a pandemic. A significant rate of both major and minor as well as psychological harm was reported. In addition, VVs had a significant detriment to quality of life.
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Affiliation(s)
- Roshan Bootun
- Vascular Trainee, East of England Deanery, United Kingdom, and Honorary Research Fellow, Section of Vascular Surgery, Imperial College London, UK,Department of Vascular Surgery, Norfolk and Norwich University Hospital, UK,Roshan Bootun, Department of Vascular Surgery, Norfolk and Norwich University Hospital, Norwich, NR4 7UY, UK.
| | - Mandy Burrows
- Department of Vascular Surgery, Norfolk and Norwich University Hospital, UK
| | - Mohammed M Chowdhury
- Department of Vascular Surgery, Norfolk and Norwich University Hospital, UK,NIHR Clinical Lecturer in Vascular Surgery, Department of Vascular Surgery, Cambridge University Hospitals, University of Cambridge, UK
| | - Philip W Stather
- Department of Vascular Surgery, Norfolk and Norwich University Hospital, UK,Clinical Associate Professor, Norwich Medical School, University of East Anglia, UK
| | - Wissam Al-Jundi
- Department of Vascular Surgery, Norfolk and Norwich University Hospital, UK,Honorary Senior Lecturer, Norwich Medical School, University of East Anglia, UK
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Grabowska I, Antczak R, Zwierzchowski J, Panek T. How to measure multidimensional quality of life of persons with disabilities in public policies - a case of Poland. Arch Public Health 2022; 80:230. [DOI: 10.1186/s13690-022-00981-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 10/10/2022] [Indexed: 11/11/2022] Open
Abstract
Abstract
Background
The aim of this paper is to construct a tool that can be used to measure multidimensional quality of life of persons with disabilities in comparison with population without disabilities for the purpose of monitoring of the UN Convention on the Rights of Persons with Disabilities (UNCRPD) in Poland.
Methods
The Sen’s capability approach was applied to conceptualize the quality of life in various life domains. We followed guidelines of The Quality of Life Framework developed within the European Statistical System on choosing the life domains in which the QoL should be measured. The QoL scores in each domain (covered by the UNCRPD) were constructed using multiply indicators and multiple causes model (MIMIC). All analysis were based on 2018 EU-SILC data for Poland. We constructed quality of life indicators for population with and without disabilities and compared the differences.
Results
Persons without disability experienced higher QoL as compared to population with disabilities, overall and in various domains. Lower average QoL of persons with disabilities is a result of a lower share of those who experience high QoL. The biggest difference is observed for health and for productive and main activity domains. For material conditions and economic security and physical safety there was a moderate difference recorded. For the leisure and social relations domain there is almost no difference observed. Additionally, we identified diversified associations between such factors as age, gender, household situation, education, partner status, urbanization, health on the QoL across domains and analysed populations.
Conclusions
A tool developed in this paper can be calibrated to enable cross-country and in time comparisons between different populations and support evidenced-based social policy.
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OUP accepted manuscript. Br J Surg 2022; 109:679-685. [DOI: 10.1093/bjs/znac116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/08/2022] [Accepted: 03/21/2022] [Indexed: 11/13/2022]
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Silva MJ, Louzada ACS, da Silva MFA, Portugal MFC, Teivelis MP, Wolosker N. Epidemiology of 869,220 varicose vein surgeries over 12 years in Brazil: trends, costs and mortality rate: Epidemiology of 869220 varicose vein surgeries. Ann Vasc Surg 2021; 82:1-6. [PMID: 34942339 DOI: 10.1016/j.avsg.2021.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/19/2021] [Accepted: 11/22/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND varicose vein surgeries are the most commonly performed vascular procedure to treat the most prevalent vascular disease, chronic venous disease. However, nationwide studies on the epidemiology of varicose vein surgeries are scarce, none in developing countries. Therefore, we designed this study to assess the total number of varicose vein surgeries performed between 2008 and 2019 in the Public Health System, which exclusively insures more than 160 million Brazilians, their trends, costs and mortality rates. METHODS public and open data referring to all surgeries to treat chronic venous disease between 2008 and 2019 were extracted from the Brazilian Ministry of Health database. RESULTS 869,220 surgeries were performed to treat chronic venous disease in Brazilian public hospitals and outpatient clinics, with an average rate of 4.5 surgeries per 10,000 inhabitants per year. Starting in 2015, we observed a slight non-significant downward trend in the total number of procedures. The total amount reimbursed by the government was US$ 232,775,518.11. A total of 49 deaths were reported after varicose vein surgery, corresponding to a mortality rate of 0.0056%. CONCLUSIONS 869,220 surgeries were performed to treat chronic venous disease over twelve years, with an overall rate of 4.52 procedures per 10,000 population per year. The mortality rate was very low, 0.0056%.
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Affiliation(s)
| | | | | | | | - Marcelo Passos Teivelis
- Hospital Israelita Albert Einstein, São Paulo, Brazil; Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, Brazil
| | - Nelson Wolosker
- Hospital Israelita Albert Einstein, São Paulo, Brazil; Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, Brazil; São Paulo University Medical School, São Paulo, Brazil
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Farah MH, Nayfeh T, Urtecho M, Hasan B, Amin M, Sen I, Wang Z, Prokop LJ, Lawrence PF, Gloviczki P, Murad MH. A systematic review supporting the Society for Vascular Surgery, the American Venous Forum, and the American Vein and Lymphatic Society guidelines on the management of varicose veins. J Vasc Surg Venous Lymphat Disord 2021; 10:1155-1171. [PMID: 34450355 DOI: 10.1016/j.jvsv.2021.08.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 08/13/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Several diagnostic tests and treatment options for patients with lower extremity varicose veins have existed for decades. The purpose of this systematic review was to summarize the latest evidence to support the forthcoming updates of the clinical practice guidelines on the management of varicose veins for the Society for Vascular Surgery (SVS), the American Venous Forum (AVF) and the American Vein and Lymphatic Society. METHODS We searched multiple databases for studies that addressed four clinical questions identified by the AVF and the SVS guideline committee about evaluating and treating patients with varicose veins. Studies were selected and appraised by pairs of independent reviewers. A meta-analysis was conducted when feasible. RESULTS We included 73 original studies (45 were randomized controlled trials) and 1 systematic review from 12,915 candidate references. Moderate certainty of evidence supported the usefulness of duplex ultrasound (DUS) examination as the gold standard test for diagnosing saphenous vein incompetence in patients with varicose veins and chronic venous insufficiency (clinical, etiological, anatomic, pathophysiological classification [CEAP] class C2-C6). High ligation and stripping (HL/S) was associated with higher anatomic closure rates at 30 days and 5 years when compared with radiofrequency ablation and ultrasound-guided foam sclerotherapy (UGFS) (moderate certainty), while no significant difference was seen when compared with endovenous laser ablation (EVLA) at 5 years. UGFS was associated with an increased risk of recurrence compared with HL/S. EVLA was associated with lower anatomic closure rates at 30 days than cyanoacrylate closure (CAC) and higher rates at one and 5 years when compared with UGFS. Thermal interventions were associated with lower generic quality of life scores and an increased risk of adverse events when compared with CAC or n-butyl cyanoacrylate (low certainty). Thermal interventions were associated with a lower risk of recurrent incompetence when compared with UGFS and an increased risk of recurrent incompetence than CAC. The evidence for great saphenous vein ablation alone to manage perforator disease was inconclusive. CONCLUSIONS The current systematic review summarizes the evidence to develop and support forthcoming updated SVS/AVF/American Vein and Lymphatic Society clinical practice guideline recommendations. The evidence supports duplex scanning for evaluating patients with varicose veins and confirms that HL/S resulted in similar long-term saphenous vein closure rates as EVLA and in better rates than radiofrequency ablation and UGFS. Thermal interventions were associated with inferior generic quality of life scores than nonthermal interventions, but had a lower risk of recurrent incompetence than UGFS. The recommendations in the guidelines should consider this information as well as other factors such as patients' values and preferences, anatomic considerations of individual patients, and surgical expertise.
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Affiliation(s)
- Magdoleen H Farah
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minn; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minn
| | - Tarek Nayfeh
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minn; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minn
| | - Meritxell Urtecho
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minn; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minn
| | - Bashar Hasan
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minn; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minn
| | - Mustapha Amin
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minn; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minn
| | - Indrani Sen
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Zhen Wang
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minn; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minn
| | | | - Peter F Lawrence
- Division of Vascular Surgery, Department of Surgery, University of California, Los Angeles, Calif
| | - Peter Gloviczki
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
| | - M Hassan Murad
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minn; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minn.
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Ortega MA, Fraile-Martínez O, García-Montero C, Álvarez-Mon MA, Chaowen C, Ruiz-Grande F, Pekarek L, Monserrat J, Asúnsolo A, García-Honduvilla N, Álvarez-Mon M, Bujan J. Understanding Chronic Venous Disease: A Critical Overview of Its Pathophysiology and Medical Management. J Clin Med 2021; 10:3239. [PMID: 34362022 PMCID: PMC8348673 DOI: 10.3390/jcm10153239] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 01/19/2023] Open
Abstract
Chronic venous disease (CVD) is a multifactorial condition affecting an important percentage of the global population. It ranges from mild clinical signs, such as telangiectasias or reticular veins, to severe manifestations, such as venous ulcerations. However, varicose veins (VVs) are the most common manifestation of CVD. The explicit mechanisms of the disease are not well-understood. It seems that genetics and a plethora of environmental agents play an important role in the development and progression of CVD. The exposure to these factors leads to altered hemodynamics of the venous system, described as ambulatory venous hypertension, therefore promoting microcirculatory changes, inflammatory responses, hypoxia, venous wall remodeling, and epigenetic variations, even with important systemic implications. Thus, a proper clinical management of patients with CVD is essential to prevent potential harms of the disease, which also entails a significant loss of the quality of life in these individuals. Hence, the aim of the present review is to collect the current knowledge of CVD, including its epidemiology, etiology, and risk factors, but emphasizing the pathophysiology and medical care of these patients, including clinical manifestations, diagnosis, and treatments. Furthermore, future directions will also be covered in this work in order to provide potential fields to explore in the context of CVD.
