Patient perceptions and preferences of minimally invasive treatment modalities in varicose veins: a cross-sectional survey

Purpose

Minimally invasive therapies (MIT) have gained popularity due to their capacity to reduce trauma, enhance aesthetic outcomes, and shorten recovery periods. This article explores patients' perceptions and preferences regarding MIT for varicose veins (VVs) while analyzing associated influencing factors to provide a better understanding.

Patients and methods

A cross-sectional survey at Zhejiang Rongjun Hospital was performed from January 2022 to June 2023, involving 305 participants with VVs. The questionnaire assessed patient demographics, VVs severity, prior treatment experiences, and treatment preferences. Statistical analyses, including chi-square and Kruskal-Wallis tests, were conducted to explore the correlations between patient characteristics, treatment preferences, and factors influencing these choices.

Results

Nearly half of the participants (44.3%) lacked information on any surgical options, whereas a slight majority (55.7%) possessed familiarity with at least one treatment modality, and only 9.8% knew of all six treatment methods presented. Patient surveys discerned that the majority (68.5%) declared an inadequate grasp of treatment methodologies to articulate a treatment preference. Among the 96 patients who made a treatment choice, 24.0% opted for traditional surgery, while 76.0% chose MIT and a higher preference for MIT among male patients compared to female patients (p = 0.006). The patients preferred treatment options for VVs significantly affected by vascular surgeon recommendations and the number of follow-up visits (r = 0.129, p = 0.024; r = 0.122, p = 0.033).

Conclusion

The study highlights limited awareness of MIT among Chinese patients with VVs. The insights emphasize the influential role of vascular surgeons' recommendations and suggest a growing predilection for less invasive treatments due to their advantages in recovery and aesthetics. Provider-patient communication, including education about available treatments and shared decision-making, is essential to align treatment plans with patient expectations and improve outcomes.

Reliability and validity of specific quality of life assessment questionnaires related to chronic venous insufficiency: a systematic review

This systematic review aimed to discuss the main findings regarding the reliability and validity of health-related quality of life questionnaires for chronic venous insufficiency. Searches were performed on the MEDLINE, CINAHL, Web of Science, LILACS, and Scopus databases. The search terms used were related to "venous insufficiency", and "quality of life". The CIVIQ-20 and CIVIQ-14 instruments had adequate internal consistency and both were able to discriminate disease severity. The VEINES-QoL showed adequate internal consistency but was not able to discriminate disease severity. Most studies did not demonstrate a correlation between VEINES-QoL and the mental component of the SF-36. The AVVQ had inadequate reliability but its validity was also doubtful when compared to the SF-36. The VARIShort demonstrated good internal consistency, reproducibility, and validity, but only the original study was included. For venous leg ulcers, the CCVUQ showed adequate reliability and validity when compared to VLU-QoL.

Differences in health-related quality of life in patients with mild and severe chronic venous insufficiency: A systematic review and meta-analysis

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.

The management of venous leg ulceration post the EVRA (early venous reflux ablation) ulcer trial: Management of venous ulceration post EVRA

Objectives

This survey study evaluates current management strategies for venous ulceration and the impacts of the EVRA trial results.

Methods

An online survey was disseminated to approximately 15000 clinicians, through 12 vascular societies in 2018. Survey themes included: referral times, treatment times and strategies, knowledge of the EVRA trial and service barriers to managing venous ulceration. Data analysis was performed using Microsoft Excel and SPSS.

Results

664 responses were received from 78 countries. Respondents were predominantly European (55%) and North American (23%) vascular surgeons (74%). Responses varied between different countries. The median vascular clinic referral time was 6 weeks and time to be seen in clinic was 2 weeks. This was significantly higher in the UK (p ≤ 0.02). 77% of respondents performed surgical/endovenous interventions prior to ulcer healing, the median time to intervention was 4 weeks. 31% of participants changed their practice following EVRA. Frequently encountered barriers to implementing change were a lack of operating space/time (18%).

