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Cui HJ, Wu YF. The Effects of Different Dosages on Micronized Purified Flavonoid Fraction's Treatment of Lower Limb Chronic Venous Disease: A Meta-Analysis. J Endovasc Ther 2024:15266028241262700. [PMID: 39066519 DOI: 10.1177/15266028241262700] [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: 07/28/2024]
Abstract
BACKGROUND Micronized purified flavonoid fraction (MPFF) is a widely prescribed and extensively investigated venoactive drug (VAD). The standard dosage for MPFF is 500 mg administered twice daily. However, a new daily dose of 1000 mg has just been introduced. OBJECTIVE This study investigated whether a daily dose of 1000 mg MPFF could be implemented and embraced by the public and still has the same therapeutic effects as conventional pharmaceuticals. METHODS For this meta-analysis, we searched MEDLINE, Embase, Science of Web, Cochrane, and PubMed databases and forward and backward citations for studies published between database inception and March 2023. Three randomized controlled trials (RCTs) of comparison of different dosages of MPFF to evaluate whether there is a significant difference between them were included, without language or date restrictions. Due to the small sample size of the study included, we conducted a simple sensitivity test using a one-by-one exclusion method, and the results showed that the study did not affect the final consolidation conclusion. The quality of the evidence was assessed using the Cochrane risk-of-bias tool. RESULTS Out of 232 studies, 99 were eligible and 39 RCTs had data, all with low to moderate bias. Overall, 1924 patients (experimental group: 967, control group: 957) in 3 RCTs met the criteria. There is no significant difference in patient compliance, efficacy, clinical adverse events, and quality of life scores between MPFF 1000 mg once daily and MPFF 500 mg twice daily (standardized mean difference [SMD]: 0.049 [0.048, 0.145], p=0.321, risk ratio [RR]: 0.981 [0.855, 1.125], p=0.904, and SMD: 0.063 [0.034, 0.160], p=0.203). INTERPRETATION In symptomatic chronic venous disease patients, MPFF 1000 mg once daily and MPFF 500 mg twice daily improve patient compliance, lower limb discomfort, clinical adverse events, and quality of life scores similarly. Regular medical care should recommend MPFF 1000 mg daily more often. CLINICAL IMPACT Micronized purified flavonoid fraction (MPFF) is a popular venoactive medication (VAD) in modern medicine.MPFF is effective in treating lower extremity venous problems.Currently, besides conventional 500 mg tablets, there exist alternative dosage forms such as solutions, chewable tablets, and other novel formulations for MPFF.The excessive frequency and amount of medication may have a negative impact on patient adherence.
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Affiliation(s)
- Hong-Jie Cui
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ying-Feng Wu
- Department of Vascular Surgery, Luhe Hospital, Capital Medical University, Beijing, China
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Jayaraj A, Rossi FH, Lurie F, Muck P. Diagnosis of chronic iliac venous obstruction. J Vasc Surg Venous Lymphat Disord 2024; 12:101744. [PMID: 38242206 DOI: 10.1016/j.jvsv.2023.101744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 12/05/2023] [Accepted: 12/12/2023] [Indexed: 01/21/2024]
Abstract
Stenting has become the first line of treatment for symptomatic chronic iliofemoral venous obstruction in patients with quality-of-life-impairing clinical manifestations who have failed conservative therapy. Patient selection for such intervention is, however, dependent on clear identification of relevant clinical manifestations and subsequent testing to confirm the diagnosis. In this regard, the physician engaged in management of such patients needs to be well-aware of symptoms and signs of chronic iliofemoral venous obstruction, and instruments used to grade chronic venous insufficiency and determine quality of life, in addition to diagnostic tests available and their individual roles. This review serves to provide an overview of the diagnosis of chronic iliofemoral venous obstruction and patient selection for stenting.
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Affiliation(s)
- Arjun Jayaraj
- RANE Center for Venous and Lymphatic Diseases, St Dominic Hospital, Jackson, MS.
| | - Fabio H Rossi
- Dante Pazzanese Cardiovascular Institute, Sao Paulo, Brazil
| | - Fedor Lurie
- Jobst Vascular Institute, Toledo, OH; Division of Vascular Surgery, University of Michigan, Ann Arbor, MI
| | - Patrick Muck
- Division of Vascular Surgery, Department of Surgery, Good Samaritan Hospital, Cincinnati, OH
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3
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Guven H. Plethysmography: A game changer for chronic venous insufficiency diagnosis, treatment, and follow-up. Vascular 2024:17085381241240870. [PMID: 38509041 DOI: 10.1177/17085381241240870] [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: 03/22/2024]
Abstract
OBJECTIVE Chronic Venous Insufficiency (CVI) presents a various clinical symptoms and treatment options. Although it is generally known which treatment option is more appropriate in which situations in CVI, it is even more difficult to find the right option in some uncertain situations. In this study, we aimed to evaluate the potential contribution of Digital Photoplethysmography (D-PPG) in the diagnosis of CVI and especially in the selection of treatment options. PATIENTS AND METHOD This retrospective study was conducted at Bursa Heart and Arrhythmia Hospital, involving 721 consecutive patients diagnosed with CVI and with Endovenous Laser Ablation (EVLA) indication. The patients were divided into 2 groups according to the extent of the failure in Doppler USG. In Group 1, the insufficiency ended above the knee, and in Group 2, the insufficiency progressed to below the knee. Patients were evaluated based on anamnesis, physical examination, Doppler USG, and D-PPG. Clinical classification, Venous Clinic Severity Score (VCSS), Quality of Life (QoL) assessment, venous pump capacity (VPC), and venous refill time (VRT) were measured. RESULTS The study included 263 male and 458 female patients with a mean age of 52.37 ± 12.26 years. Significant differences were observed between Group 1 (above knee reflux) and Group 2 (below knee reflux) patients in terms of VCSS, QoL, VPC, and VRT values. The mean values of VCSS, patient complaints, VPC, and VRT were higher in Group 2 patients. Similar findings were observed within the CEAP 2 subgroup. CONCLUSION D-PPG shows potential as a valuable tool in the diagnosis and treatment of CVI. By providing information about venous hemodynamics and volume changes, it can assist in optimizing treatment decisions, including saphenous vein preservation. Combining D-PPG with Doppler USG may improve the comprehensive assessment of CVI and change the treatment option, especially for CEAP 2 patients. More research is needed to confirm these findings and explore wider applications of plethysmographic methods in the management of CVI.
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Affiliation(s)
- Hakan Guven
- Department of Cardiovascular Surgery, Heart an Arrythmia Hospital, Bursa, Türkiye
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Lindegaard SF, Højen AA, Rolving N. Electronic adaptation and danish cross-cultural translation of PEmb-QoL and VEINES-QoL/Sym for patients with venous thromboembolism. J Patient Rep Outcomes 2024; 8:21. [PMID: 38407682 PMCID: PMC10897079 DOI: 10.1186/s41687-024-00698-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 02/07/2024] [Indexed: 02/27/2024] Open
Abstract
PURPOSE Most patient-reported outcome (PROs) used in thrombosis research and clinical practice are delivered using technology like online questionnaires. However, only few have undergone formal electronic adaptation from paper to digital versions, threatening the validity and reliability of the PROs. The present study aimed to perform an electronic adaption and cross-cultural translation of two PROs measuring health-related quality of life in a Danish cohort of patients with venous thrombosis (VTE), specifically the VEINES-QoL/Sym questionnaire and the PEmb-QoL questionnaire. METHODS The electronic adaption and cross-cultural translation processes followed the international guidelines recommended by ISPOR. The migration of the questionnaires from paper to electronic versions was conducted in the Research Electronic Data Capture (REDCap). Following approval of the electronically adapted and translated versions, a pretest of the questionnaires was performed by cognitive interviewing patients with VTE recruited from a hospital setting. RESULTS Nine men and ten women between the age of 19 and 73 years participated in cognitive interviews. The questionnaires were successfully adapted from paper to electronic versions, and during the migration process only a few modifications to the content and format were made. Most comments were related to technicalities, e.g. touch functions and checkboxes. The cross-cultural translation of both questionnaires was satisfactory, as only minor rephrasing was required. CONCLUSIONS The original and Danish version of VEINES-QoL/Sym and PEmb-QoL were successfully adapted into electronic versions and are ready to share for REDCap users. Furthermore, the Danish versions of the two questionnaires have shown satisfactory face validity.
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Affiliation(s)
- Stine Foged Lindegaard
- Danish Center for Health Services Research, Aalborg University Hospital and Aalborg University , Aalborg, Denmark
| | - Anette Arbjerg Højen
- Danish Center for Health Services Research, Aalborg University Hospital and Aalborg University , Aalborg, Denmark
| | - Nanna Rolving
- Department of Physical and Occupational Therapy, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, 8200, Denmark.
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Kikuchi R, Nhuch C, Drummond DAB, Santiago FR, Coelho F, Mauro FDO, Silveira FT, Peçanha GP, Merlo I, Corassa JM, Stambowsky L, Figueiredo M, Takayanagi M, Gomes Flumignan RL, Evangelista SSM, Campos W, Joviliano EE, de Araujo WJB, de Oliveira JCP. Brazilian guidelines on chronic venous disease of the Brazilian Society of Angiology and Vascular Surgery. J Vasc Bras 2023; 22:e20230064. [PMID: 38021274 PMCID: PMC10648055 DOI: 10.1590/1677-5449.202300642] [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: 05/11/2023] [Accepted: 08/01/2023] [Indexed: 12/01/2023] Open
Abstract
The Brazilian Society of Angiology and Vascular Surgery has set up a committee to provide new evidence-based recommendations for patient care associated with chronic venous insufficiency. Topics were divided in five groups: 1. Classification, 2. Diagnosis, 3. Conservative or non-invasive treatment, 4. Invasive treatment and 5. Treatment of small vessels. This last series is closely related to the activities of Brazilian angiologists and vascular surgeons, who are heavily involved in the treatment of small superficial veins. These guidelines are intended to assist in clinical decision-making for attending physicians and health managers. The decision to follow a guideline recommendation should be made by the responsible physician on a case-by-case basis taking into account the patient's specific condition, as well as local resources, regulations, laws, and clinical practice recommendations.
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Affiliation(s)
- Rodrigo Kikuchi
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
- Faculdade de Ciências Médicas Santa Casa de São Paulo – FCMSCSP, São Paulo, SP, Brasil.
- Instituto de Excelência Vascular, Londrina, PR, Brasil.
| | - Claudio Nhuch
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
- Clínica Vascular, Porto Alegre, RS, Brasil.
| | - Daniel Autran Burlier Drummond
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
- Pontifícia Universidade Católica do Rio de Janeiro – PUC-Rio, Departamento de Ciências da Computação, Rio de Janeiro, RJ, Brasil.
| | - Fabricio Rodrigues Santiago
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
- Instituto de Excelência Vascular, Londrina, PR, Brasil.
- Instituto de Doenças Venosas e Linfáticas – IDVL, Goiânia, GO, Brasil.
| | - Felipe Coelho
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
- Pontifícia Universidade Católica do Paraná – PUCPR, Departamento de Cirurgia, Londrina, PR, Brasil.
| | | | | | | | - Ivanesio Merlo
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
| | - Jose Marcelo Corassa
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
| | - Leonardo Stambowsky
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
| | - Marcondes Figueiredo
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
| | - Miriam Takayanagi
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
| | - Ronald Luiz Gomes Flumignan
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
- Universidade Federal de São Paulo – UNIFESP, Departamento de Cirurgia, São Paulo, SP, Brasil.
| | - Solange Seguro Meyge Evangelista
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
- Clínica Varizemed, Belo Horizonte, MG, Brasil.
| | - Walter Campos
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
- Universidade de São Paulo – USP, Faculdade de Medicina, Disciplina de Cirurgia Vascular, São Paulo, SP, Brasil.
| | - Edwaldo Edner Joviliano
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
- Universidade de São Paulo – USP, Faculdade de Medicina – FMRP, Departamento de Cirurgia e Anatomia, São Paulo, SP, Brasil.
| | - Walter Junior Boim de Araujo
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
- Universidade Federal do Paraná – UFPR, Residência em Angiorradiologia e Cirurgia Vascular, Hospital de Clínicas, Curitiba, PR, Brasil.
| | - Julio Cesar Peclat de Oliveira
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
- Universidade Federal do Estado do Rio de Janeiro – UNIRIO, Departamento de Cirurgia Geral e Especializada, Rio de Janeiro, RJ, Brasil.