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Affiliation(s)
- Miguel A. Ortega
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; (M.A.O.); (O.F.-M.); (C.G.-M.); (C.C.); (L.P.); (J.M.); (N.G.-H.); (M.Á.-M.); (J.B.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain;
- Cancer Registry and Pathology Department, Hospital Universitario Principe de Asturias, 28806 Alcalá de Henares, Spain
| | - Oscar Fraile-Martínez
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; (M.A.O.); (O.F.-M.); (C.G.-M.); (C.C.); (L.P.); (J.M.); (N.G.-H.); (M.Á.-M.); (J.B.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain;
| | - Cielo García-Montero
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; (M.A.O.); (O.F.-M.); (C.G.-M.); (C.C.); (L.P.); (J.M.); (N.G.-H.); (M.Á.-M.); (J.B.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain;
| | - Miguel A. Álvarez-Mon
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; (M.A.O.); (O.F.-M.); (C.G.-M.); (C.C.); (L.P.); (J.M.); (N.G.-H.); (M.Á.-M.); (J.B.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain;
| | - Chen Chaowen
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; (M.A.O.); (O.F.-M.); (C.G.-M.); (C.C.); (L.P.); (J.M.); (N.G.-H.); (M.Á.-M.); (J.B.)
| | - Fernando Ruiz-Grande
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain;
- Department of Vascular Surgery, Príncipe de Asturias Hospital, 28801 Alcalá de Henares, Spain
| | - Leonel Pekarek
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; (M.A.O.); (O.F.-M.); (C.G.-M.); (C.C.); (L.P.); (J.M.); (N.G.-H.); (M.Á.-M.); (J.B.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain;
| | - Jorge Monserrat
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; (M.A.O.); (O.F.-M.); (C.G.-M.); (C.C.); (L.P.); (J.M.); (N.G.-H.); (M.Á.-M.); (J.B.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain;
| | - Angel Asúnsolo
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain;
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain;
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY 10027, USA
| | - Natalio García-Honduvilla
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; (M.A.O.); (O.F.-M.); (C.G.-M.); (C.C.); (L.P.); (J.M.); (N.G.-H.); (M.Á.-M.); (J.B.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain;
| | - Melchor Álvarez-Mon
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; (M.A.O.); (O.F.-M.); (C.G.-M.); (C.C.); (L.P.); (J.M.); (N.G.-H.); (M.Á.-M.); (J.B.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain;
- Immune System Diseases—Rheumatology and Internal Medicine Service, University Hospital Príncipe de Asturias, (CIBEREHD), 28806 Alcalá de Henares, Spain
| | - Julia Bujan
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; (M.A.O.); (O.F.-M.); (C.G.-M.); (C.C.); (L.P.); (J.M.); (N.G.-H.); (M.Á.-M.); (J.B.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain;
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Symptom improvement after cyanoacrylate glue adhesion and endovenous laser ablation in low-grade CEAP clinical classes. J Vasc Surg Venous Lymphat Disord 2021; 10:360-369.e2. [PMID: 34271248 DOI: 10.1016/j.jvsv.2021.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 07/01/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Low-grade primary superficial venous reflux (C0 - C3EpAsPr) is a common feature of chronic venous disease. However, the procedural efficacy focusing on symptom characteristics and improvement patterns in this population has not been fully explored. METHODS From 2018 to 2019, 325 limbs from 279 patients with C0 - C3EpAsPr (including 66.1% with C0-1) who underwent cyanoacrylate ablation (CA) with ultrasonography-guided foam sclerotherapy (UGFS) or endovenous laser ablation (EVLA) with UGFS were included in this study. Venous symptoms were classified into five categories: leg heaviness, calf cramping, itching sensation, pain, and numbness. A retrospective propensity score-matched analysis of a prospectively designed case report form (CRF) was performed to identify the improvement magnitude of each symptom. As secondary outcomes, postoperative changes in symptom severity (0 - 5 points), the Venous Reflux Originated Severity Score (VROSS), the Venous Clinical Severity Score (VCSS), and the ChronIc Venous Insufficiency Quality of Life Questionnaire (CIVIQ-14) were evaluated by performing a three-month postoperative data analysis. RESULTS After adjusting the data, 174 limbs (87 CA with UGFS and 87 EVLA with UGFS) were matched. Symptoms that showed the greatest improvement after treatment were night cramping (94.7%) and itching (93.8%), followed by heaviness (85.2%), numbness (77.8%), and pain (60.9%). All symptom improvement scores after each endovenous procedure showed similar patterns in both groups. Advantages of CA with UGFS over EVLA with UGFS were observed in procedure time (20.1± 10.6 min vs. 28.4± 10.9 min, p = .001) and perioperative visual analogue pain scores (2.99± 2.34 vs. 3.74 ± 2.49, p = .03). Compared to preoperative values, VROSS, VCSS, CIVIQ-14, and symptom severity scores were significantly improved in both groups (all p < .001). Improvements in all five symptoms (p = .085 to 1.0), VCSS (p = .435), CIVIQ-14 (p = .788) and satisfaction scores (p = .392) three months postoperatively were comparable between the two groups. There were two cases of endovenous glue-induced thrombosis and 24 (27.6%) cases of type IV hypersensitivity reactions in the CA group. CONCLUSIONS Minimally invasive endovenous surgery with CA and EVLA provides significant symptom improvement for patients with low-grade CEAP classes.
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Gawas M, Bains A, Janghu S, Kamat P, Chawla P. A Comprehensive Review on Varicose Veins: Preventive Measures and Different Treatments. J Am Coll Nutr 2021; 41:499-510. [PMID: 34242131 DOI: 10.1080/07315724.2021.1909510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The purpose of this article was to review the different preventive measures and treatments for varicose veins disease. Varicose veins are tortuous, enlarged veins that are usually found in the lower extremities damages blood vessels leading to its painful swelling cause's blood clots, affecting people over increasing prevalence with age and affects the proficiency, productivity, and life quality of a person. Prolonged standing and obesity are the major reason for varicose vein disease. The mechanisms, prevention, risk factors, complications, and treatment of varicose veins are explained in this review. Various types of treatments such as endovascular, surgical, and herbal treatments improve quality of life and reduce the secondary complications of varicose veins. Besides these methods of treatments, varicose vein disease can be prevented by doing regular yoga/exercise and consumption of several fruits and vegetables such as Grapes, blackberries, avocados, ginger, and rosemary. Typically, varicose veins can be a benign process with several problems that can influence the life quality of an individual that can lead to potentially life-threatening complications. However, there are numerous surgical, endovascular, and chemical treatments that improve quality of life and decrease secondary complications of varicose veins. Patients with varicose veins should take an antioxidant medicament from the flavonoid groups to reduce the arterial blood pressure value, risk of atherosclerosis development, prevent thrombotic incidents.Key teaching pointsChronic venous disease is a pathological state of vein circulatory systems of the lower limbsProlonged standing and obesity are the major reason for varicose vein diseaseEndovascular, surgical, and herbal treatments improve quality of life and reduce the secondary complications of varicose veinsVenoactive drugs such as flavonoids, saponins, and others have a therapeutic effect on chronic venous disordersPhlebotropic drugs are semi-synthetic substances widely used in different states of chronic venous insufficiencyFood rich in phytoconstituents are more effective in varicose veins.
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Affiliation(s)
- Mandar Gawas
- Department of Food Technology and Nutrition, School of Agriculture, Lovely Professional University, Phagwara, Punjab, India
| | - Aarti Bains
- Department of Biotechnology, Chandigarh group of Colleges Landran, Mohali, Punjab, India
| | - Sandeep Janghu
- Indian Institute of Food Processing Technology, Thanjavur, Tamilnadu, India
| | - Pranali Kamat
- Department of Pharmacy, Goa College of Pharmacy, Panaji, Goa, India
| | - Prince Chawla
- Department of Food Technology and Nutrition, School of Agriculture, Lovely Professional University, Phagwara, Punjab, India
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Lajos P, Safir S, Weber J, Bangiyev R, Faries P, Ting W. Utility of compression immediately after venous closure: Does it matter? Phlebology 2021; 36:841-847. [PMID: 34212789 DOI: 10.1177/02683555211028533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Leg compression after venous closures for 24-48 hours or longer is commonplace and controversial. OBJECTIVE The goal of our study was to evaluate compression immediately post-venous closures and its associated costs. METHODS Records were retrospectively reviewed after consecutive therapies of sclerotherapy, mechanochemical ablation (MOCA) & radiofrequency ablation (RFA) from 1 clinic with 2 cohorts: 7/2/13-10/15/15 were immediately ACE-wrapped for 3-5 days (AW, N = 52) and 10/20/15-1/5/16 were non ACE-wrapped (NAW, N = 49). All procedures were performed in an outpatient office setting of one surgeon (P.L.). Follow-up was within 1 week and 3 months with ultrasounds. Financial data of ACE wraps and ABD pads were assessed. RESULTS Closures consisted of consecutive therapies of sclerotherapy (4 patients); MOCA (44 patients) and RFA (53 patients). No statistical difference existed in age (p = 0.61), sex (p = 0.2063); race (0.3689), CAD (p = 0.1442), ESRD (p = 0.2914), diabetes mellitus (p = 0.8943), hypertension (p = 0.681), COPD (p = 0.38), or smoking (p = 0.3628). NAW group had higher rate of hyperlipidemia (p = 0.0225), obesity (p = 0.0283), MOCA and sclerotherapy (p = 0.0005). No difference existed in pain (p = 0.8897); wound complications were too small to perform analysis; and swelling was greater in AW group compared to NAW group (p = 0.0132, OR 3.3951, CI 1.269; 9.0834). Closure rates were 98% and 100% in AW and NAW groups, respectively. NAW were only a total cost savings of $1.58 per leg per procedure. CONCLUSION AW for compression after vein closures confers no benefit in postoperative period with no effect on closure rates; may be associated with increased swelling, discomfort, and wound complications while increasing unnecessary and negligible monetary costs. Larger sample size is needed to validate these conclusions.