Conclusion

Venous ulcers are not managed as quickly as they should be. An evaluation of local resource requirements should be performed to improve service provision for venous ulceration. When interpreting the results of this survey consideration should be given to the response rate.

The Seriousness of Chronic Venous Disease: A Review of Real-World Evidence

Chronic venous disease (CVD) is a prevalent condition that tends to worsen with age. Patients initially seek treatment to relieve symptoms of leg pain, discomfort, heaviness and swelling, all of which impact their quality of life. As the disease increases in severity to include varicose veins, skin changes, and venous ulcer, the demand for treatment increases while the quality of life further diminishes. The prevalence of CVD is highest in Western countries where it already consumes up to 2% of healthcare budgets. With the aging of the global population, the prevalences of CVD and severe CVD are projected to increase substantially, foretelling unsustainably large increases in the healthcare resources and costs needed to treat CVD patients in the coming decades. Effective venoactive drug treatments and ablation procedures are available that provide symptom relief, improve quality of life, slow disease progression, and promote ulcer healing. In addition, venoactive drug treatments may be highly cost-effective. However, there is evidence that physician awareness of CVD is suboptimal and that many patients with CVD are not being treated or referred to specialists according to established guidelines. To decrease this treatment gap and prevent unnecessary disease progression, international guidelines are available to help physicians consider CVD treatment options and refer patients when warranted. Improved disease awareness and appropriate early treatment may help reduce the coming burden of CVD.Funding: Servier.

Truncal varicose vein diameter and patient-reported outcome measures

Background

Varicose veins and chronic venous disease are common, and some funding bodies ration treatment based on a minimum diameter of the incompetent truncal vein. This study assessed the effect of maximum vein diameter on clinical status and patient symptoms.

Methods

A prospective observational cohort study of patients presenting with symptomatic varicose veins to a tertiary referral public hospital vascular clinic between January 2011 and July 2012. Patients underwent standardized assessment with venous duplex ultrasonography, and completed questionnaires assessing quality of life (QoL) and symptoms (Aberdeen Varicose Vein Questionnaire, EuroQol Five Domain QoL assessment and EuroQol visual analogue scale). Clinical scores (Venous Clinical Severity Score (VCSS) and Clinical Etiologic Anatomic Pathophysiologic (CEAP) class) were also calculated. Regression analysis was used to investigate the relationship between QoL, symptoms and vein diameter.

Results

Some 330 patients were assessed before surgery. The median maximum vein diameter was 7·0 (i.q.r. 5·3–9·2) mm overall, 7·9 (6·0–9·8) mm for great saphenous vein and 6·0 (5·2–8·9) mm for small saphenous vein. In linear regression analysis, vein diameter was shown to have a significant association with VCSS (P = 0·041). For every 1-mm increase in vein diameter, there was a 2·75-fold increase in risk of being in CEAP class C4 compared with C2. No other QoL or symptom measures were related to vein diameter.

Conclusion

Incompetent truncal vein diameter was associated with increasing VCSS, but not a variety of other varicose vein disease-specific and generic patient-reported outcome measures.

5th Congress of WUWHS Abstract book Florence, Italy September 25–29 2016

The abstract book contains the abstracts of keynote lectures, focus sessions, symposia, workshops, AIUC annual meeting, AISLEC annual meeting, EPUAP annual meeting, ETRS special session, sponsor symposia, oral presentations, poster presentations and the subject index.

Positive Outcomes of Varicose Vein Surgery: The Patient Perspective

BACKGROUND

Patient-reported outcomes are increasingly recognized as important to understanding outcomes of medical interventions such as varicose vein surgery (VVS). Our aim was to compare positive outcomes of VVS as defined by several patient-reported measures, and to identify baseline characteristics associated with positive outcomes of VVS.

METHODS

A secondary analysis of the UK Patient-Reported Outcome Measures database was conducted on patients undergoing VVS, in the period 2009-2011 who completed the generic EQ-5D (index and visual analog scale [VAS] summary scores) and disease-specific Aberdeen varicose vein questionnaire (AVVQ). Surgical outcome was defined as positive if pre/post change scores exceeded half a standard deviation of mean baseline scores. Logistic regression models were used to identify significant predictors of positive outcomes, including age, gender, and baseline health.