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Tettelbach WH, Driver V, Oropallo A, Kelso MR, Niezgoda JA, Wahab N, De Jong JL, Hubbs B, Forsyth RA, Magee GA. Treatment patterns and outcomes of Medicare enrolees who developed venous leg ulcers. J Wound Care 2023; 32:704-718. [PMID: 37907359 DOI: 10.12968/jowc.2023.32.11.704] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
OBJECTIVE To retrospectively evaluate the comorbidities, treatment patterns and outcomes of Medicare enrolees who developed venous leg ulcers (VLUs). METHOD Medicare Limited Data Standard Analytic Hospital Inpatient and Outpatient Department Files were used to follow patients who received medical care for a VLU between 1 October 2015 and 2 October 2019. Patients diagnosed with chronic venous insufficiency (CVI) and a VLU were propensity matched into four groups based on their treatment regimen. Episode claims were used to document demographics, comorbidities and treatments of Medicare enrolees who developed VLUs, as well as important outcomes, such as time to ulcer closure, rates of complications and hospital utilisation rates. Outcomes were compared across key propensity-matched groups. RESULTS In total, 42% of Medicare enrolees with CVI (n=1,225,278), developed at least one VLU during the study, and 79% had their episode claim completed within one year. However, 59% of patients developed another VLU during the study period. This analysis shows that only 38.4% of VLU episodes received documented VLU conservative care treatment. Propensity-matched episodes that received an advanced treatment or high-cost skin substitutes for a wound which had not progressed by 30 days demonstrated the best outcomes when their cellular, acellular, matrix-like product (CAMP) treatment was applied weekly or biweekly (following parameters for use). Complications such as rates of infection (33%) and emergency department visits (>50%) decreased among patients who received an advanced treatment (following parameters for use). CONCLUSION Medicare enrolees with CVI have diverse comorbidities and many do not receive sufficient management, which contributes to high rates of VLUs and subsequent complications. Medicare patients at risk of a VLU who receive early identification and advanced CAMP treatment demonstrated improved quality of life and significantly reduced healthcare resource utilisation.
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Affiliation(s)
- William H Tettelbach
- HCA Healthcare, Mountain Division, US
- College of Podiatric Medicine, Western University of Health Sciences, US
- Duke University School of Medicine, Department of Anesthesiology, US
- Association for the Advancement of Wound Care, US
- American Professional Wound Care Association, US
- MiMedx Group Inc., GA, US
| | - Vickie Driver
- Wound Care and Hyperbaric Centers at INOVA Healthcare, US
- Wound Care Collaborative Community, US
| | - Alisha Oropallo
- Comprehensive Wound Healing Center, US
- Hyperbarics at Northwell Health, US
| | | | | | - Naz Wahab
- Wound Care Experts, NV, US
- HCA Mountain View Hospital, US
- Roseman University College of Medicine, US
- Common Spirit Dignity Hospitals, US
| | | | | | - R Allyn Forsyth
- MiMedx Group Inc., GA, US
- Department of Biology, San Diego State University, US
| | - Gregory A Magee
- Keck School of Medicine, University of Southern California, US
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7
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Nogueira JFL, Teixeira-Viana FC, Barboza-Silva BL, Mendes-Pinto D, Rodrigues-Machado MDG. Advanced Levels of Chronic Venous Insufficiency are Related to an Increased in Arterial Stiffness. Ann Vasc Surg 2023; 96:365-373. [PMID: 37003361 DOI: 10.1016/j.avsg.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 02/28/2023] [Accepted: 03/08/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Chronic venous insufficiency (CVI) is characterized by progressive inflammatory changes. Inflammatory damage occurs in the veins, adjacent tissues, and can lead to structural changes in the arteries. The aim of this study is to analyze whether the degree of CVI is associated with arterial stiffness. METHODS Cross-sectional study including patients with CVI classified by clinical, etiological, anatomical, and pathophysiological classification (CEAP) 1 to 6. We performed correlation between the degree of CVI, central and peripheral arterial pressure, and arterial stiffness measured by brachial artery oscillometry. RESULTS We evaluated 70 patients, 53 of whom were women with a mean age of 54.7 years. Patients with advanced degrees of venous insufficiency CEAP 4,5,6, had higher levels of systolic, diastolic, central, and peripheral arterial pressures compared to those with early stages (CEAP 1,2,3). The CEAP 4,5,6 group had higher arterial stiffness indices than the CEAP 1,2,3 group: pulse wave velocity (PWV) 9.3 m/s vs. 7.0 m/s, P < 0.001; augmentation pressure (AP) 8.0 mm Hg vs. 6.3 mm Hg; P = 0.04. There was a positive correlation between the degree of venous insufficiency measured by the venous clinical severity score, villalta score and CEAP classification, and the arterial stiffness indices (Spearman's coefficient = 0.62 for PWV and CEAP, P < 0.01). The factors influencing PWV were age, peripheral systolic arterial pressure (SAPp), and AP. CONCLUSIONS There is a correlation between the degree of venous disease and arterial structural changes characterized by arterial pressure and stiffness indices. Degenerative changes secondary to venous insufficiency are associated with impairment of the arterial system, which has implications for the development of cardiovascular disease.
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Affiliation(s)
- João Flávio Lima Nogueira
- Post-Graduate Program in Health Sciences, Faculty of Medical Sciences of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; University Hospital of the Faculty of Medical Sciences of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Flávia Costa Teixeira-Viana
- Post-Graduate Program in Health Sciences, Faculty of Medical Sciences of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Bruna Lorena Barboza-Silva
- Post-Graduate Program in Health Sciences, Faculty of Medical Sciences of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Daniel Mendes-Pinto
- Department of Vascular Surgery, Hospital Felicio Rocho, Belo Horizonte, Minas Gerais, Brazil
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Guven H. Strain-gauge venous occlusion plethysmography: An objective and non-invasive approach to the evaluation of venous hemodynamics in patients with acute deep-vein thrombosis undergoing post-pharmacomechanical thrombolysis. Vascular 2023:17085381231174951. [PMID: 37167292 DOI: 10.1177/17085381231174951] [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: 05/13/2023]
Abstract
OBJECTIVES Strain-gauge venous occlusion plethysmography (SGVOP) is a means of acquiring hemodynamic data non-invasively, unlike other methods used routinely for the diagnosis and follow-up of venous diseases. The present study compares the plethysmographic data with early- and mid-term routine data of patients with acute deep-vein thrombosis (DVT) who underwent pharmacomechanical thrombolysis. PATIENTS AND METHOD Included in this retrospective study were 118 patients with acute DVT, who underwent pharmacomechanical thrombolysis between February 2018 and July 2019. Pre- and post-procedure follow-up data including CIVIQ-20 (quality of life), VCSS (Venous Clinical Severity Score), D-Dimer, Doppler USG results, venous capacity (VC), and venous outflow (VO) obtained by SGVOP were recorded and compared. RESULTS In all 118 (100%) patients who underwent the procedure, early- and mid-term patency was seen to have been provided on Doppler USG follow-up, and various degrees of venous insufficiency were identified. A statistically significant improvement was observed in VCSS, CIVIQ-20, D-Dimer, VO, and VC measurements, although when the discrepancies between CIVIQ-20 and plethysmographic measurements were examined individually during the 6-month follow-up, nine (13.1%) patients were identified with comorbidities. CONCLUSIONS Pharmacomechanical thrombolysis is an effective treatment approach for patients with acute DVT. Providing non-invasive objective data supporting the diagnosis and follow-up of venous diseases, the SGVOP approach offers significant benefits and should be considered more frequently as a viable therapy.
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Affiliation(s)
- Hakan Guven
- Cardiovascular Surgery Department, Bursa Heart and Arrhythmia Hospital, Bursa, Turkey
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Gloviczki P, Lawrence PF, Wasan SM, Meissner MH, Almeida J, Brown KR, Bush RL, Di Iorio M, Fish J, Fukaya E, Gloviczki ML, Hingorani A, Jayaraj A, Kolluri R, Murad MH, Obi AT, Ozsvath KJ, Singh MJ, Vayuvegula S, Welch HJ. The 2022 Society for Vascular Surgery, American Venous Forum, and American Vein and Lymphatic Society clinical practice guidelines for the management of varicose veins of the lower extremities. Part I. Duplex Scanning and Treatment of Superficial Truncal Reflux: Endorsed by the Society for Vascular Medicine and the International Union of Phlebology. J Vasc Surg Venous Lymphat Disord 2023; 11:231-261.e6. [PMID: 36326210 DOI: 10.1016/j.jvsv.2022.09.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 09/23/2022] [Indexed: 11/06/2022]
Abstract
The Society for Vascular Surgery, American Venous Forum, and American Vein and Lymphatic Society collaborated to update the 2011 Society for Vascular Surgery/American Venous Forum clinical practice guidelines and provide new evidence-based recommendations on critical issues affecting the care of patients with varicose veins. Each recommendation is based on a recent, independent systematic review and meta-analysis of the diagnostic tests and treatments options for patients with lower extremity varicose veins. Part I of the guidelines includes evidence-based recommendations for the evaluation of patients with CEAP (Clinical Class, Etiology, Anatomy, Pathology) class 2 varicose vein using duplex ultrasound scanning and other diagnostic tests, open surgical treatment (ligation and stripping) vs endovenous ablation techniques, thermal vs nonthermal ablation of the superficial truncal veins, and management of incompetent perforating veins in CEAP class 2 disease. We have also made recommendations on the concomitant vs staged treatment of varicose tributaries using phlebectomy or liquid or foam sclerotherapy (with physician-compounded foam or commercially prepared polidocanol endovenous microfoam) for patients undergoing ablation of incompetent superficial truncal veins.
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Affiliation(s)
- Peter Gloviczki
- Division of Vascular and Endovascular Surgery, Gonda Vascular Center, Mayo Clinic, Rochester, MN.
| | - Peter F Lawrence
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, Los Angeles, Los Angeles, CA
| | - Suman M Wasan
- Department of Medicine, University of North Carolina, Chapel Hill, and Rex Vascular Specialists, UNC Health, Raleigh, NC
| | | | - Jose Almeida
- Miller School of Medicine, University of Miami, Miami, FL
| | | | - Ruth L Bush
- Central Texas Veterans Affairs Healthcare System and Texas A&M University College of Medicine, Temple, TX
| | | | - John Fish
- Department of Medicine, Jobst Vascular Institute, University of Toledo, Toledo, OH
| | - Eri Fukaya
- Division of Vascular Surgery, Stanford University, Stanford, CA
| | | | | | - Arjun Jayaraj
- RANE Center for Venous and Lymphatic Diseases, Jackson, MS
| | - Raghu Kolluri
- Heart and Vascular Service, OhioHealth Riverside Methodist Hospital, Columbus, OH
| | - M Hassan Murad
- Evidence-Based Practice Research Program, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
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10
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Gavrilov SG, Grishenkova AS, Mishakina NY, Krasavin GV. Use of a novel Likert scale instrument to assess patient satisfaction following endovascular and surgical treatment of pelvic venous disorders. Phlebology 2022; 37:241-251. [DOI: 10.1177/02683555211053119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective The study was aimed at assessing satisfaction with endovascular and surgical treatment, using a novel Likert scale procedure satisfaction instrument, in patients with pelvic venous disorder (PeVD) caused by the gonadal vein reflux. Methods This prospective cohort study included 100 women with PeVD who underwent gonadal veins embolization with coils (GVE group, n = 71) or gonadal veins endoscopic resection (GVR group, n = 29) in 2012–2020. The GVE was performed under local anesthesia and sedation, and was left-sided in 61, right-sided in three, and bilateral in seven patients. The GVR was performed under general anesthesia through transperitoneal ( n = 19) or retroperitoneal ( n = 10) access with three access ports in both cases. The GVR was left-sided in 19, right-sided in one, and bilateral in nine patients. To assess satisfaction with GVE and GVR treatment of PeVD, patients were asked to evaluate statements related to their experience using a new Likert scale instrument. The responses for each item were compared between the groups at Day 7 (D7) and at Month 6 (M6) after the procedure, as was a summary score of all the responses at both time points. The summary score allowed categorization on a spectrum from “completely satisfied” to “completely dissatisfied.” Results The comparison between GVЕ and GVR groups at D7 showed that 80% and 100% of patients, accordingly, reported the overall summary satisfaction, 49% and 79% agreed with a complete pelvic pain relief by D7, 79% and 0% agreed with the absence of a significant discomfort during the first postoperative day, 71% and 100% reported no need for analgesics to relief pain in the assess area, 80% and 100% reported fast return to daily activity, and 19.7% and 100% still experienced pelvic pain at D7 (pain in the GVR group was more severe and required the use of analgesics) (all p < .05). At the same time, 94% and 96% patients were satisfied with the aesthetic result of the procedure at D7 ( p = n.s.). The comparison between GVЕ and GVR groups at M6 showed that 100% of patients in both groups reported overall satisfaction with treatment ( p = n.s.), 96% and 100% confirmed a complete pelvic pain relief by M6, 79% and 65% agreed with the absence of a significant discomfort after the procedure, 79% and 65% reported no need for analgesics, 83% and 100% reported about the return to daily activity (all p < .05), and 100% in both groups were satisfied with the aesthetic result of the procedure ( p = n.s.). Conclusions In patients with PeVD, both GVE and GVR are associated with a high, although not significantly different, overall treatment satisfaction in the long term and have advantages and disadvantages. GVE is associated with less severe post-procedural pain, while GVR provides faster relief of pelvic pain and a return to usual daily activity.