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Affiliation(s)
- Paul Lajos
- Division of Vascular Surgery, University of Pittsburgh Medical Center Hamot, Erie, PA, USA
| | - Scott Safir
- Division of Vascular Surgery, the Mount Sinai Hospital, New York, NY, USA
| | - Jonathan Weber
- Departments of Research and Cardiac Imaging, St Francis Hospital, Roslyn, NY, USA
| | - Ronald Bangiyev
- Division of Vascular Surgery, the Mount Sinai Hospital, New York, NY, USA
| | - Peter Faries
- Division of Vascular Surgery, the Mount Sinai Hospital, New York, NY, USA
| | - Windsor Ting
- Division of Vascular Surgery, the Mount Sinai Hospital, New York, NY, USA
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Berszakiewicz A, Kasperczyk J, Sieroń A, Krasiński Z, Cholewka A, Stanek A. The effect of compression therapy on quality of life in patients with chronic venous disease: a comparative 6-month study. Postepy Dermatol Alergol 2021; 38:389-395. [PMID: 34377118 PMCID: PMC8330868 DOI: 10.5114/ada.2020.92277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 12/04/2019] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Chronic venous diseases (CVD), because of its chronic and progressive nature, impairs patients' quality of life (Qol). AIM To compare the QoL in patients with primary superficial venous insufficiency at different stages before and after compression therapy (CT). MATERIAL AND METHODS We compared the change in the QoL parameters from baseline to the end of a 6-month compression therapy. 180 subjects were enrolled. They were subdivided into 6 equal subgroups according to CEAP classes. The QoL was assessed using questionnaires, the general SF-36v2 and the disease-specific CIVIQ-20. At the beginning and after the completion of the study intervention, the severity of CVD was assessed in each patient using CEAP and VCSS. The pain intensity was assessed using the numerical rating scale. RESULTS The CT reduced the severity of CVD, which translated into the increased size of C2 an d C5 subgroups, and reduced size of C3 and C6 subgroups. Another marker of reduced severity of CVD after CT was a significant reduction in VCSS scores in C1, and C3-C6 subgroups. A 6-month CT was associated with a significant QoL improvement in all CEAP class-based subgroups, across all individual and composite domains of SF-36v2, as well as dimensions and GIS of CIVIQ-20. Similarly, there was a significant pain reduction reported in all CEAP class-based subgroups. CONCLUSIONS Compression therapy using ready-made compression hosiery significantly affects the quality of life in patients with chronic venous disease at all its stages, CEAP classes C1-C6.
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Affiliation(s)
- Andrzej Berszakiewicz
- Department of Internal Medicine, Angiology and Physical Medicine, No. 2 Specialist Hospital, Bytom, Poland
- Fresenius Dialysis Centre, No. 38 in Oswiecim, Fresenius Nephrocare Polska, Oswiecim, Poland
| | - Janusz Kasperczyk
- Chair and Department of Environmental Medicine and Epidemiology, Medical University of Silesia, Zabrze, Poland
| | - Aleksander Sieroń
- Department of Internal Medicine, Angiology and Physical Medicine, No. 2 Specialist Hospital, Bytom, Poland
- Department of Physiotherapy, Jan Dugosz University, Czestochowa, Poland
| | - Zbigniew Krasiński
- Department of General and Vascular Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Armand Cholewka
- Department of Medical Physics, Chelkowski Institute of Physics, University of Silesia, Katowice, Poland
| | - Agata Stanek
- Department of Internal Medicine, Angiology and Physical Medicine, Medical University of Silesia, Faculty of Medicine in Zabrze, Bytom, Poland
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Welch HJ, Schul MW, Monahan DL, Iafrati MD. Private payers' varicose vein policies are inaccurate, disparate, and not evidence based, which mandates a proposal for a reasonable and responsible policy for the treatment of venous disease. J Vasc Surg Venous Lymphat Disord 2021; 9:820-832. [PMID: 33684590 DOI: 10.1016/j.jvsv.2020.12.076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
Varicose veins afflict more than one in five Americans, and although varicose veins may be an asymptomatic cosmetic concern in some, many others experience symptoms of pain, aching, heaviness, itching, and swelling. More advanced venous disease can result from untreated venous insufficiency. The complications of chronic venous disease, including bleeding, thrombosis, and ulceration, are seen in up to 2 million Americans annually. Numerous reports have documented venous disease adversely affects quality of life and that treatment of venous disease can improve quality of life. It has previously been documented that private insurers, and Centers for Medicare & Medicaid Services subcontractors for that matter, have disparate policies that in many instances are self-serving, contain mistakes, use outdated evidence, and disregard evidence-based guidelines. The two leading venous medical societies, the American Venous Forum and the American Venous and Lymphatic Society, have come together to review the varicose vein coverage policies of seven major U.S. private medical insurance carriers whose policies cover more than 150 million Americans. The authors reviewed the policies for venous disease and, if significant gaps or inconsistencies are found, we hope to point them out, and, finally, to propose a thoughtful and reasonable policy based on the best available evidence.
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Affiliation(s)
- Harold J Welch
- Department of Vascular Surgery, Lahey Hospital and Medical Center, Burlington, Mass.
| | - Marlin W Schul
- Lafayette Regional Vein and Laser Center, Lafayette, Ind
| | | | - Mark D Iafrati
- Department of Vascular Surgery, Tufts Medical Center, Boston, Mass
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Intermittent pneumatic compression after varicose vein surgery. J Vasc Surg Venous Lymphat Disord 2021; 9:1526-1534.e2. [PMID: 33667741 DOI: 10.1016/j.jvsv.2021.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 02/12/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Intermittent pneumatic compression (IPC) is an established treatment option to remove tissue fluid from patients with lymphedema and chronic venous disease. The effects of IPC applied directly after varicose vein surgery performed with high volumes of tumescent local anesthesia have not been investigated. The aim of the present study was to evaluate the use of postoperative IPC concerning its effects on the leg volume and patient comfort after surgery. METHODS We performed an investigator-initiated, single-center, open-label randomized controlled trial. A total of 186 patients indicated for saphenofemoral junction ligation and great saphenous vein or anterior accessory saphenous vein stripping or great saphenous vein redo surgery were randomly assigned 1:1 to the intervention or control group. The patients in the intervention group were treated with IPC at 40 mm Hg for 45 minutes directly after surgery. The outcome measures were the leg volume changes calculated using an optical three-dimensional scanning system (primary objective), quality of life (QoL; Freiburg Life Quality Assessment for chronic venous disease, short form), pain, and extent of ecchymosis with follow-up examinations on days 1 and 7 after surgery. RESULTS The patients in both groups had comparable mean leg volume reductions from baseline to day 1 (IPC group, 58.8 mL; control group, 37.4 mL; P = .967) and to day 7 (63.1 mL and 57.0 mL, respectively; P = .546). We also did not observe significant differences between the two groups in QoL and pain. The patients in the IPC group had developed larger areas of ecchymosis compared with the control group (16% vs 13.3% of leg surface, respectively; P = .046), with a tendency toward an increase in pain at 7 days after surgery compared with no IPC application. CONCLUSIONS The present randomized controlled trial was designed to evaluate the decongestive effects of a single postoperative session of IPC and its effect on QoL, pain, and ecchymosis in patients who had undergone varicose vein surgery under tumescent local anesthesia. Because no evidence for a benefit from IPC could be found in the present study and increased ecchymosis was found, its standard use after varicose vein surgery cannot be recommended.
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Hummel T, Aryafar A, Mayböck N, Mumme A, Stücker M, Mühlberger D. "Quality of Life after Varicose Vein Surgery in Patients with High-ligation and Stripping, External Valvuloplasty and Sapheno-femoral Redo Surgery". Ann Vasc Surg 2021; 74:331-338. [PMID: 33548404 DOI: 10.1016/j.avsg.2020.12.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/17/2020] [Accepted: 12/26/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND High-ligation and stripping (HL/S) and external valvuloplasty (eVP) with the implantation of an external device to restore the valve's function, are surgical methods to eliminate reflux at the saphenofemoral junction. Furthermore, redo-surgery (RedoS) can be performed in terms of same side groin recurrences. It is unclear, if there is a difference in quality of life (QoL) between these 3 surgical treatment options. Therefore, it was the aim of our study to elucidate QoL in patients before and after surgical treatment at the saphenofemoral junction by comparing HL/S, eVP, and RedoS. METHODS A total of 303 participants (156 HL/S, 81eVP, 64 RedoS) were recruited during the daily clinical routine. QoL was measured at admission and 6 weeks after the surgical procedure by means of SF-12 (12 item short form health survey) and Aberdeen Varicose Vein Questionnaire. RESULTS The mean value of Aberdeen Varicose Vein Questionnaire was 14.5 (SD 2.1) preoperatively and 4.9 (SD 3.3) postoperatively in the HL/S group, 16.4 (SD 1.4) preoperatively and 6.8 (SD 2.5) postoperatively in the eVP group and 15.5 (2.2) preoperatively and 5.8 (SD 4.2) postoperatively in the RedoS group, which was statistically significant (P< 0.05) in all groups. Postoperatively, the mean values were statistically significant within the groups. Concerning physical aspects of the SF-12 we found a significant improvement in the RedoS group, while mental aspects were significantly better in the HL/S and eVP group postoperatively. Nevertheless, the clinical relevance of these SF-12 differences is questionable under consideration of the minimal important difference. CONCLUSIONS Varicose vein surgery leads to a significant improvement of QoL in all groups. The implantation of an external patch could have a negative influence in QoL.