RESULTS

Of 9,113 patients analyzed (71% females, 57% aged >50 years), positive outcomes were identified in 62% using the AVVQ, 43% based on EQ-5D index scores, and 24% according to EQ-VAS; 10% improved on all three measures. Patients with poorer baseline functioning (AVVQ scores ≥ 11) were more likely to have a positive outcome based on the EQ-5D index (odds ratio [OR] 1.23, 95% confidence interval [CI] 1.11-1.36) and EQ-VAS (OR 1.30, 95% CI 1.14-1.47).

CONCLUSIONS

Defining surgery as successful will clearly depend on how health-related quality of life (HRQL) is operationalized and the criteria used to identify meaningful change. Across a range of criteria, a consistently greater proportion of patients had positive outcomes in terms of VV-related functioning (via AVVQ) compared with those who improved in terms of generic health (via EQ-index), or self-rated health (EQ-VAS).

Management of chronic venous disease by general practitioners in Serbia: a cross-sectional study

BACKGROUND

Chronic venous disease (CVD) is one of the most prevalent medical conditions in the general population worldwide.

OBJECTIVE

To evaluate the management of CVD provided by general practitioners (GPs).

METHODS AND MATERIALS

The 2-center cross-sectional study comprised 2284 patients with CVD diagnosed and treated by GPs. Demographic and clinical data were obtained by physical examinations and standardized interviews.

RESULTS

Patients were counseled about different types of therapy; lifestyle advice was recommended to 88.8%, venoactive drugs to 90.8%, compression therapy to 44.0% of patients, anticoagulants to 16.7%, surgical treatment to 8.3%, and other types of therapy were recommended to 7.8% of patients. The most common types of treatment were dual and triple therapies recommended to 39.5% and 33.1%, respectively. The number of therapies recommended to patients increased with CVD progression. Treatment was not recommended to < 1% of patients. Only 8.4% of patients were referred to a vein specialist.

CONCLUSIONS

Although GPs had undergone special medical training about CVD before they were included in the study, some patients did not receive complete management of their condition. Continuous training of GPs and clinical guidelines for the management of CVD may help GPs to make adequate decisions.

The disparate management of superficial venous thrombosis in primary and secondary care

OBJECTIVES

Superficial venous thrombosis is common and traditionally considered a benign condition requiring only symptomatic treatment. Recent evidence, however, advocates more aggressive management. Extensive guidance is available but actual practice is unknown. This study aimed to assess the management of superficial venous thrombosis by general practitioners (primary care physicians) and vascular surgeons.

METHODS

A 19-question validated electronic survey was created and circulated by e-mail to general practitioners and vascular surgeons in the United Kingdom. The survey evaluated presentation, investigation and treatment of superficial venous thrombosis.

RESULTS

Three hundred sixty-nine surveys were returned from 197 vascular surgeons and 172 general practitioners. Most clinicians saw less than 20 cases a year, with 40% of clinicians not performing any investigations. Venous duplex was the investigation of choice in over 55%. Treatment with anti-inflammatory drugs was widespread, but anticoagulation and compression were seldom prescribed. Follow-up and treatment duration were disparate.

DISCUSSION

The management of superficial venous thrombosis varies widely despite good levels of evidence and guidance. Investigation and treatment of superficial venous thrombosis show marked differences both between and within groups. Improvements in education are required to optimise the treatment pathway and advance patient care.

Short-term gain for long-term pain? Which patients should be treated and should we ration?

Objectives:

Treatments of common conditions which do not affect mortality often become sidelined in the drive to improve efficiency and reduce costs. The rationing of patients is a divisive but crucial component to universal health care. How should this be accomplished?

Methods and Results:

In this article we examine the outcomes of various rationing methods in varicose veins.

Conclusions:

No method is perfect and treatment of symptoms and complications should remain the target for all physicians.