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Affiliation(s)
- Sergey G Gavrilov
- Faculty surgery N°1, Savelyev University Surgical Clinic, Pirogov Russian National Research Medical University, Moskva, Russia
| | - Anastasiya S Grishenkova
- Faculty surgery N°1, Savelyev University Surgical Clinic, Pirogov Russian National Research Medical University, Moskva, Russia
| | - Nadezhda Yu Mishakina
- Faculty surgery N°1, Savelyev University Surgical Clinic, Pirogov Russian National Research Medical University, Moskva, Russia
| | - Gennady V Krasavin
- Faculty surgery N°1, Savelyev University Surgical Clinic, Pirogov Russian National Research Medical University, Moskva, Russia
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Ko H, Ahn HJ. Causes and symptoms of varicose veins. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2022. [DOI: 10.5124/jkma.2022.65.4.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Varicose veins are a common disease that cause edema, heaviness, pigmentation, and skin ulcers, ultimately affecting the quality of life. Various treatments have recently been developed; therefore, clinicians need to understand the anatomy, pathophysiology, risk factors, and symptoms of varicose veins to provide optimal treatment.Current Concepts: Lower extremity veins are composed of deep, superficial, perforating, and communicating vein systems, and the main axial superficial veins are composed of the great and small saphenous veins. Venous circulation primarily relies on muscle pumps in the foot and calf. Pressure on the sole and contraction of calf muscles compress the veins, sending blood upward or to the deep vein system. Varicose veins are caused by valvular abnormalities, muscle pump failure, etc., and associated risk factors include age, pregnancy, obesity, and family history. The main symptoms include heaviness, fatigue, and edema.Discussion and Conclusion: Varicose veins have complex anatomical structures and are developed by various factors. Therefore, appropriate treatments should be selected considering patients’ symptoms, anatomical structure, and economic aspects.
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Bissacco D, Malloggi C, Lomazzi C, Domanin M, Odero A, Trimarchi S, Casana R. Quality-of-life assessment in patients treated with radiofrequency ablation with or without great saphenous vein recanalization. Phlebology 2022; 37:223-225. [DOI: 10.1177/02683555211060622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Quality of life (QoL) in patients with chronic venous disorders has a central role to decide the correct treatment approach. In particular, in case of mini-invasive therapy, such as endovenous radiofrequency ablation (RFA), the postoperative QoL improvement remains one of the most important outcome to be reached. Despite this, very few data are published on the long-term QoL modifications after RFA. The aim of this brief report is to describe and analyze the role of QoL scales in a population of patients treated with RFA of the great saphenous vein and phlebectomies, highlighting results in short- and long-term follow-up period, and differences between recanalized and non-recanalized patients.
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Affiliation(s)
- Daniele Bissacco
- Vascular Surgery Unit, IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Malloggi
- Laboratory of Research in Vascular Surgery, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Chiara Lomazzi
- Vascular Surgery Unit, IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maurizio Domanin
- Vascular Surgery Unit, IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Andrea Odero
- Vascular Surgery Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Santi Trimarchi
- Vascular Surgery Unit, IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Renato Casana
- Laboratory of Research in Vascular Surgery, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Vascular Surgery Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy
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13
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Silva JC, Constâncio V, Lima P, Nunes C, Silva E, Anacleto G, Fonseca M. Determinants of Quality of Life in Patients with Post-Thrombotic Syndrome. Ann Vasc Surg 2022; 85:253-261. [PMID: 35339602 DOI: 10.1016/j.avsg.2022.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 02/20/2022] [Accepted: 03/04/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Chronic post-thrombotic syndrome (PTS) may develop in up to 50% of patients after deep vein thrombosis (DVT) and may reduce patients' quality of life (QoL). We aimed to evaluate the association of PTS severity with QoL in patients with proximal DVT submitted to medical treatment and also to identify modifiable and non-modifiable risk factors related to PTS. METHODS Patients with iliac or femoropopliteal DVT observed in Vascular Surgery consultation in our institution from 1 year period with unilateral DVT were selected. Patients with total vein recanalization were excluded. Villalta scale was applied to assess PTS degree and VEINES-QoL/Sym questionnaire was used as a disease-specific QoL measure. Correlation between PTS degree and VEINES-QoL/Sym score and predictors of PTS were determined. RESULTS 56 patients accepted to enter the study. From those, 66.1% were female, 64.3% (n=36) had iliac and 35.7% (n=20) femoropopliteal DVT. PTS was present in 52.8% of iliac and 65.0% of femoropopliteal DVT patients observed in consultation (P=0.413). There was a significant correlation with PTS degree and both VEINES-QoL and VEINES-Sym scores (P<0.001). Major depression (OR=5.63, P=0.045) and regular wear of compressing stockings (OR=4.69, P=0.041) were the only independent factors associated with PTS. Patients with depression had lower QoL scores, while patients with PTS who wear compression stockings had similar QoL scores compared to patients without PTS. Ultrasound alterations (OR=3.28, P=0.174), age, gender, iliac DVT, multiple DVT and time after DVT (P>0.2) were not associated with PTS syndrome. CONCLUSIONS VEINES-QoL/Sym had moderate inverse correlation with PTS degree. Depression was associated with both PTS and lower QoL scores. Patients with PTS criteria compliant to wearing compressing stockings had similar QoL scores to patients without PTS.
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Affiliation(s)
- Joana Cruz Silva
- Angiology and Vascular Surgery Department, Centro Hospitalar e Universitário de Coimbra, Praceta Rua Prof. Mota Pinto, Coimbra, Portugal.
| | - Vânia Constâncio
- Angiology and Vascular Surgery Department, Centro Hospitalar e Universitário de Coimbra, Praceta Rua Prof. Mota Pinto, Coimbra, Portugal
| | - Pedro Lima
- Angiology and Vascular Surgery Department, Centro Hospitalar e Universitário de Coimbra, Praceta Rua Prof. Mota Pinto, Coimbra, Portugal
| | - Celso Nunes
- Angiology and Vascular Surgery Department, Centro Hospitalar e Universitário de Coimbra, Praceta Rua Prof. Mota Pinto, Coimbra, Portugal
| | - Eduardo Silva
- Angiology and Vascular Surgery Department, Centro Hospitalar e Universitário de Coimbra, Praceta Rua Prof. Mota Pinto, Coimbra, Portugal
| | - Gabriel Anacleto
- Angiology and Vascular Surgery Department, Centro Hospitalar e Universitário de Coimbra, Praceta Rua Prof. Mota Pinto, Coimbra, Portugal
| | - Manuel Fonseca
- Angiology and Vascular Surgery Department, Centro Hospitalar e Universitário de Coimbra, Praceta Rua Prof. Mota Pinto, Coimbra, Portugal
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Silva WT, Ávila MR, de Oliveira LFF, de Souza IN, de Almeida ILGI, Madureira FP, Lacerda ACR, Mendonça VA, Pereira DAG, Lima VP, Figueiredo PHS, Costa HS. Differences in health-related quality of life in patients with mild and severe chronic venous insufficiency: A systematic review and meta-analysis. JOURNAL OF VASCULAR NURSING 2021; 39:126-133. [PMID: 34865723 DOI: 10.1016/j.jvn.2021.09.002] [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: 03/22/2021] [Revised: 07/18/2021] [Accepted: 09/26/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Chronic venous insufficiency (CVI) has a broad spectrum of clinical expression, ranging from mild to severe cases, which negatively impacts the health-related quality of life (HRQoL). However, the comparison in HRQoL between mild and severe CVI has not yet been systematically discussed, which could assist in the adoption of preventive strategies METHODS: A systematic review and meta-analysis was conducted (protocol register https://osf.io/mr4aj/) following a search of the MEDLINE, CINAHL, Web of Science, LILACS, and Scopus databases, using the terms related to CVI and HRQoL. Observational studies that assessed the HRQoL in individuals with CVI in different degrees of severity were included, without date restriction RESULTS: We retrieved 4750 titles and abstracts and 9 were included in this review. The HRQoL was worse in patients with severe CVI compared to mild patients at Short-form of Health Survey (SF-36) (mean difference 11.02, 95% CI from 8.62 to 13.43; p<0.001), Chronic Venous Insufficiency Quality Of Life Questionnaire (CIVIQ-14) (mean difference 13.07; 95% CI from 11.33 to 14.82; p<0.001) and Aberdeen Varicose Veins Questionnaire (mean difference 7.7; 95% CI: -12.82 to -2.58; p=0.003), especially in the physical domains. There was no difference in the HRQoL between severe and mild patients at CIVIQ-20 (p=0.09) CONCLUSION: The HRQoL was worse in the physical domains in patients with severe CVI when compared to mild patients. However, the heterogeneity of the results was high and the data should be interpreted with caution.
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Affiliation(s)
- Whesley Tanor Silva
- Departamento de Fisioterapia, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Matheus Ribeiro Ávila
- Departamento de Fisioterapia, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | | | - Iara Nepomuceno de Souza
- Departamento de Fisioterapia, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Igor Lucas Geraldo Izalino de Almeida
- Programa de Pós-graduação em Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | | | - Ana Cristina Rodrigues Lacerda
- Departamento de Fisioterapia, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil; Programa de Pós-graduação em Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Vanessa Amaral Mendonça
- Departamento de Fisioterapia, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil; Programa de Pós-graduação em Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Danielle Aparecida Gomes Pereira
- Departamento de Fisioterapia, Escola de Educação Física, Fisioterapia e Terapia Ocupacional, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Vanessa Pereira Lima
- Departamento de Fisioterapia, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil; Programa de Pós-graduação em Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Pedro Henrique Scheidt Figueiredo
- Departamento de Fisioterapia, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil; Programa de Pós-graduação em Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | - Henrique Silveira Costa
- Departamento de Fisioterapia, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil; Programa de Pós-graduação em Reabilitação e Desempenho Funcional, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil.
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15
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Klein TM, Bal B, Newi AL, Bruning G, Sommer R, Augustin M, Blome C. Psychometric properties of the short version of the Freiburg Life Quality Assessment for chronic venous disease (FLQA-VS-10). J Vasc Surg Venous Lymphat Disord 2021; 10:139-145.e1. [PMID: 34530177 DOI: 10.1016/j.jvsv.2021.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 09/03/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Chronic venous disease is a frequent vascular condition. International societies recommend the assessment of health-related quality of life (HRQoL) instruments in patients with vascular diseases. For this purpose, the 10-item questionnaire FLQA-VS-10 had previously been developed. The aim of this study was to validate this instrument in a prospective study. METHODS We recruited 100 patients with recurrent varicosis or (in)complete venous insufficiency undergoing interventional vein treatment (high ligation of the great or the small saphenous vein, or endovenous ablation therapy) who answered the questionnaire along with instruments assessing convergent validation criteria at four timepoints: pre- (T1) and post-surgical (T2) and twice three years later with one week in-between (T3 and T4). RESULTS Patients had a mean age of 56.0 years (SD 13.7), 66.0% were women. Patients presented with recurrent varicosis of the sapheno-femoral junction (28.0%), recurrent varicosis of the sapheno-popliteal junction (1.0%), (in)complete insufficiency of the great saphenous vein (69.0%), or complete insufficiency of the small saphenous vein (2.0%). The items showed few missing values. The FLQA-VS-10 global score showed no ceiling effect (patients reporting highest possible impairments in HRQoL) but a floor effect (patients reporting lowest possible impairments in HRQoL), which was highest at the post-surgical assessments. The internal consistency of the global score was high at all timepoints. Convergent validity and responsiveness analysis revealed that, the FLQA-VS-10 correlated in the expected direction with convergent instruments, including the FLQA-V (venous-disease specific HRQoL) and the EQ-5D-5L (generic HRQoL). Data from T3 and T4 revealed a high test-retest reliability (intraclass correlation = 0.92). Overall, patients stated that the FLQA-VS-10 was comprehensible, comprehensive, and easy-to-answer. CONCLUSION Our data suggest that the FLQA-VS-10 is a reliable, valid, responsive, and feasible HRQoL questionnaire for patients with chronic venous diseases. This questionnaire can serve as short and easy-to-use instrument to assess patient-reported outcomes in the treatment of these patients.