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Affiliation(s)
- Thomas Hummel
- Department of Vascular Surgery, St. Josef Hospital Bochum, Katholisches Klinikum Bochum, Ruhr University Bochum, Germany; Vein Center of the Departments of Dermatology and Vascular Surgery, Katholisches Klinikum Bochum, Germany
| | - Annahita Aryafar
- Department of Vascular Surgery, St. Josef Hospital Bochum, Katholisches Klinikum Bochum, Ruhr University Bochum, Germany
| | - Nora Mayböck
- Department of Vascular Surgery, St. Josef Hospital Bochum, Katholisches Klinikum Bochum, Ruhr University Bochum, Germany; Vein Center of the Departments of Dermatology and Vascular Surgery, Katholisches Klinikum Bochum, Germany
| | - Achim Mumme
- Department of Vascular Surgery, St. Josef Hospital Bochum, Katholisches Klinikum Bochum, Ruhr University Bochum, Germany; Vein Center of the Departments of Dermatology and Vascular Surgery, Katholisches Klinikum Bochum, Germany
| | - Markus Stücker
- Vein Center of the Departments of Dermatology and Vascular Surgery, Katholisches Klinikum Bochum, Germany; Department of Dermatology, St. Josef Hospital Bochum, Katholisches Klinikum Bochum, Ruhr University Bochum, Germany
| | - Dominic Mühlberger
- Department of Vascular Surgery, St. Josef Hospital Bochum, Katholisches Klinikum Bochum, Ruhr University Bochum, Germany; Vein Center of the Departments of Dermatology and Vascular Surgery, Katholisches Klinikum Bochum, Germany.
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Khryshchanovich V, Skobeleva N. Medical prevention and management of varicose vein disease during pregnancy. ROSSIISKII VESTNIK AKUSHERA-GINEKOLOGA 2021. [DOI: 10.17116/rosakush20212104127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Yang Q, Zhao Y, Chen X, Tang P, Li L, Zhao J, Han Y, Wu D, An L, Zhang B, Zhou X, Liu L, Chi YW. Association between vein diameters, reflux characteristics, and clinical severity in patients with chronic venous insufficiency in Northwest China. J Vasc Surg Venous Lymphat Disord 2020; 9:401-408.e1. [PMID: 32730997 DOI: 10.1016/j.jvsv.2020.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/09/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Our goal was to summarize the relationship between vein diameters, reflux characteristics, and clinical severity in consecutive patients with chronic venous insufficiency (CVI) in Northwest China. METHODS We evaluated 531 consecutive patients with CVI (249 women) who presented to the Department of Ultrasound of Xijing Hospital from September 2017 to July 2019. Reflux times and the mean diameters of the great saphenous, the small saphenous, and the calf perforator veins based on duplex ultrasound scans obtained in the standing position were recorded. Venous-specific assessment tools-the Heaviness, Achiness, Swelling, Throbbing, Itching (HASTI) score, the Venous Clinical Severity Score (VCSS), and the Clinical, Etiological, Anatomical, Pathophysiological (CEAP) class-were analyzed. Regression analysis was used to investigate the relationship between the clinical scores, vein diameters, and reflux times. A P value of less than .05 was considered statistically significant. RESULTS We analyzed 531 consecutive patients with 728 limbs. The mean age was 55.24 ± 11.38 years; the mean body mass index (BMI) was 24.75 ± 3.49 kg/m2. Three hundred thirty-four patients (62.9%) presented with unilateral limb findings and 197 (37.1%), with bilateral limb involvement. No significant changes were noted in age and BMI across CEAP classes (F = 2.322 and F = 3.917, respectively; P > .05 for both). Both the HASTI score (r2 = 0.8741; P < .001) and the VCSS (r2 = 0.9257; P < .001) correlated with the CEAP class. The HASTI score strongly correlated with the mean diameters of the great saphenous and small saphenous veins (r2 = 0.9252, r2 = 0.6304, respectively; P < .001 for both) similarly to VCSS (r2 = 0.9396, r2 = 0.7195, respectively; P < .001 for both). The HASTI score and VCSS correlated equally with the mean diameters of the calf perforator veins (r = 0.7773 and r = 0.7781, respectively; P < .001 for both). In those with C6, both great saphenous vein (F = 4.608; P < .001) and small saphenous vein reflux times (F = 14.97; P < .001) were significantly higher than those in C1. Both the HASTI score and VCSS strongly associated with the reflux times of the great saphenous (r2 = 0.7706 and r2 = 0.8181, respectively; P < .001 for both) and small saphenous veins (r2 = 0.6470 and r2 = 0.7865, respectively; P < .001 for both). CONCLUSIONS This analysis is one of the few epidemiologic studies of patients with CVI in Northwest China. Age and BMI did not correlate with CEAP class. Both the HASTI score and VCSS correlated strongly with the CEAP classification; vein diameters and reflux time in both the great saphenous vein and the small saphenous vein, indicating the validity of these outcome tools to venous hemodynamics and to CVI in general.
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Affiliation(s)
- Qian Yang
- Department of Ultrasound, Xijing Hospital of the Forth Military Medical University, Xian, China
| | - Yongfeng Zhao
- Department of Ultrasound, Xijing Hospital of the Forth Military Medical University, Xian, China
| | - Xi Chen
- Department of Ultrasound, Xijing Hospital of the Forth Military Medical University, Xian, China
| | - Peng Tang
- Department of Orthopedics, China Rehabilitation Research Center, Beijing Charity Hospital, Beijing, China
| | - Lamei Li
- Department of Ultrasound, Xijing Hospital of the Forth Military Medical University, Xian, China
| | - Junfeng Zhao
- Department of Ultrasound, Xijing Hospital of the Forth Military Medical University, Xian, China
| | - Yongfeng Han
- Department of Ultrasound, Xijing Hospital of the Forth Military Medical University, Xian, China
| | - Dangjie Wu
- Department of Ultrasound, Xijing Hospital of the Forth Military Medical University, Xian, China
| | - Li An
- Department of Ultrasound, Xijing Hospital of the Forth Military Medical University, Xian, China
| | - Binqing Zhang
- Department of Ultrasound, Xijing Hospital of the Forth Military Medical University, Xian, China
| | - Xiaodong Zhou
- Department of Ultrasonic Diagnosis and Treatment Center, Xian International Medical Center Hospital, Xian, China
| | - Liwen Liu
- Department of Ultrasound, Xijing Hospital of the Forth Military Medical University, Xian, China
| | - Yung-Wei Chi
- University of California, Davis, Vascular Center, Sacramento, Calif.
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Shakya R, Karmacharya RM, Shrestha R, Shrestha A. Varicose veins and its risk factors among nurses at Dhulikhel hospital: a cross sectional study. BMC Nurs 2020; 19:8. [PMID: 32042263 PMCID: PMC6998362 DOI: 10.1186/s12912-020-0401-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 01/28/2020] [Indexed: 11/18/2022] Open
Abstract
Background Women in nursing professions are at high risk for developing varicose veins as it requires physical work and prolonged standing. The aim of the study is to estimate the current prevalence of varicose veins among nurses at Dhulikhel Hospital and assess its risk factors. Methods A cross sectional study was carried out among 181 female nurses from different clinical settings of Dhulikhel Hospital. A structured questionnaire was administered to gather the demographic, work related and medical history information. The participants underwent Doppler ultrasound for varicose veins confirmation. Varicose veins was defined as Doppler finding of reflux or vein diameter equal or greater than 5 mm. Results A total of 181 nurses participated in this study and 83 (46%) had varicose veins. The mean standing time was 4.28 (0.8) hours /day, mean sitting time was 1.28 (0.6) hours/day, mean walking time was 2.37 (0.8) hours/day. In the adjusted model the odds of having varicose veins was 27 times greater with every 1 hour increase in standing time per day (adjusted OR: 27.44; 95% CI 4.09–180.77; p-value <0.00). Conclusions Varicose veins was prevalent among nurses’ at Dhulikhel Hospital. Prolonged standing was found to be a significant factor for varicose veins.
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Affiliation(s)
- Regan Shakya
- 1Department of Physiotherapy, Kathmandu University School of Medical Sciences/Dhulikhel Hospital, Kavre, Dhulikhel, Nepal
| | - Robin Man Karmacharya
- 2Department of Cardiovascular Surgery, Kathmandu University School of Medical Sciences/Dhulikhel Hospital, Kavre, Dhulikhel, Nepal
| | - Rojina Shrestha
- 1Department of Physiotherapy, Kathmandu University School of Medical Sciences/Dhulikhel Hospital, Kavre, Dhulikhel, Nepal
| | - Archana Shrestha
- 3Department of Community Programs, Kathmandu University School of Medical Sciences/Dhulikhel Hospital, Kavre, Dhulikhel, Nepal
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Zolotukhin IA, Seliverstov EI, Shevtsov YN, Avakiants IP, Tatarintsev AM, Kirienko AI. Risk factors for venous symptoms in Russian patients with chronic venous disease. Curr Med Res Opin 2019; 35:1583-1587. [PMID: 30958033 DOI: 10.1080/03007995.2019.1605050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: The study aimed to investigate risk factors for venous symptoms in Russian patients with chronic venous disease (CVD).Methods: Data on 487 patients with CVD aged 18 years and more were extracted from the database of a cross-sectional population-based study on the prevalence of CVD in a rural settlement. Risk factors for venous symptoms were calculated by multiple regression analysis. The study is registered at clinicaltrials.gov as NCT03900234, 1 April 2019.Results: A total of 259 patients (53.2%) had venous symptoms. Female gender, hard labour (HRs 1.8 and 1.4, p < .01), age, family history of CVD and being employed (HRs 1.009, 1.3, 1.27, p < .05) are risk factors for development of symptoms. After calculating for different complaints separately, female gender was confirmed as a risk factor for all symptoms. Family history of CVD with HR 1.4 is a risk factor for heaviness (p < .01) and fatigue (p < 0.05). Employment predicts heaviness, sensation of swelling and night cramps - HRs 1.38, 1.7 and 1.9 respectively (p < .05). Hard labour is a risk factor for sensation of swelling with HR 2.1 (p < .05), pain and night cramps (HRs 2.2 and 4.4, p < .01). Prolonged standing is associated with sensation of swelling - HR 1.05 (p < .05). Superficial venous reflux is a predictor only for venous pain (HR 2.4, p < .01).Conclusions: This study presents independent risk factors for venous symptoms in CVD patients. It demonstrates that different symptoms are associated with different factors.
