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

Association between the saphenous vein diameter and venous reflux on computed tomography venography in patients with varicose veins

Three-dimensional computed tomography venography is a useful tool to identify increased saphenous vein diameter and provides a complementary road map for surgery in patients with varicose veins. In this study, we investigated the correlation between saphenous vein diameter on computed tomography venography and venous reflux detected on duplex ultraonography. We enrolled 152 patients (213 extremities) who underwent endovenous laser ablation therapy, following high ligation of the saphenofemoral junction between January 2014 and December 2019. All patients underwent preoperative computed tomography venography evaluation. The saphenous vein diameter was measured on computed tomography venography, and venous reflux was evaluated in the operating room using Doppler ultrasonography. Among the 152 patients included in the study, 61 showed varicose veins affecting the bilateral extremities. Among the 213 extremities investigated, 165 (77.5%) and 48 (22.5%) extremities showed varicosities involving the greater and lesser saphenous veins, respectively. Among all extremities, venous reflux was detected in 172 (80.8%). The mean diameter of the greater saphenous vein measured 5 cm distal to the saphenofemoral junction was 8.07±1.82 mm in patients with reflux and 5.11±1.20 mm in patients without reflux (p < .05). The small saphenous vein diameter measured 5 cm distal to the saphenopopliteal junction was 7.65±1.74 mm in patients with reflux and 5.04±1.80 mm in patients without reflux (p < .05). Based on the receiver operating characteristic curve, the greater saphenous vein threshold diameter of 5.880 mm measured 5 cm distal to the saphenofemoral junction was the optimal cut-off value to predict reflux (sensitivity 91.4%, specificity 81.8%). The lesser saphenous vein diameter of 5.285 mm measured 5 cm distal to the saphenopopliteal junction was the optimal cut-off value to predict reflux (sensitivity 94.9%, specificity 75.0%). Vein diameter cannot be used as an absolute reference for venous reflux; however, it may have predictive value in patients with varicose veins. Computed tomography venography based measurements of vein diameter may serve as a useful diagnostic tool to predict venous reflux and recommend treatment.

Population-Based Epidemiologic Study in Venous Diseases in Germany - Prevalence, Comorbidity, and Medical Needs in a Cohort of 19,104 Workers

Introduction

Data on the prevalence of chronic venous disorders (CVD) at the national level in Germany are scarce.

Methods

We performed a population-based observational study based on clinical examinations, personal history, and technical examinations. Data were collected from 2006 to 2015. Descriptive data analysis was done to determine CVD and chronic venous insufficiency (CVI) prevalence and occurrence of potential risk factors. Chi-squared tests were performed to estimate the influence of risk factors on the prevalence of CVD.

Results

In total, 19,104 employees from different branches were included. The majority of the examined people were doing office work (n = 8157; 80.2%). A total of 4038 persons (21.1%) show at least one sign of CVD. At least one sign of CVI could be found in 679 persons (3.6%). Being female was found to be protective with an odds ratio of 0.66 (95% CI 0.59-0.73).

Conclusion

There is clear indication for active venous treatment in 22.3% of the adult working population in Germany.

Long-Term Outcomes of Endovenous Laser Ablation, n-Butyl Cyanoacrylate and Radiofrequency Ablation in the Treatment of Chronic Venous Insufficiency

INTRODUCTION

This study aims to evaluate the long-term results regarding the effectiveness and reliability of endovenous laser ablation (EVLA), endovenous n-butyl cyanoacrylate (NBCA) application and radiofrequency ablation (RFA) methods in the management of Chronic venous insufficiency (CVI).

METHODS

Charts of patients treated with EVLA, NBCA and RFA methods for CVI between January 1^st, 2014 and January 1^st, 2017, were reviewed. Records were made of personal information including sex, age, body mass index (BMI), American Society of Anesthesiologists score (ASA) and admission symptoms. Great saphenous vein (GSV) diameter, score of CEAP (Clinical, Etiology, Anatomy and Pathophysiology) classification, and Venous Clinical Severity Score (VCSS) were also noted. All patients were followed up with physical examination and CDUS at the first week, and 6^th and 12^th months after the procedures. After 12^th month, follow-ups were annual.

RESULTS

Enrolled in the study were a total of 232 patients who underwent lower limb CVI procedures (77 patients with EVLA, 73 patients with NBCA and 82 patients with RFA). The mean follow-up time was 67.5±4.7 months. Time of procedure was significantly shorter in patients treated with NBCA (13.5 minutes) in comparison of patients treated with EVLA (31.7 minutes) and RFA (27.9 minutes) (p= 0.001). Pain score was highest in EVLA group (p= 0.001). Significantly higher complication rates and longer time to return daily activity was recorded in those undergoing EVLA procedure (p= 0.001). Post hoc analysis revealed comparable occlusion success among groups on post-operative first day, and at 6^th month, first year and second year. However, significantly better success of occlusion rates were found for RFA in comparison of EVLA in third and fifth-years follow-ups (p= 0.024 and p= 0.011). The success of NBCA and RFA was similar in third and fifth-years follow-ups (p= 0.123 vs p= 0.330) CONCLUSION: Outcomes showed similar levels of early postoperative occlusion success among all three CVI treatment techniques, but RFA has a significantly higher success rate over EVLA in the third and fifth-year follow-ups. Additionally, NBCA and RFA procedures achieved comparable long-term success. EVLA was associated with significantly higher complication rates and pain scores, and longer time to return daily activities, while NBCA procedure had a significantly shorter operation time than the other procedures.

Psychometric properties of the short version of the Freiburg Life Quality Assessment for chronic venous disease (FLQA-VS-10)

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.

Factors influencing the choice of treatment modality for individual patients with varicose veins

INTRODUCTION There is evidence of effectiveness for a range of different treatment modalities for varicose veins but limited information about factors that influence treatment choice for individual patients. METHODS A postal survey was sent to 438 UK members of the Vascular Society of Great Britain and Ireland. RESULTS Overall, 251 responses were received (response rate 57%). A total of 222 respondents treated varicose veins using conventional surgery (84%), endothermal ablation (82%) and foam sclerotherapy (68%). The clinical pattern of veins appeared to have the greatest influence on treatment choice. This was followed by guidance from the National Institute for Health and Care Excellence, patient expectations, facilities, cost and whether treatment was carried out in the public or private sector. Respondents were asked to indicate whether each of 13 clinical 'scenarios' (eg very extensive varicose veins in both legs) would influence them towards or against using specified treatment modalities. 'Consensus' was defined as ≥80% of responses either towards or against any treatment modality; and disagreement as 41-59% both towards and against any modality (i.e. ∼50:50 split). There was consensus towards using endothermal ablation for truncal reflux, towards UGFS for localised varicose veins and towards conventional surgery for large, extensive, bilateral veins. There was consensus against UGFS for large truncal veins, and against surgery for obese patients and those with a history of venous thromboembolism. There were important disagreements about the influence of large or extensive veins, about whether patients were obese or slim and about a prior history of venous thromboembolism. CONCLUSIONS Conventional surgery is still widely available in the UK. Disagreements about treatment choice in different clinical scenarios suggest substantial variation in the treatments patients are offered. Attention to identifying subgroups in trials would help to guide treatment choice for individual patients.