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Affiliation(s)
- Toni Maria Klein
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
| | - Birsel Bal
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Antonia-Luise Newi
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Guido Bruning
- Institute for Scientific Phlebology, Krankenhaus Tabea, Hamburg, Germany
| | - Rachel Sommer
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Christine Blome
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Randomized controlled trial on Dryland And Thermal Aquatic standardized exercise protocol for chronic venous disease (DATA study). J Vasc Surg Venous Lymphat Disord 2021; 9:1226-1234.e2. [DOI: 10.1016/j.jvsv.2020.12.078] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/23/2020] [Indexed: 11/20/2022]
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17
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Asady E, Ghanima W, Jelsness‐Jorgensen L, Klok FA, Kahn SR, Stromme H, Wik HS. Health-related quality-of-life questionnaires for deep vein thrombosis and pulmonary embolism: A systematic review on questionnaire development and methodology. Res Pract Thromb Haemost 2021; 5:e12556. [PMID: 34278190 PMCID: PMC8279125 DOI: 10.1002/rth2.12556] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/19/2021] [Accepted: 05/04/2021] [Indexed: 12/25/2022] Open
Abstract
To improve the quality and accuracy of the patient-reported outcome measures that assess health-related quality of life (HRQoL), guidelines have been developed to standardize the development and validation process. Considering the increasing importance of HRQoL questionnaires in research, we set out to review the literature and evaluate whether existing questionnaires developed for deep vein thrombosis (DVT) and pulmonary embolism (PE) fulfill state-of-the-art requirements. The literature search was conducted in March 2019 and updated in September 2020. Seven databases were searched. No time limit was set for the search to include all available questionnaires. The inclusion criteria were original publications describing the development of disease-specific HRQoL questionnaires specific to DVT or PE in adults and available in English. The questionnaires were assessed to determine whether they fulfill the requirements in the latest guidelines. A total of 3826 references were identified. After the exclusion process, 15 papers were reviewed in full, of which 7 were included. Four questionnaires were developed for chronic venous disease, two were specific to DVT, and one was specific to PE. Most questionnaires we found in this review, fulfilled some but none fulfilled all recommendations in existing guidelines. Because the development of current available HRQoL questionnaires specific to DVT or PE do not fulfil all recommendations of existing guidelines, there is room for improvements within this field. Such improvements could likely enhance the quality associated with the use of these end points in clinical trials and practice.
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Affiliation(s)
- Elia Asady
- Department of ResearchØstfold Hospital TrustGrålumNorway
- Institute of Clinical MedicineUniversity of OsloOsloNorway
| | - Waleed Ghanima
- Department of ResearchØstfold Hospital TrustGrålumNorway
- Institute of Clinical MedicineUniversity of OsloOsloNorway
- Department of HaematologyOslo University HospitalOsloNorway
| | - Lars‐Petter Jelsness‐Jorgensen
- Department of ResearchØstfold Hospital TrustGrålumNorway
- Department of Health SciencesØstfold University CollegeHaldenNorway
| | - F. A. Klok
- Department of Medicine – Thrombosis and HemostasisLeiden University Medical CenterLeidenThe Netherlands
| | - Susan R. Kahn
- McGill UniversityMontrealQCCanada
- Jewish General HospitalMontrealQCCanada
| | - Hilde Stromme
- Library of Medicine and ScienceUniversity of OsloNorway
| | - Hilde S. Wik
- Department of HaematologyOslo University HospitalOsloNorway
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Bavalia R, Bistervels IM, Boersma WG, Quere I, Brisot D, Falvo N, Stephan D, Couturaud F, Schellong S, Beyer‐Westendorf J, Montaclair K, Ghanima W, ten Wolde M, Coppens M, Ferrari E, Sanchez O, Carroll P, Roy P, Kahn SR, Meijer K, Birocchi S, Kovacs MJ, Hugman A, ten Cate H, Wik H, Pernod G, Sevestre‐Pietri M, Grosso MA, Shi M, Lin Y, Hutten BA, Verhamme P, Middeldorp S. Quality of life in patients with pulmonary embolism treated with edoxaban versus warfarin. Res Pract Thromb Haemost 2021; 5:e12566. [PMID: 34278193 PMCID: PMC8279124 DOI: 10.1002/rth2.12566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/19/2021] [Accepted: 05/28/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Long-term sequelae of acute pulmonary embolism (PE) include decreased quality of life (QoL). Evidence suggests that adequacy of initial anticoagulant treatment in the acute phase of venous thrombosis has a key impact on late postthrombotic complications. We hypothesize that patients with acute PE treated with edoxaban for acute PE experience have improved QoL compared to those treated with warfarin. METHODS Patients with PE who participated in the Hokusai-VTE trial were contacted between June 2017 and September 2020 for a single long-term follow-up visit. Main outcomes were the generic and disease-specific QoL measured by the 36-Item Short Form Health Survey (SF-36) and Pulmonary Embolism Quality of Life questionnaire. RESULTS We included 251 patients from 26 centers in eight countries, of which 129 (51%) had been assigned to edoxaban and 122 (49%) to warfarin. Patient- and thrombus-specific characteristics were similar in both groups. Mean time since randomization in the Hokusai-VTE trial was 7.0 years (standard deviation, 1.0). No relevant or statistical differences were observed in the QoL for patients treated with edoxaban compared to patients treated with warfarin. The mean difference between patients treated with edoxaban and patients with PE treated with warfarin was 0.8 (95% confidence interval [CI]. -1.6 to 3.2) for the SF-36 summary mental score and 1.6 (95% CI, -0.9 to 4.1) for summary physical score. CONCLUSION Our findings indicate that patients with an index PE treated with edoxaban or warfarin have a similar long-term QoL. Since our study was a follow-up study from a well-controlled clinical trial setting, future studies should be designed in a daily clinical practice setting. We suggest a longitudinal design for investigation of changes in QoL over time.
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Affiliation(s)
- Roisin Bavalia
- Department of Vascular MedicineAmsterdam Cardiovascular SciencesAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Ingrid M. Bistervels
- Department of Vascular MedicineAmsterdam Cardiovascular SciencesAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
- Department of Internal MedicineFlevo HospitalAlmereThe Netherlands
| | - Wim G. Boersma
- Department of PulmonologyNoordwest ZiekenhuisgroepAlkmaarThe Netherlands
| | - Isabelle Quere
- Department of Vascular MedicineMontpellier University HospitalUniversity of MontpellierMontpellierFrance
| | - Dominique Brisot
- Department of Vascular MedicineClinique du ParcCastelnau Le LezFrance
| | - Nicolas Falvo
- Department of Internal Medicine and ImmunologyCentre Hospitalier Regionale Universitaire DijonDijonFrance
| | - Dominique Stephan
- Department of Hypertension, Vascular Disease and Clinical PharmacologyRegional University HospitalStrasbourgFrance
| | - Francis Couturaud
- Department of PulmonologyCentre Hospitalier Regionale Universitaire BrestBrestFrance
| | | | - Jan Beyer‐Westendorf
- Division of Hematology and HemostasisDeptartment of Medicine IThrombosis ResearchUniversity Hospital “Carl Gustav Carus” DresdenDresdenGermany
| | | | - Waleed Ghanima
- Department of ResearchØstfold Hospital and Institute of Clinical MedicineUniversity of OsloOsloNorway
| | - Marije ten Wolde
- Department of Internal MedicineFlevo HospitalAlmereThe Netherlands
| | - Michiel Coppens
- Department of Vascular MedicineAmsterdam Cardiovascular SciencesAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Emile Ferrari
- Department of CardiologyCentre Hospitalier Universitaire de NiceNiceFrance
| | - Olivier Sanchez
- Department of PulmonologyHôpital Européen Georges‐PompidouParisFrance
| | - Patrick Carroll
- Department of Vascular MedicineRedcliffe HospitalRedcliffeQldAustralia
| | - Pierre‐Marie Roy
- Department of Emergency MedicineCentra Hospitalier Universitaire d'AngersAngersFrance
| | - Susan R. Kahn
- Department of MedicineMcGill UniversityMontrealQCCanada
| | - Karina Meijer
- Department of HematologyUniversity Medical Centre GroningenGroningenThe Netherlands
| | | | - Michael J. Kovacs
- Department of Hematology and ThrombosisLondon Health Sciences CentreVictoria HospitalLondonONCanada
| | - Amanda Hugman
- Department of HaematologySt George HospitalSydneyNSWAustralia
| | - Hugo ten Cate
- Thrombosis Expertise CentreHeart+Vascular CenterMaastricht University Medical CentreMaastrichtThe Netherlands
| | - Hilde Wik
- Department of HaemotologyOslo University HospitalOsloNorway
| | - Gilles Pernod
- Department of MedicineCentre Hospitalier Regionale Universitaire de Grenoble‐AlpesGrenobleFrance
| | | | | | - Minggao Shi
- Daiichi Sankyo Pharma DevelopmentBasking RidgeNJUSA
| | - Yong Lin
- Daiichi Sankyo Pharma DevelopmentBasking RidgeNJUSA
| | - Barbara A. Hutten
- Department of Epidemiology and Data SciencesAmsterdam Cardiovascular SciencesAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Peter Verhamme
- Department of Vascular Medicine and HemostasisUniversity Hospital LeuvenLeuvenBelgium
| | - Saskia Middeldorp
- Department of Vascular MedicineAmsterdam Cardiovascular SciencesAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
- Department of Internal Medicine & Radboud Institute of Health Sciences (RIHSRadboud University Medical CenterNijmegenThe Netherlands
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Sadek M, Pergamo M, Almeida JI, Jacobowitz GR, Kabnick LS. An algorithm combining VVSYmQ® and VCSS scores may help to predict disease severity in C2 patients. Phlebology 2021; 36:809-815. [PMID: 34121506 DOI: 10.1177/02683555211023306] [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
OBJECTIVES The purpose was to assess whether combining patient reported scores (VVSymQ®) and physician reported scores (VCSS) stratifies disease severity in C2 patients. METHODS Consecutive patients were pooled from the VANISH-1 and VANISH-2 cohorts. VCSS and VVSymQ® were calculated for each patient. The relationship between scoring systems was evaluated using Pearson's correlation and frequency distribution analysis. RESULTS Two-hundred and ten C2 limbs were included. Scoring systems demonstrated: VVSymQ®: mean = 8.72; VCSS: mean = 6.32; correlation (r = 0.22, p = 0.05). Frequency distribution analysis demonstrated 61.4% of patients had low VVSymQ® and low VCSS; 31.3% had elevated VVSymQ® and increased VCSS; 7.3% were inconsistent with C2 disease. Strict concordance analysis revealed 40.5% had VVSymQ® (< 9)/VCSS (0-6), 18.6% had VVSymQ® (≥ 9)/VCSS (7-9), and 2.9% had VVSymQ® (≥9)/VCSS (≥10). CONCLUSIONS For combined elevated VVSymQ® and VCSS, moderate/severe disease is corroborated, and intervention may be indicated. For combined lower scores, the disease severity is mild and conservative therapy is more appropriate.