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Affiliation(s)
- Igor A Zolotukhin
- Pirogov Russian National Research Medical University, Moscow, Russia
| | | | | | - Ilona P Avakiants
- Pirogov Russian National Research Medical University, Moscow, Russia
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Menezes PDP, Gomes CVC, de Carvalho YMBG, Santos NGL, Andrade VM, Oliveira AMS, de Lima CM, Araújo AADS. Evaluation of the Use of Compressive Stockings Impregnated With Hesperetin-Based Nanocapsules in the Healing of Venous Ulcers: A Case Report. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2019; 12:1179547619858977. [PMID: 31360076 PMCID: PMC6640063 DOI: 10.1177/1179547619858977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 05/24/2019] [Indexed: 11/24/2022]
Abstract
Venous ulcers are a more severe complication of chronic venous insufficiency, significantly compromising patient quality of life (QoL). Compressive stockings are still the gold standard treatment method with alternative therapies currently being evaluated. In this perspective, we investigate the influence of compressive stockings impregnated with hesperetin-based nanocapsules in the healing process of venous ulcers. Compressive stockings impregnated with hesperetin-based nanocapsules were applied to a consenting patient for 6 months following all relevant ethical principles for patient studies. The patient was evaluated at baseline (T0), 3 months (T3), and 6 months (T6), using photographic register (healing) probes to measure skin melanin, erythema and hydration parameters, and venous diameters, followed by questionnaires regarding QoL and pain perception. Healing was observed at the 3-month time point and with 91.6% and 93.1% of retraction area in larger ulcers of the right leg and lateral portion of the left leg, respectively. The deepest ulcer in a medial portion of the left leg healed 47.3%. A reduction of all measured skin parameters was observed, indicating a possible hesperetin effect. The scores of QoL and pain were, respectively, in the ranges of 91.6 to 31.2 and 7 to 0. Reduction in venous diameters also indicates healing function. These preliminary findings suggest that compressive stockings impregnated with hesperetin nanocapsules enhance venous ulcer healing. Further clinical trial controlled by placebo, involving a greater number of patients, is required to confirm the findings of this case report.
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Blättler W, Mendoza E, Zollmann C, Bendix J, Amsler F. Homeostatic feelings - a novel explanation of vein symptoms derived from an experimental patient study. VASA 2019; 48:492-501. [PMID: 31244386 DOI: 10.1024/0301-1526/a000807] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: Vein symptoms (VS) entail diffuse leg discomfort and pain coinciding with a perception of weighty or swollen legs. Their traditional classification as a form of venous disease may be inaccurate as they occur in patients with no or any venous disorder. We hypothesized that VS would emerge from a primordially standing associated perturbation in the lower limbs which is not necessarily connected with a venous disorder. Patients and methods: Patients were sorted into groups according to the CEAP classification, VS only (C0s), primary varicose veins (C2p), varicose veins plus oedema (C2p and C3), and venous dermatopathy (C4). Patients completed questionnaires before and one week after they were exposed to a test of stationary standing. Results: Patients (N = 127) in the four groups differed by sex, age and body weight. The VS experienced in the preceding week scored the same in all groups at 3.1 on a numeric rating scale (range 0-10; SD 1.6). During standing, lower leg volume increased and symptoms emerged to the same extent across patient groups and were reduced similarly by compression (volume by 1.7 %, symptoms by 41.7 %). The emergence of symptoms was neither correlated with leg volume increase per se, nor with limiting this increase by compression. Symptoms recorded at baseline correlated with the symptoms provoked by the stress test with bare legs while the symptoms reported at follow-up, when stockings were worn regularly, correlated with the stress test with compression. Conclusions: VS, in terms of neuropsychology, reflect a homeostatic disturbance experienced in the presence and absence of venous disease. Thus, VS are not distinctive for the presence of venous disease insofar as they may reflect dynamic homeostatic feelings resulting from a standing-related disequilibrium in the legs' internal environment.
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Affiliation(s)
| | | | | | - John Bendix
- Department of Political Science, University of Zurich, Zurich, Switzerland
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Tan MK, Sutanto SA, Onida S, Davies AH. The Relationship Between Vein Diameters, Clinical Severity, and Quality of Life: A Systematic Review. Eur J Vasc Endovasc Surg 2019; 57:851-857. [DOI: 10.1016/j.ejvs.2019.01.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 01/21/2019] [Indexed: 12/11/2022]
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Mohamed A, Leung C, Hitchman L, Wallace T, Smith G, Carradice D, Chetter I. A prospective observational cohort study of concomitant versus sequential phlebectomy for tributary varicosities following axial mechanochemical ablation. Phlebology 2019; 34:627-635. [DOI: 10.1177/0268355519835625] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
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.
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Affiliation(s)
| | - Clement Leung
- Academic Vascular Surgical Unit, Hull York Medical School, Hull, UK
| | - Louise Hitchman
- Academic Vascular Surgical Unit, Hull York Medical School, Hull, UK
| | - Tom Wallace
- Academic Vascular Surgical Unit, Hull York Medical School, Hull, UK
| | - George Smith
- Academic Vascular Surgical Unit, Hull York Medical School, Hull, UK
| | - Daniel Carradice
- Academic Vascular Surgical Unit, Hull York Medical School, Hull, UK
| | - Ian Chetter
- Academic Vascular Surgical Unit, Hull York Medical School, Hull, UK
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Ahmed M, Lutze S, Tembulatow M, Daeschlein G, Jünger M, Arnold A. Long-term outcome of open surgery in CVI patients concerning postoperative complications, perioperative hemodynamics and clinical efficacy, Part II1. Clin Hemorheol Microcirc 2018; 71:117-127. [PMID: 30584123 DOI: 10.3233/ch-189401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Chronic venous disease (CVD) is extremely common worldwide with prevalence increasing with age. It is associated with a reduced quality of life, particularly in relation to pain, physical function and mobility. Symptomatic chronic venous insufficiency (CVI) with venous ulcer at its' endpoint, indicates interventional surgery to cure venous reflux therewith promoting wound healing and preventing recurrence. In this retrospective, single-centre, consecutive case-control study in a single patient population of a university clinic in northern Germany a holistic evaluation of varicose vein surgeries has been undertaken. Part I covered postoperative complications in relation to co-morbidities, co-medication and clinical presentation. Part II of this article presents now the hemodynamic results in relation to the perioperative evolution of CVI specific symptoms. METHODS Records of n = 429 (467 extremities) patients from 2009-2013 treated with open surgery were analysed with regards to perioperative hemodynamics. Evolution of CVI symptomology was accessed postoperatively with the help of a questionnaire and patient records in the case of complication development. Venous hemodynamics was analysed in the whole patient population and with regards to complication subgroups: no events (NE), neglectable adverse events (NAE) and non-neglectable adverse events (NNAE). RESULTS Postoperatively, patients' CVI-symptoms like pain (p < 0.001), swelling (p < 0.001) and itching (p = 0.003) significantly improved. The venous refill time and venous pump capacity improved significantly after open vein surgery (p < 0.05). Regardless of the development of postoperative complications there was a significant improvement of venous function at 6 weeks- and one-year postoperative in follow-up (p < 0.05). Symptom regression was strongly correlated with hemodynamic improvement. CONCLUSION A significant improvement of patients' symptoms was achieved by means of open-surgery, regardless of postoperative complication development. This was in accordance with the improvement of venous hemodynamics. A strong correlation between symptom regression and improvement in venous hemodynamics could be proven.
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Affiliation(s)
- M Ahmed
- Dermatological Clinic of the University of Greifswald, Germany
| | - S Lutze
- Dermatological Clinic of the University of Greifswald, Germany
| | - M Tembulatow
- Dermatological Clinic of the University of Greifswald, Germany
| | - G Daeschlein
- Dermatological Clinic of the University of Greifswald, Germany
| | - M Jünger
- Dermatological Clinic of the University of Greifswald, Germany
| | - A Arnold
- Dermatological Clinic of the University of Greifswald, Germany
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Lumley E, Phillips P, Aber A, Buckley‐Woods H, Jones GL, Michaels JA. Experiences of living with varicose veins: A systematic review of qualitative research. J Clin Nurs 2018; 28:1085-1099. [DOI: 10.1111/jocn.14720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 10/08/2018] [Accepted: 11/03/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Elizabeth Lumley
- School of Health and Related Research The University of Sheffield Sheffield UK
- Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital Sheffield UK
| | - Patrick Phillips
- School of Health and Related Research The University of Sheffield Sheffield UK
- Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital Sheffield UK
| | - Ahmed Aber
- School of Health and Related Research The University of Sheffield Sheffield UK
| | - Helen Buckley‐Woods
- School of Health and Related Research The University of Sheffield Sheffield UK
| | - Georgina L. Jones
- Dapertment of Psychology, School of Social Sciences Leeds Beckett University Leeds UK
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Gerontopoulou SA, Kath W, Rass K. Short-Term Efficacy of Inguinal Reoperation for Recurrent Saphenofemoral Incompetence using the Stump Suture Technique. Ann Vasc Surg 2018; 53:197-204. [DOI: 10.1016/j.avsg.2018.04.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 04/01/2018] [Accepted: 04/10/2018] [Indexed: 11/16/2022]
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Carradice D, Forsyth J, Mohammed A, Leung C, Hitchman L, Harwood AE, Wallace T, Smith GE, Campbell B, Chetter I. Compliance with NICE guidelines when commissioning varicose vein procedures. BJS Open 2018; 2:419-425. [PMID: 30511042 PMCID: PMC6253791 DOI: 10.1002/bjs5.95] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 06/28/2018] [Indexed: 01/13/2023] Open
Abstract
Background Varicose veins impair quality of life and can lead to chronic leg ulcers. National Institute for Health and Care Excellence (NICE) guidelines (CG168) set out evidence-based standards for patient management. In England, Clinical Commissioning Groups (CCGs) fund NHS care within their locality. The objective of this study was to evaluate CCGs' commissioning policies and compare them with CG168. Methods Searches were made for the published policies of all 206 English CCGs. They were reviewed for compliance with NICE guidelines and the associated quality standard. Areas of disagreement were analysed for themes. Results Some 203 CCGs (98·5 per cent) had a published policy and 190 (93·6 per cent) of these were published after publication of CG168. Only 73 of the policies (36·0 per cent) were compliant with CG168. Treatment was restricted on the basis of clinical disease severity in 119 CCGs (58·6 per cent); 29 (14·3 per cent) stipulated delay of treatment using a 'trial' of conservative treatment; 22 (10·8 per cent) used lifestyle-related factors such as BMI and smoking status to ration treatment. Treatment was commissioned for uncomplicated symptomatic varicose veins in 87 CCGs (42·9 per cent), but some applied additional rationing mechanisms; 109 CCGs (53·7 per cent) would treat oedema, 183 (90·1 per cent) would treat skin and soft tissue damage, 202 (99·5 per cent) healed ulceration, and all would allow active ulcers to be treated. Discussion The majority of CCGs in England have commissioning policies that contradict NICE guidelines. Rationing strategies include disease severity, delay and patient lifestyle-related factors, creating unwarranted geographical variation for varicose vein treatment, disregarding the NHS Constitution for England, and perhaps leading to an increase in costly treatment of chronic complications in the long term.