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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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21
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Pappas PJ, Lakhanpal S, Nguyen KQ, Fernandez E, Sufian S. Extended Center for Vein Restoration study assessing comparative outcomes for the treatment of chronic venous insufficiency in Medicare- and non-Medicare-eligible patients. J Vasc Surg Venous Lymphat Disord 2021; 9:1426-1436.e2. [PMID: 33965612 DOI: 10.1016/j.jvsv.2021.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/20/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND We previously reported that chronic venous insufficiency treatment of Medicare-eligible patients achieved outcomes similar to those for non-Medicare-eligible patients. The goal of the present investigation was to assess the long-term treatment outcomes and the effect of race in a larger patient cohort. METHODS From January 2015 to December 2019, we retrospectively reviewed the data from 131,268 patients who had presented for a lower extremity venous evaluation. We divided the patients into two groups by age: group A was aged ≥65 years and group B, <65 years. The treatments analyzed in each group were axial thermal ablation (TA), axial Varithena ablation (VA), TA plus phlebectomy, VA plus phlebectomy, and TA or VA with phlebectomy and ultrasound-guided foam sclerotherapy (UGFS). The treatment outcomes were assessed using the revised venous clinical severity score (rVCSS) and Chronic Venous Insufficiency Quality of Life 20-item questionnaire (CIVIQ-20) scores at the initial consultation and 1, 6, and 12 months after completion of the treatment plan. RESULTS Of the 131,268 patients, 40,020 were in group A and 91,248 in group B, with an average age of 74.4 ± 6.6 and 49.9 ± 10.6 years, respectively. Of the 40,020 patients in group A, 15,697 (n = 25,234 limbs) had undergone TA and 1910 (n = 3222 limbs) had undergone VA. Of the 91,248 patients in group B, 35,220 (n = 53,717 limbs) had undergone TA and 2178 (n = 3672 limbs) had undergone VA. For the TA subgroups, all rVCSSs had significantly improved after treatment at each evaluation point (P ≤ .001). For the TA and VA plus phlebectomy with or without UGFS subgroup, the older patients (group A) required 6 months to develop the same degree of improvement as the younger patients (group B) at 1 month. When subdivided by race, all initial and 6-month rVCSSs and CIVIQ-20 scores within a race had improved and were better in group B, except for Asian and Hispanic patients (P ≤ .001). After TA or VA plus phlebectomy, with or without UGFS, the CIVIQ-20 outcomes had improved by 1 month in both groups, although the rVCSS lagged by 6 months in group A. No differences in the rVCSSs or CIVIQ-20 scores were observed between the groups treated with TA or VA. CONCLUSIONS Medicare-eligible beneficiaries demonstrated improved outcomes similar to those of non-Medicare-eligible beneficiaries after ablation. When TA or VA plus phlebectomy with or without UGFS were examined, group A required 6 months to demonstrate rVCSSs equivalent to those of group B at 1 month. The CIVIQ-20 scores had improved by 1 month in both groups, regardless of the treatment modality. The difference in rVCSSs appeared to be driven by African American and white patients because Hispanic and Asian patients demonstrated equivalent results regardless of age. Patients treated with TA or VA demonstrated equivalent results.
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22
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Silva KLS, Figueiredo EAB, Lopes CP, Vianna MVA, Lima VP, Figueiredo PHS, Costa HS. The impact of exercise training on calf pump function, muscle strength, ankle range of motion, and health-related quality of life in patients with chronic venous insufficiency at different stages of severity: a systematic review. J Vasc Bras 2021; 20:e20200125. [PMID: 34093685 PMCID: PMC8147883 DOI: 10.1590/1677-5449.200125] [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] [Indexed: 11/22/2022] Open
Abstract
Exercise training (ET) is an important tool in the management of patients with chronic venous insufficiency (CVI). The objective of this article was to discuss the effects of ET on the calf pump, functional parameters, and quality of life of patients with mild and advanced CVI. A systematic review was conducted and eleven studies were included. In patients with mild CVI, ET was effective for improving venous reflux, muscle strength, ankle range of motion, and quality of life. In advanced CVI patients, ET increased ejection fraction, reduced residual volume fraction, and improved muscle strength and ankle range of motion, but did not change venous reflux indices or quality of life. It is concluded that ET is effective for improving calf pump function, muscle strength, and ankle range of motion in CVI. In patients with mild CVI, additional benefits were observed in quality of life.
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Affiliation(s)
- Keity Lamary Souza Silva
- Universidade Federal dos Vales do Jequitinhonha e Mucuri - UFVJM, Faculdade de Ciências Biológicas e da Saúde, Departamento de Fisioterapia, Diamantina, MG, Brasil
| | - Eduardo Augusto Barbosa Figueiredo
- Universidade Federal dos Vales do Jequitinhonha e Mucuri - UFVJM, Faculdade de Ciências Biológicas e da Saúde, Departamento de Fisioterapia, Diamantina, MG, Brasil
| | - Cíntia Pimenta Lopes
- Universidade Federal dos Vales do Jequitinhonha e Mucuri - UFVJM, Faculdade de Ciências Biológicas e da Saúde, Departamento de Fisioterapia, Diamantina, MG, Brasil
| | | | - Vanessa Pereira Lima
- Universidade Federal dos Vales do Jequitinhonha e Mucuri - UFVJM, Faculdade de Ciências Biológicas e da Saúde, Departamento de Fisioterapia, Diamantina, MG, Brasil.,Universidade Federal dos Vales do Jequitinhonha e Mucuri - UFVJM, Programa de Pós-graduação em Reabilitação e Desempenho Funcional, Diamantina, MG, Brasil
| | - Pedro Henrique Scheidt Figueiredo
- Universidade Federal dos Vales do Jequitinhonha e Mucuri - UFVJM, Faculdade de Ciências Biológicas e da Saúde, Departamento de Fisioterapia, Diamantina, MG, Brasil.,Universidade Federal dos Vales do Jequitinhonha e Mucuri - UFVJM, Programa de Pós-graduação em Reabilitação e Desempenho Funcional, Diamantina, MG, Brasil
| | - Henrique Silveira Costa
- Universidade Federal dos Vales do Jequitinhonha e Mucuri - UFVJM, Faculdade de Ciências Biológicas e da Saúde, Departamento de Fisioterapia, Diamantina, MG, Brasil.,Universidade Federal dos Vales do Jequitinhonha e Mucuri - UFVJM, Programa de Pós-graduação em Reabilitação e Desempenho Funcional, Diamantina, MG, Brasil
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23
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Serra R, Ielapi N, Bitonti A, Candido S, Fregola S, Gallo A, Loria A, Muraca L, Raimondo L, Velcean L, Guadagna S, Gallelli L. Efficacy of a Low-Dose Diosmin Therapy on Improving Symptoms and Quality of Life in Patients with Chronic Venous Disease: Randomized, Double-Blind, Placebo-Controlled Trial. Nutrients 2021; 13:nu13030999. [PMID: 33808784 PMCID: PMC8003468 DOI: 10.3390/nu13030999] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/14/2021] [Accepted: 03/16/2021] [Indexed: 11/20/2022] Open
Abstract
Chronic Venous Disease (CVD) is a common medical condition affecting up to 80% of the general population. Clinical manifestations can range from mild to more severe signs and symptoms that contribute to the impairment of the quality of life (QoL) of affected patients. Among treatment options, venoactive drugs such as diosmin are widely used in the symptomatic treatment in all clinical stages. The aim of this study is to determine the effectiveness of a new formulated diosmin in relieving symptoms and improving QoL in patients suffering from CVD. In this randomized, double-blind, placebo-controlled, multicenter clinical study, CVD patients with a Clinical-Etiology-Anatomy-Pathophysiology (CEAP) classification system between C2 and C4 were randomized to receive a bioavailable diosmin (as μsmin® Plus) 450 mg tablet once daily or a placebo for 8 weeks. Clinical symptoms and QoL were monitored using the measurement of leg circumference, visual analogue scale (VAS) for pain, Global Index Score (GIS) and Venous Clinical Severity Score (VCSS). A total of 72 subjects completed the study. From week 4, leg edema was significantly decreased in the active group (p < 0.001). An improvement in the VAS score was observed in the active group compared to placebo at the end of treatment (p < 0.05). GIS and VCSS scores were significantly improved in the active group at week 8 (p < 0.001). No treatment related-side effects were recorded. The results of this study showed that the administration of low-dose μsmin® Plus was safe and effective in relieving symptoms and improving QoL in subjects with CVD.
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Affiliation(s)
- Raffaele Serra
- Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, University Magna Graecia of Catanzaro, Viale Europa, 88100 Catanzaro, Italy; (N.I.); (S.F.); (A.G.)
- Department of Medical and Surgical Sciences, University of Catanzaro, 88100 Catanzaro, Italy
- Correspondence: ; Tel.: +39-0961-364-7380
| | - Nicola Ielapi
- Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, University Magna Graecia of Catanzaro, Viale Europa, 88100 Catanzaro, Italy; (N.I.); (S.F.); (A.G.)
- Department of Public Health and Infectious Disease “Sapienza”, University of Rome, 00153 Rome, Italy
| | | | - Stefano Candido
- Intensive Care Unit, Pugliese Ciaccio Hospital of Catanzaro, 88100 Catanzaro, Italy;
| | - Salvatore Fregola
- Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, University Magna Graecia of Catanzaro, Viale Europa, 88100 Catanzaro, Italy; (N.I.); (S.F.); (A.G.)
- EthosLab SRL, 80100 Catanzaro, Italy
| | - Alessandro Gallo
- Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, University Magna Graecia of Catanzaro, Viale Europa, 88100 Catanzaro, Italy; (N.I.); (S.F.); (A.G.)
- EthosLab SRL, 80100 Catanzaro, Italy
| | - Antonio Loria
- Thoracic Surgery Unit, Annunziata Hospital of Cosenza, 87100 Cosenza, Italy;
| | - Lucia Muraca
- Department of General Medicine, Health Agency of Catanzaro, 88100 Catanzaro, Italy;
| | - Luca Raimondo
- Department Emergency, Pugliese Ciaccio Hospital of Catanzaro, 88100 Catanzaro, Italy;
| | | | - Simone Guadagna
- Opera CRO, a Tigermed Company 10 Cozia St., 300209 Timisoara, Romania;
| | - Luca Gallelli
- Department of Health Sciences, University of Catanzaro, 88100 Catanzaro, Italy;
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24
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Morris RI, Pouncey AL, Quintana B, Khan T, Smith A, Saha P, Black SA. Quality of life outcomes for patients undergoing venous stenting for chronic deep venous disease. J Vasc Surg Venous Lymphat Disord 2021; 9:1185-1192.e2. [PMID: 33540137 DOI: 10.1016/j.jvsv.2021.01.009] [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: 08/13/2020] [Accepted: 01/17/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective of the study was to evaluate change in venous disease-specific quality of life (QoL) after iliac vein stenting for chronic venous outflow obstruction. METHODS We performed a retrospective analysis of all Venous Insufficiency Epidemiological and Economic Study - Quality of Life/Symptoms (VEINES-QoL/Sym) questionnaires completed at a single-center between 2016 and 2019 by patients treated with iliac vein stenting for chronic venous outflow obstruction. Patients were asked to complete the questionnaire at baseline (before stenting) and at subsequent follow-up appointments (after stenting), at 6, 12, 24, and 36 months. The Villalta score was recorded by a venous nurse specialist. The initial unpaired analysis compared all completed VEINES-QoL/Sym and Villalta scores at baseline to all follow-up time-points, and then compared them individually between baseline and each follow-up point. A secondary paired analysis included data only from patients who had completed the questionnaire at baseline and at least one follow-up. RESULTS A total of 385 questionnaires from 187 patients who completed the VEINES-QoL/Sym between 2016 and 2019 were included. The median follow-up was 12 months, 127 patients (68%) were female, and 148 (79%) were treated for post-thrombotic syndrome. The median VEINES-QoL score at baseline was 35.69 (interquartile range [IQR], 20.85-46.67). Significant improvement was observed postoperatively and sustained throughout the study period (6 months, 64.81 [IQR, 38.12-83.88]; 12 months, 60.52 [IQR, 33.6-82.3]; 24 months, 60.37 [IQR, 34.31-80.65]; 36 months, 55.98 [IQR, 39.18-81.47]). The VEINES-Sym scores demonstrated similar improvement. A secondary analysis of paired baseline/follow-up data from 61 patients confirmed significant improvement from baseline for VEINES-QoL (6 months +26.45; 12 months, +25.81; 24 months, +30.09; P ≤ .0001), VEINES-Sym (6 months, +23.86; 12 months, +20.43; 24 months, +27.55; P > .001), and Villalta scores (6 months, -3.7; 12 months, -4.2; 24 months, -6.4; P < .0001). The median Villalta score was 14 (IQR, 10-16). This score improved to 9 (IQR, 5-13) at 6 months of follow-up; to 8 (IQR, 5-11) at 12 months; to 7 (IQR, 4-12) at 24 months; and to 6 (IQR, 3.75-10.25) at 36 months (P ≤ .0001). Good correlation between the Villalta and both VEINES-QoL and SYM scores was observed at follow-up (r = 0.69 and r = 0.71, respectively; P < .0001). CONCLUSIONS Venous disease-specific QoL improves and severity of post-thrombotic syndrome is decreased after iliac vein stenting for chronic venous outflow obstruction. These improvements are sustained at 36-month follow-up.
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Affiliation(s)
- Rachael I Morris
- School of Cardiovascular Medicine and Sciences, King's College London, London, UK
| | - Anna L Pouncey
- Department of Vascular Surgery, St Thomas' Hospital, London, UK
| | - Belen Quintana
- Department of Vascular Surgery, St Thomas' Hospital, London, UK
| | - Taha Khan
- Department of Vascular Surgery, St Thomas' Hospital, London, UK
| | - Alberto Smith
- School of Cardiovascular Medicine and Sciences, King's College London, London, UK
| | - Prakash Saha
- School of Cardiovascular Medicine and Sciences, King's College London, London, UK
| | - Stephen A Black
- School of Cardiovascular Medicine and Sciences, King's College London, London, UK.
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25
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Affiliation(s)
- Su-kyung Kwon
- Division of Vascular and Endovascular Surgery, Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hyangkyoung Kim
- Division of Vascular Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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26
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SANRI US, ÖZSİN KK, ATLI F, TOKTAŞ F, YAVUZ S. Kronik venöz yetmezlik olgularında Endovenöz Radyofrekans Ablasyonun Klinik Sonuçları: İki Yıllık Takip Sonuçları. ACTA MEDICA ALANYA 2020. [DOI: 10.30565/medalanya.752398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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27
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Joyce DP, Walsh SR, Tang TY. Adopting a value-based healthcare approach to deep venous obstruction and intervention. Phlebology 2020; 36:4-7. [PMID: 32819206 DOI: 10.1177/0268355520948998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | | | - Tjun Yip Tang
- Department of Vascular Surgery, Singapore General Hospital, Singapore, Singapore.,Duke NUS Graduate Medical School, Singapore, Singapore
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28
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Pappas P, Gunnarsson C, David G. Evaluating patient preferences for thermal ablation versus nonthermal, nontumescent varicose vein treatments. J Vasc Surg Venous Lymphat Disord 2020; 9:383-392. [PMID: 32791306 DOI: 10.1016/j.jvsv.2020.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/02/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To measure patient preferences for attributes associated with thermal ablation and nonthermal, nontumescent varicose vein treatments. METHODS Data were collected from an electronic patient preference survey taken by 70 adult participants (aged 20 years or older) at three Center for Vein Restoration clinics in New Jersey from July 19, 2019, through August 13, 2019. Survey participation was voluntary and anonymous (participation rate of 80.5% [70/87]). Patients were shown 10 consecutive screens that displayed three hypothetical treatment scenarios with different combinations of six attributes of interest and a none option. Choice-based conjoint analysis estimated the relative importance of different aspects of care, trade-offs between these aspects, and total satisfaction that respondents derived from different healthcare procedures. Market simulation analysis compared clusters of attributes mimicking thermal ablation and nonthermal, nontumescent treatments. RESULTS Of the six attributes studied, out-of-pocket (OOP) expenditures were the most important to patients (37.2%), followed by postoperative discomfort (17.1%), risk of adverse events (16.3%), time to return to normal activity (11.0%), number of injections (10.0%), and number of visits (8.4%). Patients were willing to pay the most to avoid postoperative discomfort ($68.9) and risk of adverse events ($65.8). The market simulation analysis found that, regardless of the level of OOP spending, 60% to 80% of respondents favored attribute combinations corresponding with nonthermal, nontumescent procedures over thermal ablation, and that less than 1% of participants would forgo either treatment under no cost sharing. CONCLUSIONS Patients are highly sensitive to OOP costs for minimally invasive varicose vein treatments. Market simulation analysis favored nonthermal, nontumescent procedures over thermal ablation.
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Affiliation(s)
| | | | - Guy David
- University of Pennsylvania Wharton School, Philadelphia, Pa
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29
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Ozturk S, Akbaba KT, Kilic S, Cicek T, Peskircioglu L, Tandogan I, Gurlek A, Aydemir O, Ileri M, Yetkin E. Ecchymosis and Coldness in Peripheral Varicose Vein Patients: Observations From VEIN-TURKEY Study. INT J LOW EXTR WOUND 2020; 19:262-268. [DOI: 10.1177/1534734620917911] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The purpose of this subgroup analysis is to investigate and analyze the venous leg symptoms including sense of coldness and sign of ecchymosis in patients with or without peripheral varicose veins (PVVs) from VEIN-TURKEY study population. A total of 600 patients, who were enrolled to VEIN-TURKEY study recently, were included in this subgroup analysis. Patients were examined clinically for the presence and severity of PVV and varicocele. Patients were asked to answer the VEINES-Sym questionnaire consisting of 10 parts and questions about ecchymosis and coldness in their legs. Frequency of symptoms present in the VEINES-Sym instrument, coldness (16.6%, 6.5%, P = .002, respectively), and ecchymosis (16.6%, 2.7%, P < .001, respectively) were significantly higher in patients with PVV compared to patients without PVV. Mean score of each symptom was significantly lower in PVV (+) patients including scores of ecchymosis and coldness. Total VEINES-Sym score was also correlated with the scores of ecchymosis ( r = 0.18, P < .001) and coldness ( r = 0.35, P < .001). Logistic regression analysis revealed that heavy legs, aching legs, night cramps, and ecchymosis are significantly and independently associated with PVV. In conclusion, sign of ecchymosis and coldness are significantly higher in patients with PVV compared to patients without PVV in a population recruited from the urology clinics. In clinical evaluation, presence or sign of ecchymosis and coldness in legs should be considered to be compatible with PVV in the absence of trauma, hematologic pathologies including antiplatelet treatment, and arterial stenosis or obstruction.
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Affiliation(s)
- Selcuk Ozturk
- Ankara Education and Research Hospital, Ankara, Turkey
| | | | | | - Tufan Cicek
- Baskent University Konya Education and Research Hospital, Konya, Turkey
| | | | | | | | | | - Mehmet Ileri
- University of Health Sciences Ankara Bilkent City Hospital, Ankara, Turkey
| | - Ertan Yetkin
- Istinye University Liv Hospital, Istanbul, Turkey
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30
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Lurie F, Passman M, Meisner M, Dalsing M, Masuda E, Welch H, Bush RL, Blebea J, Carpentier PH, De Maeseneer M, Gasparis A, Labropoulos N, Marston WA, Rafetto J, Santiago F, Shortell C, Uhl JF, Urbanek T, van Rij A, Eklof B, Gloviczki P, Kistner R, Lawrence P, Moneta G, Padberg F, Perrin M, Wakefield T. The 2020 update of the CEAP classification system and reporting standards. J Vasc Surg Venous Lymphat Disord 2020; 8:342-352. [PMID: 32113854 DOI: 10.1016/j.jvsv.2019.12.075] [Citation(s) in RCA: 326] [Impact Index Per Article: 81.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 12/22/2019] [Indexed: 12/26/2022]
Abstract
The CEAP (Clinical-Etiology-Anatomy-Pathophysiology) classification is an internationally accepted standard for describing patients with chronic venous disorders and it has been used for reporting clinical research findings in scientific journals. Developed in 1993, updated in 1996, and revised in 2004, CEAP is a classification system based on clinical manifestations of chronic venous disorders, on current understanding of the etiology, the involved anatomy, and the underlying venous pathology. As the evidence related to these aspects of venous disorders, and specifically of chronic venous diseases (CVD, C2-C6) continue to develop, the CEAP classification needs periodic analysis and revisions. In May of 2017, the American Venous Forum created a CEAP Task Force and charged it to critically analyze the current classification system and recommend revisions, where needed. Guided by four basic principles (preservation of the reproducibility of CEAP, compatibility with prior versions, evidence-based, and practical for clinical use), the Task Force has adopted the revised Delphi process and made several changes. These changes include adding Corona phlebectatica as the C4c clinical subclass, introducing the modifier "r" for recurrent varicose veins and recurrent venous ulcers, and replacing numeric descriptions of the venous segments by their common abbreviations. This report describes all these revisions and the rationale for making these changes.
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Affiliation(s)
- Fedor Lurie
- Jobst Vascular Institute, Toledo, Ohio; Division of Vascular Surgery, University of Michigan, Ann Arbor, Mich.
| | - Marc Passman
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Ala
| | - Mark Meisner
- Department of Surgery, University of Washington School of Medicine, Seattle, Wash
| | - Michael Dalsing
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Ind
| | - Elna Masuda
- Department of Surgery, University of Hawaii, Honolulu, Hi
| | - Harold Welch
- Vascular Surgery, Lahey Hospital and Medical Center, Burlington, Mass
| | - Ruth L Bush
- University of Houston College of Medicine, Houston, Tex
| | - John Blebea
- Department of Surgery, Central Michigan University College of Medicine, Saginaw, Mich
| | | | | | | | | | - William A Marston
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Joseph Rafetto
- Harvard Medical School, Uniformed Services University of the Health Sciences, VA Boston HCS, Brigham and Women's Hospital, Boston, Mass
| | | | - Cynthia Shortell
- Department of Surgery, Duke University Medical Center, Durham, NC
| | | | | | - André van Rij
- Dunedin School of Medicine, University of Otago, Otago, New Zealand
| | - Bo Eklof
- Department of Surgery, University of Hawaii, Honolulu, Hi
| | | | - Robert Kistner
- Department of Surgery, University of Hawaii, Honolulu, Hi
| | | | | | | | - Michel Perrin
- Service de Chirurgie Vasculaire, Clinique du Grand Large, Décines, France
| | - Thomas Wakefield
- Division of Vascular Surgery, University of Michigan, Ann Arbor, Mich
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Abstract
PURPOSE OF THE REVIEW Venous disease is common. Depending on the population studied, the prevalence may be as high as 80%. Significant chronic venous disease with venous ulcers or trophic skin changes is reported to affect 1-10% of the population. A systematic assessment of the clinical findings associated with chronic venous disease will facilitate appropriate imaging. Based on imaging and assessment, patients with reflux or obstruction can be recommended proper medical and endovascular or surgical management. RECENT FINDINGS Many types of endovascular management are available to treat reflux and eliminate varicose veins and tributaries. More recently adopted non-thermal non-tumescent techniques have been shown to be comparable with more widely performed laser or radiofrequency ablation techniques. A thorough clinical assessment, appropriate duplex ultrasound imaging, and use of advanced imaging when needed will allow clinicians to optimize therapy for patients with chronic venous disease based on the etiology, anatomy involved, and the pathophysiology.
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Affiliation(s)
- Teresa L Carman
- University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Mail stop LKS 3038, Cleveland, OH, 44106, USA.
| | - Ali Al-Omari
- Northern Light Eastern Maine Medical Center, Bangor, ME, USA
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Ozberk S, Karadibak D, Polat M. Predictors of exercise capacity in chronic venous disease patients. Phlebology 2019; 35:190-198. [DOI: 10.1177/0268355519870895] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objectives The aim of this study was to determine predictors of exercise capacity and explore the relationship between exercise capacity, lower extremity performance level, pain, fatigue, physical activity, sleep quality, and quality of life in patients with chronic venous disease. Methods A total of 170 chronic venous disease patients who were referred to the Cardiovascular Surgery department were included. Assessment tools included the six-minute walk test for exercise capacity, repeated sit-to-stand test for lower limb performance level, Visual Analog Scale for pain, Fatigue Severity Scale for fatigue, Pittsburgh Sleep Quality Index for sleep quality, International Physical Activity Questionnaire for physical activity, and Venous Insufficiency Epidemiological and Economic Study’s Quality of Life questionnaire for quality of life. Results Exercise capacity was weakly and negatively correlated with body mass index (r = –0.391, p < 0.001), pain level (r = –0.268, p < 0.001), age (r = –0.355, p < 0.001), and fatigue severity (r = –0.141, p < 0.05). There was a weak positive correlation in walking distance with quality of life (r = –0.129, p < 0.05) and education level (r = 0.166, p < 0.05), whereas moderate positive correlation was observed between walking distance and lower limb performance level (r = 0.518, p < 0.001). Lower limb performance level was a significant predictor of exercise capacity, accounting for 50% of the variance. Conclusions Exercise capacity is an important determinant of morbidity. Therefore, there is a need to improve lower extremity performance and functional mobility in patients suffering from chronic venous disease.