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Affiliation(s)
- D Carradice
- Academic Vascular Surgical Unit Hull York Medical School and Hull Royal Infirmary Hull UK
| | - J Forsyth
- Academic Vascular Surgical Unit Hull York Medical School and Hull Royal Infirmary Hull UK
| | - A Mohammed
- Academic Vascular Surgical Unit Hull York Medical School and Hull Royal Infirmary Hull UK
| | - C Leung
- Academic Vascular Surgical Unit Hull York Medical School and Hull Royal Infirmary Hull UK
| | - L Hitchman
- Academic Vascular Surgical Unit Hull York Medical School and Hull Royal Infirmary Hull UK
| | - A E Harwood
- Academic Vascular Surgical Unit Hull York Medical School and Hull Royal Infirmary Hull UK
| | - T Wallace
- Academic Vascular Surgical Unit Hull York Medical School and Hull Royal Infirmary Hull UK
| | - G E Smith
- Academic Vascular Surgical Unit Hull York Medical School and Hull Royal Infirmary Hull UK
| | - B Campbell
- Department of Vascular Surgery Royal Devon and Exeter Hospital (Wonford) Exeter UK
| | - I Chetter
- Academic Vascular Surgical Unit Hull York Medical School and Hull Royal Infirmary Hull UK
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Bogachev VY, Boldin BV, Turkin PY. Administration of Micronized Purified Flavonoid Fraction During Sclerotherapy of Reticular Veins and Telangiectasias: Results of the National, Multicenter, Observational Program VEIN ACT PROLONGED-C1. Adv Ther 2018; 35:1001-1008. [PMID: 29949043 DOI: 10.1007/s12325-018-0731-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Sclerotherapy is a common technique for the removal of intradermal veins. This study examined the rationale for prescribing micronized purified flavonoid fraction (MPFF) in clinical, etiological, anatomic, pathophysiologic (CEAP) class C1 patients with dilated intradermal veins scheduled for sclerotherapy. METHODS In a national, multicenter, observational program, physicians recruited CEAP C1s patients scheduled for sclerotherapy. The decision to prescribe adjuvant MPFF (1000 mg/day for 6 weeks beginning 2 weeks before sclerotherapy) was made according to usual practice. Disease severity and treatment outcomes were assessed at baseline and 4 weeks post-sclerotherapy using a visual analog scale (VAS) as well as quality-of-life (CIVIQ-14) and patient satisfaction (Darvall) questionnaires. RESULTS A total of 70 physicians recruited 1150 patients: 1071 (93%) women, 79 (7%) men. Mean age (± SD) was 40.7 ± 10.7 years (range 18-74) and mean body mass index was 23.6 ± 3.3 kg/m2. Reticular veins were observed in 42.1% of patients and 57.9% had telangiectasias. MPPF was prescribed to 905 patients (79%). Sclerotherapy was associated with statistically significant decreases in mean VAS scores for leg heaviness, pain, sensation of swelling, night cramps, and itching. For each symptom, MPFF-treated patients showed a more pronounced improvement than those undergoing sclerotherapy alone: mean VAS pain score with MPFF decreased from 1.90 ± 2.30 to 0.30 ± 0.62 versus 1.72 ± 1.93 to 0.52 ± 0.99 with sclerotherapy alone; mean VAS leg heaviness score with MPFF decreased from 2.80 ± 2.43 to 0.47 ± 1.07 versus 2.38 ± 2.23 to 0.76 ± 0.85 with sclerotherapy alone. Patient quality-of-life indicators improved with symptom resolution, particularly pain, and for each indicator the observed improvement was greater with MPFF. The outcomes of treatment exceeded patient expectations. Fewer patients experienced sclerotherapy-induced hyperpigmentation with adjunctive MPFF versus sclerotherapy alone (33.9% versus 41.2%, respectively, P = 0.034). No adverse events related to MPFF were observed. CONCLUSION Resolution of venous symptoms post-sclerotherapy was greater in patients treated with MPFF compared with those undergoing sclerotherapy alone, supporting the rationale for use of MPFF in patients undergoing sclerotherapy. FUNDING Servier.
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Reliability and Validity of the MD Anderson Dysphagia Inventory Among Japanese Patients. Dysphagia 2017; 33:123-132. [PMID: 28840313 DOI: 10.1007/s00455-017-9842-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 08/18/2017] [Indexed: 10/19/2022]
Abstract
This study aimed to validate the Japanese version of a dysphagia-specific quality of life questionnaire, the MD Anderson Dysphagia Inventory (MDADI-J), and to verify trends between MDADI-J and Functional Oral Intake Scale (FOIS) scores. The original 20 MDADI items were translated using a forward-backward method following accepted cultural adaptation guidelines. Seventy-two patients with a history of head and neck cancer treatment completed the MDADI-J between October 2015 and August 2016. Concurrent validity was determined by correlations with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Head and Neck 35 (EORTC QLQ-H&N35) instruments. Discriminant validity was examined using cancer stage grouping between stages I-II and III-IV. Additionally, trends between the FOIS and the MDADI-J total scores were analyzed using a trend test. The Cronbach's α coefficient of the MDADI-J total score was 0.92, indicating high internal consistency. The average inter-item correlation coefficients ranged from 0.39 to 0.49. ICC, an indicator of test-retest reliability, was 0.84 for the total score, and 0.58 to 0.81 for individual subscales. The total score and all subscales were significantly associated with the scores for each factor of the EORTC QLQ-C30 and EORTC QLQ-H&N35. The total score and all subscales were significantly different between clinical tumor stages I-II and III-IV. The total scores all increased with the progress of the FOIS. In conclusion, this study validated the Japanese version of the MDADI and showed that as FOIS scores deteriorate, MDADI-J scores tend to constantly decrease.
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Argyriou C, Papasideris C, Antoniou GA, Georgakarakos E, Papanas N, Lazarides MK, Georgiadis GS. The effectiveness of various interventions versus standard stripping in patients with varicose veins in terms of quality of life. Phlebology 2017; 33:439-450. [PMID: 28720052 DOI: 10.1177/0268355517720307] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Purpose Lower limb varicose veins have a significant effect upon the quality of life and a considerable socioeconomic impact despite their relatively benign nature. The aim of this study is to compare the effects of various therapeutic strategies among patients with varicose veins to surgical ligation and vein stripping on the basis of quality of life. Methods PubMed/Medline and Scopus databases were systemically searched from 1 January 2000 until 23 December 2015 for studies reporting outcome on the quality of life of different treatment techniques for varicose veins. We used Cohen's d to make the outcomes of the reported scales comparable. Heterogeneity was calculated with the use of the Q statistic and the I2. Results A total of 1047 participants were randomized across all analyzed trials. The number of participants in a single trial ranged from 30 to 308. The majority of participants in any trial were C2 on the CEAP scores. Overall, the quality of evidence was low. For the meta-analysis performed at 12 months postintervention (seven studies, n = 1047 patients) and after random effects meta-analyses due to high heterogeneity, no differences are observed between intervention and surgical ligation and vein stripping. The pooled estimate is -0.001 and the 95% confidence interval is -0.069 to 0.067 with a p = 0.98. In the case of the 24 months, postintervention analysis (six studies, n = 840 patients) the inference is almost identical. The effect of various interventional modes of treatment compared to surgical ligation and vein stripping is negligible in terms of clinical outcomes and quality of life so that surgical ligation and vein stripping versus the other interventional procedures were equally effective approaches to treat great saphenous vein incompetence in terms of quality of life measurements. Conclusion The procedures were at least equally efficient in treating patients with varicose vein disease in terms of quality of life assessment tools at 12 and 24 months compared to surgical ligation and vein stripping.
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Affiliation(s)
- Christos Argyriou
- 1 Department of Vascular Surgery, "Democritus" University of Thrace, University General Hospital of Evros, Alexandroupolis, Greece
| | - Christos Papasideris
- 2 Department of Vascular Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - George A Antoniou
- 3 Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK
| | - Efstratios Georgakarakos
- 1 Department of Vascular Surgery, "Democritus" University of Thrace, University General Hospital of Evros, Alexandroupolis, Greece
| | - Nikolaos Papanas
- 4 Second Department of Internal Medicine, "Democritus" University of Thrace, University General Hospital of Evros, Alexandroupolis, Greece
| | - Miltos K Lazarides
- 1 Department of Vascular Surgery, "Democritus" University of Thrace, University General Hospital of Evros, Alexandroupolis, Greece
| | - George S Georgiadis
- 1 Department of Vascular Surgery, "Democritus" University of Thrace, University General Hospital of Evros, Alexandroupolis, Greece
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Proposal for a national coverage determination for the treatment of varicose veins and venous disease due to disparate Centers for Medicare and Medicaid Services local coverage determination policies. J Vasc Surg Venous Lymphat Disord 2017; 5:453-459. [DOI: 10.1016/j.jvsv.2017.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 01/03/2017] [Indexed: 11/22/2022]
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Psychometric Evaluation of a New Patient-Reported Outcome (PRO) Symptom Diary for Varicose Veins: VVSymQ(®) Instrument. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2017; 9:335-48. [PMID: 27016239 PMCID: PMC4925682 DOI: 10.1007/s40271-015-0159-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective To evaluate the psychometric properties of the VVSymQ® instrument, a new 5-item patient-reported outcome (PRO) measure for symptoms of varicose veins. Method The VVSymQ® electronic daily diary was administered to outpatients who received routine treatment for varicose veins (N = 40). Compliance with diary administration and item score variability, reliability, construct validity, sensitivity to change, and clinically meaningful change were evaluated. Results Patients completed >97 % of scheduled diary assessments (at screening, baseline, and week 8). The VVSymQ® instrument captured patients’ pre-treatment symptoms (all VVSymQ® symptoms were endorsed by ≥75 % of patients at baseline), and the change post-treatment (mean change in score −6.1), with a large Cohen effect size (1.6). Test–retest reliability was high (intraclass correlation coefficient 0.96); internal consistency was good (Cronbach’s alpha ≥0.76; baseline, week 8). VVSymQ® scores were more strongly associated with PRO scores that reflect symptoms and symptom impact (the Venous Insufficiency Epidemiological and Economic Study—Quality of Life/Symptoms [VEINES-QOL/Sym] instrument and the Chronic Venous Insufficiency Quality-of-Life Questionnaire [CIVIQ-20]) than with PRO scores that reflect appearance (the Patient Self-Assessment of Appearance of Visible Varicose Veins [PA-V3]) or clinician-reported outcome scores (the Clinical–Etiology–Anatomy–Pathophysiology [CEAP] Classification of Venous Disorders and Venous Clinical Severity Score [VCSS]), demonstrating construct validity. Patients reporting that symptoms were “moderately” or “much improved” on the Patient Global Impression of Change (PGIC) anchor (i.e., >97 % of patients) had mean improvements of −6.3 VVSymQ® points, while a cumulative distribution curve showed that 50 % of patients improved by ≥−5.8 points; thus, a score change of approximately −6 demonstrated a clinically meaningful change in this study. The clinically meaningful change in the VVSymQ® score was greater in patients with a greater baseline VVSymQ® symptom burden, and the VVSymQ® instrument captured clinically meaningful treatment benefit even in patients with a low baseline symptom burden. Conclusion The 5-item VVSymQ® instrument is a brief, psychometrically sound, useful tool for evaluating patient-reported varicose veins symptoms.