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Affiliation(s)
- Sema Ozberk
- Institute of Health Science, Dokuz Eylul University, Izmir, Turkey
| | - Didem Karadibak
- School of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
| | - Muslum Polat
- Department of Cardiovasculary Surgery, Dr. Ersin Arslan Education and Research Hospital, Gaziantep, Turkey
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Lam YL, Lawson JA, Toonder IM, Shadid NH, Sommer A, Veenstra M, van der Kleij AMJ, Ceulen RP, de Haan E, Ibrahim F, van Dooren T, Nieman FH, Wittens CHA. Eight-year follow-up of a randomized clinical trial comparing ultrasound-guided foam sclerotherapy with surgical stripping of the great saphenous vein. Br J Surg 2019; 105:692-698. [PMID: 29652081 DOI: 10.1002/bjs.10762] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 09/24/2017] [Accepted: 10/20/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND This was an 8-year follow-up of an RCT comparing ultrasound-guided foam sclerotherapy (UGFS) with high ligation and surgical stripping (HL/S) of the great saphenous vein (GSV). METHODS Patients were randomized to UGFS or HL/S of the GSV. The primary outcome was the recurrence of symptomatic GSV reflux. Secondary outcomes were patterns of reflux according to recurrent varices after surgery, Clinical Etiologic Anatomic Pathophysiologic (CEAP) classification, Venous Clinical Severity Score (VCSS) and EuroQol Five Dimensions (EQ-5D™) quality-of-life scores. RESULTS Of 430 patients originally randomized (230 UGFS, 200 HL/S), 227 (52·8 per cent; 123 UGFS, 103 HL/S) were available for analysis after 8 years. The proportion of patients free from symptomatic GSV reflux at 8 years was lower after UGFS than HL/S (55·1 versus 72·1 per cent; P = 0·024). The rate of absence of GSV reflux, irrespective of venous symptoms, at 8 years was 33·1 and 49·7 per cent respectively (P = 0·009). More saphenofemoral junction (SFJ) failure (65·8 versus 41·7 per cent; P = 0·001) and recurrent reflux in the above-knee GSV (72·5 versus 20·4 per cent; P = 0·001) was evident in the UGFS group. The VCSS was worse than preoperative scores in both groups after 8 years; CEAP classification and EQ-5D® scores were similar in the two groups. CONCLUSION Surgical stripping had a technically better outcome in terms of recurrence of GSV and SFJ reflux than UGFS in the long term. Long-term follow-up suggests significant clinical progression of venous disease measured by VCSS in both groups, but less after surgery. Registration number: NCT02304146 (http://www.clinicaltrials.gov).
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Affiliation(s)
- Y L Lam
- Department of Venous Surgery, European Venous Centre, Maastricht, The Netherlands.,Department of Dermatology, Erasmus MC, Rotterdam, The Netherlands
| | - J A Lawson
- Skin and Vein Clinic Oosterwal, Alkmaar, The Netherlands
| | - I M Toonder
- Department of Venous Surgery, European Venous Centre, Maastricht, The Netherlands
| | - N H Shadid
- Department of Dermatology, Haaglanden Medisch Centrum Antoniushove, The Hague, The Netherlands
| | - A Sommer
- Parkwegkliniek Sommer, Maastricht, The Netherlands
| | - M Veenstra
- Department of Dermatology, Rijnstate Hospital, Arnhem, The Netherlands
| | - A M J van der Kleij
- Department of Dermatology, Zuyderland Medisch Centrum, Heerlen, The Netherlands
| | - R P Ceulen
- Ceulen Huidkliniek, Helmond, The Netherlands
| | - E de Haan
- Department of Surgery, Laurentius Hospital, Roermond, The Netherlands
| | - F Ibrahim
- Department of Dermatology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - T van Dooren
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - F H Nieman
- Department of Venous Surgery, European Venous Centre, Maastricht, The Netherlands
| | - C H A Wittens
- Department of Venous Surgery, European Venous Centre, Maastricht, The Netherlands.,Department of Vascular Surgery, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Nordrhein-Westfalen, Aachen, Germany
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Shutze W, Shutze R, Dhot P, Ogola GO. Patient-reported outcomes of endovenous superficial venous ablation for lower extremity swelling. Phlebology 2018; 34:391-398. [PMID: 30466354 DOI: 10.1177/0268355518814130] [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: 11/16/2022]
Abstract
Objective To evaluate the effect of endovenous ablation in patients presenting with leg swelling. Methods We identified Clinical, Etiology, Anatomy, Pathophysiology (CEAP) clinical class 3 (C3) patients undergoing endovenous ablation from 21 January 2005 to 19 March 2015 with an 810-nm or 1470-nm laser. Patients were surveyed regarding the degree of edema, use of compression stockings, and satisfaction with the procedure. Results A total of 1634 limbs were treated by endovenous ablation for incompetent saphenous veins with or without adjunctive segmental varicose vein microphlebectomy. Of these, 528 limbs were treated for CEAP C3. The average time period from the procedure date until the survey date was 1494 days (range, 562–2795 days). Ninety-two respondents accounted for 130 ablations in 128 limbs with an average venous segmental disease score of 2.7. Ninety-seven limbs (75.8%) had reduced or resolved swelling, 29 limbs (22.6%) were unchanged, and 2 limbs (1.6%) had increased swelling. The vast majority (81%) were satisfied with their decision to have the procedure. Conclusions Endovenous ablation for edema secondary to superficial venous insufficiency is effective and has high patient satisfaction. Further investigation is needed regarding risk factors for immediate failure and delayed recurrence of edema.
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Affiliation(s)
- William Shutze
- 1 Texas Vascular Associates, Dallas, Texas, USA.,2 The Heart Hospital Baylor Plano, Dallas, Texas, USA
| | - Ryan Shutze
- 1 Texas Vascular Associates, Dallas, Texas, USA
| | - Paul Dhot
- 1 Texas Vascular Associates, Dallas, Texas, USA.,2 The Heart Hospital Baylor Plano, Dallas, Texas, USA
| | - Gerald O Ogola
- 3 Center for Clinical Effectiveness, Baylor Scott and White Health, Dallas, Texas, USA
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Kalodiki E, Azzam M, Schnatterbeck P, Geroulakos G, Lattimer CR. The Discord Outcome Analysis (DOA) as a Reporting Standard at Three Months and Five Years in Randomised Varicose Vein Treatment Trials. Eur J Vasc Endovasc Surg 2018; 57:267-274. [PMID: 30342999 DOI: 10.1016/j.ejvs.2018.09.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 09/07/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Treatment success for chronic superficial venous insufficiency could be defined as an improvement in three domains: (i) disease specific quality of life, (ii) clinical severity, (iii) reflux. The aim was to report these at five years using a Venn diagram to profile the outcomes: a discord outcome analysis (DOA). METHODS Patients (n = 50 patients/legs in each treated group) were randomised to endovenous laser ablation (EVLA) with concurrent phlebectomies vs. ultrasound guided foam sclerotherapy (UGFS). Outcomes were assessed using three domains: (i) Aberdeen varicose vein questionnaire (AVVQ), (ii) venous clinical severity score (VCSS), (iii) venous filling index (VFI) of air plethysmography. Change scores were calculated by subtracting the final score after treatment from the baseline score before treatment to quantify the improvement. This was followed by a DOA profile for each patient where a discord was defined as the percentage of patients with a numerical deterioration in one or two domains. RESULTS The median [interquartile range] follow up was 68 [64-72] months. Follow up in all three domains was EVLA: 45/50, UGFS: 42/50. On ultrasound examination, GSV occlusion at some point above the knee was 93% for EVLA and 64% for UGFS (p = .001). There was no significant difference in improvement between the two treatment groups in the VCSS and the VFI. However, the EVLA group had a statistically significant AVVQ improvement (p = .004). Using a DOA, only 76% EVLA versus 60% UGFS had success in all three domains. Using improvement thresholds, this reduced to 54% and 39%, respectively. The commonest discord pattern was an improvement in the VCSS and VFI but deterioration in the AVVQ. CONCLUSIONS A DOA demonstrated that the definition of success is reduced if deterioration in one or two domains is taken into account. A DOA should be considered as a reporting standard for comparative analyses.
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Affiliation(s)
- Evi Kalodiki
- Josef Pflug Vascular Laboratory, Ealing Hospital, Middlesex, UK; Department of Surgery and Cancer, Imperial College, London, UK; West London Vascular and Interventional Centre, Northwick Park Hospital, Harrow, UK
| | - Mustapha Azzam
- Josef Pflug Vascular Laboratory, Ealing Hospital, Middlesex, UK
| | - Peter Schnatterbeck
- Josef Pflug Vascular Laboratory, Ealing Hospital, Middlesex, UK; West London Vascular and Interventional Centre, Northwick Park Hospital, Harrow, UK
| | - George Geroulakos
- Josef Pflug Vascular Laboratory, Ealing Hospital, Middlesex, UK; Department of Surgery and Cancer, Imperial College, London, UK
| | - Christopher R Lattimer
- Josef Pflug Vascular Laboratory, Ealing Hospital, Middlesex, UK; Department of Surgery and Cancer, Imperial College, London, UK; West London Vascular and Interventional Centre, Northwick Park Hospital, Harrow, UK.
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Bechsgaard T, Hansen KL, Brandt A, Moshavegh R, Forman JL, Føgh P, Klitfod L, Bækgaard N, Lönn L, Jensen JA, Nielsen MB. Evaluation of Peak Reflux Velocities with Vector Flow Imaging and Spectral Doppler Ultrasound in Varicose Veins. Ultrasound Int Open 2018; 4:E91-E98. [PMID: 30276359 PMCID: PMC6162191 DOI: 10.1055/a-0643-4430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 04/24/2018] [Accepted: 05/17/2018] [Indexed: 10/29/2022] Open
Abstract
Purpose Spectral Doppler ultrasound (SDUS) is used for quantifying reflux in lower extremity varicose veins. The technique is angle-dependent opposed to the new angle-independent Vector Flow Imaging (VFI) method. The aim of this study was to compare peak reflux velocities obtained with VFI and SDUS in patients with chronic venous disease, i. e., pathological retrograde blood flow caused by incompetent venous valves. Materials and Methods 64 patients with chronic venous disease were scanned with VFI and SDUS in the great or the small saphenous vein, and reflux velocities were compared to three assessment tools for chronic venous disease. A flow rig was used to assess the accuracy and precision of the two methods. Results The mean peak reflux velocities differed significantly (VFI: 47.4 cm/s vs. SDUS: 62.0 cm/s, p<0.001). No difference in absolute precision (p=0.18) nor relative precision (p=0.79) was found. No correlation to disease severity, according to assessment tools, was found for peak reflux velocities obtained with either method. In vitro, VFI was more accurate but equally precise when compared to SDUS. Conclusion Both VFI and SDUS detected the pathologic retrograde flow in varicose veins but measured different reflux velocities with equal precision. VFI may play a role in evaluating venous disease in the future.
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Affiliation(s)
| | | | - Andreas Brandt
- Copenhagen University Hospital Rigshospitalet, Department of Diagnostic Radiology, 2100 Copenhagen Oe, Denmark
| | - Ramin Moshavegh
- The Technical University of Denmark, Department of Electrical Engineering Center for Fast Ultrasound Imaging, 2800 Kgs. Lyngby, Denmark
| | - Julie Lyng Forman
- Copenhagen University, Department of Public Health Section of Biostatistics, 1014 Copenhagen K, Denmark
| | - Pia Føgh
- Copenhagen University Hospital Rigshospitalet, Department of Vascular Surgery Herlev & Gentofte Hospital, 2900 Hellerup, Denmark
| | - Lotte Klitfod
- Copenhagen University Hospital Rigshospitalet, Department of Vascular Surgery Herlev & Gentofte Hospital, 2900 Hellerup, Denmark
| | - Niels Bækgaard
- Copenhagen University Hospital Rigshospitalet, Department of Vascular Surgery Herlev & Gentofte Hospital, 2900 Hellerup, Denmark
| | - Lars Lönn
- Rigshospitalet, Copenhagen, DK, Radiology, Copenhagen, Denmark
| | - Jørgen Arendt Jensen
- Technical University of Denmark, Department of Electrical Engineering Center for Fast Ultrasound Imaging, 2800 Kgs. Lyngby, Denmark
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Effects of intermittent pneumatic compression treatment on clinical outcomes and biochemical markers in patients at low mobility with lower limb edema. J Vasc Surg Venous Lymphat Disord 2018; 6:500-510. [DOI: 10.1016/j.jvsv.2018.01.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 01/27/2018] [Indexed: 01/22/2023]
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Ozturk S, Akbaba KT, Kılıc S, Cıcek T, Peskırcıoglu L, Tandogan I, Gurlek A, Aydemır O, Ilerı M, Yetkın E. Venous leg symptoms in patients with varicocele: A multicenter assessment study (VEIN-TURKEY study). Phlebology 2018; 34:128-136. [PMID: 29793400 DOI: 10.1177/0268355518777110] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The aim of this study is to evaluate chronic venous disease symptoms by using the Venous Insufficiency Epidemiological and Economic Study-Quality of Life/Symptoms (VEINES-QoL/Sym) questionnaire in varicocele patients. MATERIAL AND METHODS The study was designed as a prospective, case controlled study and conducted in four hospitals from Turkey. A total of 600 patients who admitted to urology outpatient clinic were enrolled to the study. After the exclusion of 44 patients who do not match the inclusion criteria, the remaining 556 patients were examined for the presence and grade of varicocele and subsequently examined clinically for the presence of chronic venous disease findings. Finally, patients were asked to answer the VEINES-Sym questionnaire consisting of 10 items. All patients' demographic parameters, cardiovascular risk factors, other co-morbid diseases and drug usage were noted. RESULTS Patients were classified into two groups: varicocele (+) group ( n = 269) and varicocele (-) group ( n = 287). VEINES-Sym scores of varicocele patients were lower compared to patients without varicocele (41.41 ± 5.21, 43.19 ± 3.22, respectively, p < 0.001). Grades of varicocele significantly but inversely correlated with VEINES-Sym score ( r = 0, -206, p = 0.001). Logistic regression analysis revealed that presence of varicocele irrespective of grading significantly and independently associated with the presence of aching (odds ratio: 2.054, 95% confidence interval: 1.265-3.338, p = 0.004) and throbbing (odds ratio: 2.586, 95% confidence interval: 1.353-4.943, p = 0.004). CONCLUSION Varicocele patients have lower VEINES-Sym scores compared to patients without varicocele and this finding is inversely correlated with the degree of the varicocele. This association supports the hypothesis that there may be a systemic vessel wall abnormality in venous disease patients. Patients with symptoms related to vascular dilatation in any territory may deserve to be assessed systematically with the support of further clinical studies.
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Affiliation(s)
- Selcuk Ozturk
- 1 Ankara Education and Research Hospital, Department of Cardiology, Ankara, Turkey
| | | | - Suleyman Kılıc
- 3 Batman Private Dünya Hospital, Urology Clinic, Batman, Turkey.,4 İstinye University, Department of Urology, Istanbul, Turkey
| | - Tufan Cıcek
- 5 Baskent University Konya Education and Research Hospital, Department of Urology, Konya, Turkey
| | - Levent Peskırcıoglu
- 6 Baskent University Ankara Education and Research Hospital, Department of Urology, Ankara, Turkey
| | - Izzet Tandogan
- 7 Private Malatya Gozde Hospital, Department of Cardiology, Malatya, Turkey
| | - Ahmet Gurlek
- 7 Private Malatya Gozde Hospital, Department of Cardiology, Malatya, Turkey
| | - Ozbay Aydemır
- 8 Private Malatya Gozde Hospital, Department of Urology, Malatya, Turkey
| | - Mehmet Ilerı
- 9 Ankara Numune Education and Research Hospital, Department of Cardiology Ankara, Turkey
| | - Ertan Yetkın
- 10 Private Yenisehir Hospital, Department of Cardiology, Mersin, Turkey
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Bissacco D, Oberto S. Venous procedures and quality of life scores: Time erases memories. Vascular 2018; 26:341. [PMID: 29665750 DOI: 10.1177/1708538118772677] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- D Bissacco
- 1 School of Vascular Surgery, Università degli Studi di Milano, Milan, Italy.,2 Vascular Surgery Unit, IRCCS Multimedica, Sesto San Giovanni, Italy
| | - S Oberto
- 2 Vascular Surgery Unit, IRCCS Multimedica, Sesto San Giovanni, Italy
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Lam YL, De Maeseneer M, Lawson J, De Borst GJ, Boersma D. Expert review on the VenaSeal® system for endovenous cyano-acrylate adhesive ablation of incompetent saphenous trunks in patients with varicose veins. Expert Rev Med Devices 2018; 14:755-762. [PMID: 28892412 DOI: 10.1080/17434440.2017.1378093] [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] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The treatment of incompetent truncal veins has been innovated by the introduction of minimally invasive non-thermal non-tumescent (NTNT) techniques. One of these consists of the use of cyanoacrylate glue to occlude the vein lumen by means of the VenaSeal device. Areas covered: This expert-review aims to evaluate NTNT ablation of incompetent saphenous trunks using the VenaSeal device. Expert commentary: Cyanoacrylate adhesive embolization of incompetent truncal veins using the VenaSeal device is a safe and efficacious innovative technique. Further studies are needed to evaluate anatomical and clinical outcomes at long term.
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Affiliation(s)
- Yee Lai Lam
- a Department of Dermatology , Erasmus MC , Rotterdam , The Netherlands
| | | | - James Lawson
- b Skin and Vein Clinic Oosterwal , Alkmaar , The Netherlands
| | - Gert Jan De Borst
- c Department of Vascular Surgery , University Medical Center , Utrecht , The Netherlands
| | - Doeke Boersma
- d Department of Surgery , Jeroen Bosch Hospital , 's-Hertogenbosch , The Netherlands
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Abstract
SummaryPurpose: Textile compression stockings or bandages are limited in comfort; they do not allow uninterrupted wearing. A novel elastic film bandage was evaluated regarding practicability, patient comfort and effect on vein regression. Main endpoint was the frequency of symptomatic inflammatory reactions.Methods: In a comparative pilot study, a compression film bandage (CFB, investigational) comprising an elastic, self-adhesive breathable polymer film of d <20 µm was continuously worn for 14 d after foam sclero-therapy. Inclusion: 62 patients (26–68 y.) frequently doing sports and taking daily showers, 90 legs with superficial varicosities, 5–12 mm ø (MW: 7.3 mm), randomized to A) CFB + medical compression stocking (MCS), B) MCS alone, C) CFB alone. Follow-up examinations including ultrasound and photography were performed after 2, 4 and 8 weeks.Results: Continuous wearing time of 14 days was completed in 57/60 cases with CFB (95.0 %, A+C), while 3/60 (5.0 %) finished wearing after 8–10 d. There were no adverse skin reactions except minor irritations at the upper edge (n = 2). Vein diameters were reduced within 14 days by 29–54 % (mean: 43.5 %) in group A, 16–44% (mean: 39.1 %) in group B, and 24–50 % (mean: 37.3 %) in group C. Symptomatic inflammation, indu-ration or discolouration was observed within 28 days in 5/60 cases (8.3 %) when using CFB (A, C) versus 19/30 (63.3%) related to stocking compression (B). Comfort was rated by the patients 6.6 (A), 4.3 (B) and 9.2 (C) on a 10 degree scale. This difference was statistically highly significant (p <0.01).Conclusions: The film bandage is an effective and safe compression modality. For superficial varicosities the adhesive bond to the skin seems to be relevant additional to the elastic properties. The device significantly improves vein regression of foam-treated superficial varicosities when combined with compression stockings or even as stand-alone modality. Continuous wearing for two weeks is well tolerated. The bandage may also offer an alternative for patients not tolerating textile compression media, or during summer.
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Sinabulya H, Bergström G, Hagberg J, Johansson G, Blomgren L. Cultural adaptation and validation of the Swedish VEINES-QOL/Sym in patients with venous insufficiency. Phlebology 2017; 33:540-546. [DOI: 10.1177/0268355517733406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives To translate and evaluate the psychometric properties of the Venous Insufficiency Epidemiological and Economic Studies (VEINES) questionnaire, divided into two subscales; symptoms (VEINES-Sym) and quality of life (VEINES-QOL), in a Swedish cohort of patients with venous disease. Methods The original questionnaire was translated into Swedish with forward–backward translation and administered to 112 patients who were consecutively recruited and had varying degrees of chronic venous disease. Mean age was 54.5 ± 15.2 years (range: 19–83) and 75% of the participants were female. All patients completed the RAND 36-item health survey and the VEINES-QOL/Sym. Results The results showed excellent internal consistency for both VEINES-QOL (Cronbach's alpha (α) = 0.93) and VEINES-Sym (α = 0.89). Both the VEINES-QOL and VEINES-Sym correlated well to all the RAND-36 domains, demonstrating good construct validity. Exploratory factor analysis confirmed both subscales of the VEINES-QOL/Sym. Conclusions The Swedish VEINES-QOL/Sym is a valid health-related quality of life instrument for chronic venous disease, both for research purposes and for clinical evaluation.
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Affiliation(s)
- Helen Sinabulya
- Department of Molecular Medicine and Surgery, Division of Vascular Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Vascular Surgery, Skåne University Hospital, Lund, Sweden
| | - Gunnar Bergström
- Institution of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jan Hagberg
- Institution of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Gunnar Johansson
- Department of Molecular Medicine and Surgery, Division of Vascular Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Lena Blomgren
- Department of Molecular Medicine and Surgery, Division of Vascular Surgery, Karolinska Institutet, Stockholm, Sweden
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Catarinella FS, Nieman FHM, Wittens CHA. The relation between clinical scores and quality-of-life in long-term follow-up. Phlebology 2016; 31:99-105. [PMID: 26916776 DOI: 10.1177/0268355516631653] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Quality-of-life and severity scores are both popular measures in medicine. For deep venous obstruction, the VEINES-QOL/Sym and venous clinical severity score (VCSS) are widely used. Combining a patient-reported outcome with a clinical severity score should give a more sensitive outcome for treatment results. To establish and compare their suitability for deep venous disease, we compared the outcomes of both scores in a group of patients who were interventionally treated for deep venous disease. METHODS The venous clinical severity scores and VEINES-QOL/Sym scores of a group of patients who had received interventional treatment for deep venous obstruction more than 12 months ago were compared at T0 and T12. RESULTS Both the Spearman's rho and Pearson's r show a very weak, negative correlation (statistically significant (p ≤ 0.05)), between the venous clinical severity score and VEINES-QOL at T12 and between the venous clinical severity score and the VEINES-SYM at both T0 and T12. T0 VCSS-VSYM: rho = -0.219 (p = 0.052), r = -0.236 (p = 0.037), T12 VCSS-VQOL: rho = -0.459 (p = 0.007), r = -0.379 (p = 0.030), T12 VCSS-VSYM: rho = -0.463 (p = 0.007), r = -0.432 (p = 0.012). This negative correlation was not statistically (p ≥ 0.05) confirmed for T0 VCSS-VSYM. CONCLUSION The physician-scored venous clinical severity score of patients treated for deep venous obstruction does not correlate well with their self-reported quality-of-life and symptom scores.
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Affiliation(s)
- Fabio S Catarinella
- Department of Venous Surgery, European Venous Centre, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Fred H M Nieman
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Cees H A Wittens
- Department of Venous Surgery, European Venous Centre, Maastricht University Medical Centre, Maastricht, Netherlands Department of Vascular Surgery, Uniklinikum Aachen, Aachen, Germany
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Yamany A, Hamdy B. Effect of sequential pneumatic compression therapy on venous blood velocity, refilling time, pain and quality of life in women with varicose veins: a randomized control study. J Phys Ther Sci 2016; 28:1981-7. [PMID: 27512247 PMCID: PMC4968489 DOI: 10.1589/jpts.28.1981] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 04/07/2016] [Indexed: 12/02/2022] Open
Abstract
[Purpose] The aim of this study was to investigate the effects of sequential pneumatic
compression therapy on venous blood flow, refilling time, pain level, and quality of life
in women with varicose veins. [Subjects and Methods] Twenty-eight females with varicose
veins were selected and randomly allocated to a control group, and experimental group.
Maximum and mean venous blood velocities, the refilling time, pain by visual analog scale
and quality of life by Aberdeen Varicose Veins Questionnaire were measured in all patients
before and after six weeks of treatment. Both groups received lower extremity exercises;
in addition, patients in the experimental group received sequential pneumatic compression
therapy for 30 minutes daily, five days a week for six weeks. [Results] All measured
parameters improved significantly in both groups, comparison of post treatment
measurements between groups showed that the maximum and mean blood flow velocity, the pain
level, and quality of life were significantly higher in the experimental group compared
with the control group. On the other hand there was no significant difference between
groups for refilling time. [Conclusion] Sequential pneumatic compression therapy with the
applied parameters was an effective modality for increasing venous blood flow, reducing
pain, and improving quality of women life with varicose veins.
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Affiliation(s)
- Abeer Yamany
- Department of Basic Science, Faculty of Physical Therapy, Cairo University, Egypt
| | - Bassant Hamdy
- Department of Cardiopulmonary Disorders, Faculty of Physical Therapy, Cairo University, Egypt
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Regarding "An overview of the most commonly used venous quality of life and clinical outcome measurements". J Vasc Surg Venous Lymphat Disord 2016; 3:465. [PMID: 26992628 DOI: 10.1016/j.jvsv.2015.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 03/25/2015] [Indexed: 11/22/2022]
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