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Crisóstomo R, Candeias M, Armada-da-Silva P. Venous flow during manual lymphatic drainage applied to different regions of the lower extremity in people with and without chronic venous insufficiency: a cross-sectional study. Physiotherapy 2017; 103:81-89. [DOI: 10.1016/j.physio.2015.12.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 12/03/2015] [Indexed: 11/25/2022]
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Blättler W, Thomae HJ, Amsler F. Venous leg symptoms in healthy subjects assessed during prolonged standing. J Vasc Surg Venous Lymphat Disord 2016; 4:455-62. [DOI: 10.1016/j.jvsv.2016.03.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 03/05/2016] [Indexed: 10/21/2022]
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A systematic review and meta-analysis of the risk for development of varicose veins in women with a history of pregnancy. J Vasc Surg Venous Lymphat Disord 2016; 4:518-524.e1. [PMID: 27639009 DOI: 10.1016/j.jvsv.2016.06.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 06/03/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The association between pregnancy and the development of varicose veins is uncertain. We aimed to determine whether a history of pregnancy is associated with the development of varicose veins. METHODS We performed a systematic literature search using the databases of PubMed, Embase, Robert Koch-Institut, and Cochrane Central and the references of included papers. Eligible studies were all epidemiologic observational studies in which the outcome "varicose veins" and pregnancy history were assessed. The quality of each study was evaluated on the basis of the Dutch Cochrane review checklist and by the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement. For our meta-analysis, a random effects model was applied to pool odds ratios and 95% confidence intervals across studies. RESULTS We found nine eligible studies enrolling 17,109 women. Pregnancy was associated with a significant risk increase in developing varicose veins. The results of our meta-analysis suggest that the odds for women with a history of pregnancy in developing varicose veins significantly increases by 82% (odds ratio, 1.82; 95% CI, 1.43-2.33) compared with women with no history of pregnancy. As expected for epidemiologic observational studies, the heterogeneity was considerably high (I(2) = 81%). CONCLUSIONS Our meta-analysis strongly supports the hypothesis that there is a significant and strong association between a history of pregnancy and varicose veins. However, qualitative and quantitative differences among studies were evident and were also reflected in a considerably high heterogeneity.
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El-Sheikha J, Carradice D, Nandhra S, Leung C, Smith GE, Wallace T, Campbell B, Chetter IC. A systematic review of the compression regimes used in randomised clinical trials following endovenous ablation. Phlebology 2016; 32:256-271. [DOI: 10.1177/0268355516648497] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives There is insufficient evidence to inform guidelines on the optimal compression strategy following ablation for varicose veins. This study aimed to identify the practice of key opinion leaders performing randomised clinical trials involving endovenous ablation. Method A systematic review of MEDLINE/EMBASE/CENTRAL was performed identifying the compression strategies used in randomised clinical trials where at least one comparator arm underwent endovenous ablation. Results Thirty-four randomised clinical trials were identified. At least 14 different compression products were used, with at least 6 different pressures in 7 different regimes with durations from 2 to 84 days. There was no evidence of any convergence of practice over time. Conclusions A lack of evidence as to the optimal strategy for compression has resulted in a marked variation in clinical practice. There is no suggestion that this variation is becoming less over time indicating that experience is not helping to form a consensus and, therefore, further research is required.
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Affiliation(s)
- Joseph El-Sheikha
- Hull York Medical School, Academic Vascular Surgery Unit, Hull Royal Infirmary, UK
| | - Daniel Carradice
- Hull York Medical School, Academic Vascular Surgery Unit, Hull Royal Infirmary, UK
| | - Sandip Nandhra
- Hull York Medical School, Academic Vascular Surgery Unit, Hull Royal Infirmary, UK
| | - Clement Leung
- Hull York Medical School, Academic Vascular Surgery Unit, Hull Royal Infirmary, UK
| | - George E Smith
- Hull York Medical School, Academic Vascular Surgery Unit, Hull Royal Infirmary, UK
| | - Tom Wallace
- Hull York Medical School, Academic Vascular Surgery Unit, Hull Royal Infirmary, UK
| | - Bruce Campbell
- Royal Devon and Exeter Hospital and University of Exeter Medical School, Exeter, UK
| | - Ian C Chetter
- Hull York Medical School, Academic Vascular Surgery Unit, Hull Royal Infirmary, UK
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Screening for lower extremity venous disease. Clin Imaging 2016; 40:325-9. [DOI: 10.1016/j.clinimag.2015.12.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 12/21/2015] [Indexed: 11/23/2022]
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Abstract
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.
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Affiliation(s)
- Sarah Onida
- Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, Charing Cross Hospital, London, UK
| | - Alun H Davies
- Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, Charing Cross Hospital, London, UK
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40
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Evaluation of pain associated with chronic venous insufficiency in Spanish postmenopausal women. Menopause 2015; 22:88-95. [PMID: 24977461 DOI: 10.1097/gme.0000000000000277] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Menopause status has been associated with an increase in venous diseases and lower limb-related symptoms. The purpose of our study was to evaluate pain associated with chronic venous insufficiency and its risk factors in postmenopausal women. METHODS A controlled cross-sectional study was performed in 139 postmenopausal women with chronic venous insufficiency and 40 control women. Pain was assessed with a visual analogue scale, the McGill Pain Questionnaire, and the Pain Matcher (Cefar Medical AB, Lund, Sweden). The influence of several demographic and clinical risk factors was analyzed using bivariate and multivariate regression analyses. RESULTS Women in the chronic venous insufficiency group had significantly higher pain intensity and significantly lower pain threshold (P = 0.001) than the control group. The level of pain was independently and significantly associated with venous refill time and osteoarthritis index scores. It was not associated with other risk factors or with disease severity according to the clinical, etiological, anatomical, and pathophysiological classification. CONCLUSIONS Venous pain is a consistent symptom in postmenopausal women with chronic venous insufficiency, in whom nociceptive thresholds are generally decreased. Reduced physical activity, venous reflux, and osteoarthritis seem to influence pain level in chronic venous insufficiency.
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Wrona M, Jöckel KH, Pannier F, Bock E, Hoffmann B, Rabe E. Association of Venous Disorders with Leg Symptoms: Results from the Bonn Vein Study 1. Eur J Vasc Endovasc Surg 2015; 50:360-7. [PMID: 26141786 DOI: 10.1016/j.ejvs.2015.05.013] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 05/13/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The aim was to study the association between venous disorders and leg symptoms in the population based cross sectional Bonn Vein Study 1 (BVS1). METHODS A total of 1,350 men and 1,722 women aged 18-79 years were enrolled into BVS1. Chronic venous insufficiency (CVI), varicose veins (VVs), and clinical classes (C-classes/CEAP [Clinical, Etiological, Anatomical, and Pathophysiological]) were determined by clinical and duplex investigation. Leg symptoms (heaviness, tightness, swelling, pain after standing or sitting, pain while walking, muscle cramps, itching, and restless legs) were assessed in a standardized interview. For 2,624 subjects (48.7% male) with complete information on venous disorders, relevant characteristics and information on at least one leg symptom, multivariate logistic regression analysis was performed. RESULTS More women (929/63.0%) reported at least one leg symptom within the last 4 weeks than men (560/48.7%). Prevalence of reported symptoms increased with age (45.4% of the 18-29 year olds, 73.9% of the 70-79 year olds). Leg symptoms were more frequent in obese and underweight subjects. As confirmed by clinical and duplex examination 22.6% had VV and 15.8% had CVI. VV (OR: 1.4; CI: 1.1-1.7) and CVI (OR: 1.8; CI: 1.3-2.3) were significantly associated with reporting at least one leg symptom. In particular, there was a positive association of VV and CVI with itching, feeling of heaviness, tightness, swelling, and pain after standing or sitting. C2-C6 showed a statistically significant association with feeling of heaviness, tightness, swelling, and itching, while for pain on walking and muscle cramps this was shifted towards C classes C3-C6 and C3-C4, respectively. CONCLUSIONS Venous disorders show significant associations with several leg symptoms. Itching, feeling of heaviness, or tightness seem to be more closely related than other symptoms. The associations between C classes and symptoms seem to be restricted to classes C2 or higher.
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Affiliation(s)
- M Wrona
- Department of Dermatology, University of Bonn, Germany
| | - K-H Jöckel
- Institute of Medical Informatics, Biometry und Epidemiology, University of Essen, Germany
| | - F Pannier
- Department of Dermatology, University of Cologne, & Private Practice, Bonn, Germany
| | - E Bock
- Institute of Medical Informatics, Biometry und Epidemiology, University of Essen, Germany
| | - B Hoffmann
- Medical Faculty, Deanery of the Medical School, Heinrich-Heine University of Düsseldorf, Germany; IUF Leibniz Research Institute for Environmental Medicine, Heinrich-Heine University of Düsseldorf, Germany
| | - E Rabe
- Department of Dermatology, University of Bonn, Germany.
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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: 501] [Impact Index Per Article: 55.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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El-Sheikha J, Carradice D, Nandhra S, Leung C, Smith GE, Campbell B, Chetter IC. Systematic review of compression following treatment for varicose veins. Br J Surg 2015; 102:719-25. [DOI: 10.1002/bjs.9788] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 11/25/2014] [Accepted: 01/16/2015] [Indexed: 12/13/2022]
Abstract
Abstract
Background
Consensus regarding compression following treatment of varicose veins has yet to be reached. This systematic review aims to establish the optimal compression regimen after venous treatment.
Methods
A systematic review of MEDLINE, Embase and CENTRAL was performed to identify randomized clinical trials (RCTs) investigating different compression strategies following treatment for superficial venous insufficiency.
Results
Seven RCTs comparing different durations and methods of compression fulfilled the inclusion criteria. The treatment modality was open surgery in three trials, foam sclerotherapy in two and endovenous laser ablation (EVLA) in two trials. The quality of the studies was variable, and significant sources of potential bias were present. Both the studies and compression regimens used were heterogeneous. Ten products were used in six general regimens for a duration of 0–42 days. One study suggested that 7 days rather than 2 days of stockings following EVLA was associated with superior quality of life and less pain at 1 week. Another study reported that, following surgery, application of a compression stocking after 3 days of bandaging was associated with a slightly longer recovery than no compression after 3 days. One study recorded compliance clearly, finding it to be only 40 per cent. The quality and heterogeneity of the studies precluded meta-analysis.
Conclusion
There is currently little quality evidence upon which to base any recommendations concerning compression following treatment for varicose veins.
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Affiliation(s)
- J El-Sheikha
- Academic Vascular Surgery Unit, Hull Royal Infirmary and Hull York Medical School/University of Hull, Hull, UK
| | - D Carradice
- Academic Vascular Surgery Unit, Hull Royal Infirmary and Hull York Medical School/University of Hull, Hull, UK
| | - S Nandhra
- Academic Vascular Surgery Unit, Hull Royal Infirmary and Hull York Medical School/University of Hull, Hull, UK
| | - C Leung
- Academic Vascular Surgery Unit, Hull Royal Infirmary and Hull York Medical School/University of Hull, Hull, UK
| | - G E Smith
- Academic Vascular Surgery Unit, Hull Royal Infirmary and Hull York Medical School/University of Hull, Hull, UK
| | - B Campbell
- Department of Vascular Surgery, Royal Devon and Exeter Hospital and University of Exeter Medical School, Exeter, UK
| | - I C Chetter
- Academic Vascular Surgery Unit, Hull Royal Infirmary and Hull York Medical School/University of Hull, Hull, UK
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Onida S, Shalhoub J, Davies AH. Position of the European college of phlebology. Phlebology 2015; 30:111-5. [PMID: 25729078 DOI: 10.1177/0268355515569158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Chronic venous disease is a common condition, bearing significant morbidity to patients. It is predicted that the population suffering from this disease will significantly increase in the coming years, with a growing demand for specialists in the field of phlebology. Training and delivery of services are highly heterogeneous in the European Union. The establishment of the European College of Phlebology marks the opportunity to address these differences from a European perspective, with the aim of providing all patients with standardised, high-quality, accessible medical care. In this paper, we review the current status of phlebology from a European and an international perspective, as well as highlighting the current and future roles of the European College of Phlebology.
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Affiliation(s)
- S Onida
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, UK
| | - J Shalhoub
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, UK
| | - A H Davies
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, UK
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Influence of Manual Lymphatic Drainage on Health-Related Quality of Life and Symptoms of Chronic Venous Insufficiency: A Randomized Controlled Trial. Arch Phys Med Rehabil 2015; 96:283-91. [DOI: 10.1016/j.apmr.2014.09.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 09/12/2014] [Accepted: 09/16/2014] [Indexed: 11/24/2022]
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Hudson BF, Ogden J, Whiteley MS. A thematic analysis of experiences of varicose veins and minimally invasive surgery under local anaesthesia. J Clin Nurs 2015; 24:1502-12. [DOI: 10.1111/jocn.12719] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Briony F Hudson
- School of Psychology; University of Surrey; Guildford Surrey
| | - Jane Ogden
- School of Psychology; University of Surrey; Guildford Surrey
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Ortega-Santana F, Limiñana JM, Ruano F, Ortega-Centol A, Palomino-Martín A, Jiménez F. The influence of the CIVIQ dimensions on quality of life of patients with primary superficial venous incompetence. Eur J Vasc Endovasc Surg 2014; 48:452-8. [PMID: 25150439 DOI: 10.1016/j.ejvs.2014.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 07/14/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To get to know the influence of the four domains of the Chronic Lower Limb Venous Insufficiency Questionnaire (CIVIQ) on the quality of life (QoL) of patients with primary superficial venous incompetence, and their behaviour in relation to age, gender, occupation, body mass index (BMI), and also with respect to the clinical and anatomical classes of the CEAP. MATERIAL AND METHODS The sample was composed of 468 patients with primary superficial venous reflux (135 male and 333 female) who answered 100% of the questions in the Short Form-12 (SF12) and CIVIQ questionnaires. After a clinical and duplex examination, the patients were categorized as C0-6, Ep, As, Ap or As,p and Pr according to the CEAP classification. The relationships between CIVIQ domains and gender, age, occupation, BMI, and the clinical and anatomical classes of the CEAP classification were analyzed. RESULTS Men reported better QoL than women (33.2 vs. 46.3) and this was also true for each of the CIVIQ's domains (p < .00). Pain (50.6) and physical restriction (45.3) were the dimensions with a greater influence on QoL, whereas social (41.7) and psychological (38.1) dimensions had a lesser influence. Patients aged between 45 and 64, household activities, and patients with C2-3 clinical classes were the patient groups with the worst scores in all the CIVIQ dimensions and those where significant differences were found. The BMI and anatomical distribution of the reflux had no influence on the QoL. CONCLUSIONS Pain and physical restriction were the CIVIQ domains with greater influence on the QoL of patients with primary superficial venous reflux. Age increase (up to 64 years), female gender, household activities, and C2-3 CEAP clinical class were the main factors associated with the worst QoL perception.
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Affiliation(s)
- F Ortega-Santana
- Las Palmas de Gran Canaria University, Morphology Department, CliniVar, Gran Canaria, Spain.
| | - J M Limiñana
- Las Palmas de Gran Canaria University, Clinical Sciences Department, Gran Canaria, Spain
| | - F Ruano
- Servicio Canario de la Salud, CliniVar, Gran Canaria, Spain
| | - A Ortega-Centol
- Hospital Universitario de Belvitge (Barcelona), CliniVar, Gran Canaria, Spain
| | - A Palomino-Martín
- Las Palmas de Gran Canaria University, Physical Education Department, Gran Canaria, Spain
| | - F Jiménez
- Mediteknia Clinic, Las Palmas de Gran Canaria, Gran Canaria, Spain
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Lane TRA, Dharmarajah B, Kelleher D, Franklin IJ, Davies AH. Short-term gain for long-term pain? Which patients should be treated and should we ration? Phlebology 2013; 28 Suppl 1:148-52. [DOI: 10.1177/0268355513476815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: Treatments of common conditions which do not affect mortality often become sidelined in the drive to improve efficiency and reduce costs. The rationing of patients is a divisive but crucial component to universal health care. How should this be accomplished? Methods and Results: In this article we examine the outcomes of various rationing methods in varicose veins. Conclusions: No method is perfect and treatment of symptoms and complications should remain the target for all physicians.
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Affiliation(s)
- T R A Lane
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, UK
| | - B Dharmarajah
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, UK
| | - D Kelleher
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, UK
| | - I J Franklin
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, UK
| | - A H Davies
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, UK
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50
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Lattimer CR, Kalodiki E, Azzam M, Geroulakos G. The Aberdeen Varicose Vein Questionnaire May be the Preferred Method of Rationing Patients for Varicose Vein Surgery. Angiology 2013; 65:205-9. [DOI: 10.1177/0003319712474953] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Rationing treatment of varicose veins (VVs) is of importance in countries with a public health service and limited funds. This study examines why and how the Aberdeen varicose vein questionnaire (AVVQ) can be used in achieving rationing. Baseline assessments prior to endovenous treatment included the venous clinical severity score (VCSS), venous filling index (VFI), and the refluxing great saphenous vein (GSV) diameter. Absolute change in the AVVQ defined improvement. There was no significant correlation in AVVQ improvement compared to baseline VCSS, VFI, GSV diameter or when patients were divided into mild and severe disease (C2,3 vs C4-6) or laser ablation versus foam sclerotherapy. However, AVVQ improvement significantly correlated at 3 weeks (n = 84) and 3 months (n = 70) with their baseline values ( r = .5 and r = .585), P < .0005 (Spearman). In conclusion, patients with an initial poor quality of life may benefit most from endovenous treatment, irrespective of other baseline severity assessments.
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Affiliation(s)
- Christopher R. Lattimer
- Josef Pflug Vascular Laboratory, Ealing Hospital Middlesex, UK
- Department of Surgery and Cancer, Imperial College, London, UK
| | - Evi Kalodiki
- Josef Pflug Vascular Laboratory, Ealing Hospital Middlesex, UK
- Department of Surgery and Cancer, Imperial College, London, UK
| | - Mustapha Azzam
- Josef Pflug Vascular Laboratory, Ealing Hospital Middlesex, UK
| | - George Geroulakos
- Josef Pflug Vascular Laboratory, Ealing Hospital Middlesex, UK
- Department of Surgery and Cancer, Imperial College, London, UK
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