Endovenous laser ablation vs phlebectomy of foot varicose veins.

OBJECTIVE: The aim of this study was to compare the outcomes and complications of selected patients treated with endovenous laser ablation (EVLA) or ambulatory phlebectomy for foot varicose veins. METHODS: From October 2016 to February 2022, selected patients undergoing EVLA (using 1470-nm with radial-slim or bare-tip fibers) or phlebectomy of foot varicose veins for cosmetic indications were analyzed, and the outcomes were compared. Patients were classified according to the Clinical, Etiologic, Anatomical, and Pathophysiological (CEAP) classification. Anatomic criteria provided the basis for the decision to perform EVLA or phlebectomy. Clinical and ultrasound assessments were performed on postoperative days 7, 30, and 90 for visualization of the sapheno-femoral and sapheno-popliteal junctions and the deep venous system. Disease severity was graded with the Venous Clinical Severity Score (VCSS), and quality of life was measured with the Aberdeen Varicose Vein Questionnaire (AVVQ) before and after treatment. Treatment outcomes were evaluated based on changes in VCSS and AVVQ scores. The groups were also compared for procedure-related complications. Data were statistically analyzed in SPSS v. 20.0 using the χ2, Student t test, Mann-Whitney test, Wilcoxon test, and analysis of variance. The results were presented as mean (standard deviation or median (interquartile range). RESULTS: The study included 270 feet of 171 patients. Mean patient age was 52.3 (standard deviation, 13.1) years, ranging from 21 to 84 years; 133 (77.8%) were women. Of 270 feet, 113 (41.9%) were treated with EVLA and 157 (58.1%) with phlebectomy. The median preoperative CEAP class was 2 (interquartile range, 2-3) in the phlebectomy and EVLA groups, with no statistically significant difference between the groups (P = .507). Dysesthesia was the most common complication in both groups. Only transient induration was significantly different between EVLA (7.1%) and phlebectomy (0.0%) (P = .001). The two approaches had an equal impact on quality of life and disease severity. CONCLUSIONS: Treatment complications were similar in phlebectomy and EVLA and to those previously described in the literature.

A comparison of tablet-based and paper-based venous insufficiency epidemiologic and economic study quality of life/symptom questionnaire for assessment of chronic venous disease.

OBJECTIVE: To comparatively evaluate performances of tablet-based versus paper-based Venous Insufficiency Epidemiologic and Economic Study-Quality of Life/Symptom (VEINES-QOL/Sym) questionnaire. METHODS: We prospectively evaluated 78 consecutive patients who completed tablet-based and paper-based VEINES-QOL/Sym questionnaires and compared their scores, completion time, data entry time, and ease of use. We used Student's t-test and Wilcoxon test for quantitative variables, Bland-Altman test and kappa coefficient for agreement between questionnaires and patients, respectively. Spearman's correlation coefficient was used to assess correlations. RESULTS: Most participants (83.3%) found it easier to use the tablet device. Less time was needed to complete the tablet-based (median, 4.75; IQR, 3-7 min) than the paper-based (median, 8.3; IQR, 6.3-11.3 min) questionnaire (p < .001). Better educated patients took less time to complete paper-based (p = .003) and tablet-based (p = .001) questionnaires and considered the latter easier to use (p = .010). CONCLUSIONS: The tablet-based VEINES-QOL/Sym proved to be an easy-to-use and time-saving tool.

Brazilian guidelines on chronic venous disease of the Brazilian Society of Angiology and Vascular Surgery.

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.

A Sociedade Brasileira de Angiologia e de Cirurgia Vascular organizou uma comissão para fornecer novas recomendações baseadas em evidências sobre questões críticas de atendimento ao paciente com insuficiência venosa crônica. São abordados aqui os temas de classificação, diagnóstico, tratamento conservador, tratamento invasivo e tratamento de pequenos vasos. Esta última série está muito relacionada à atividade de angiologistas e cirurgiões vasculares, que possuem forte atuação no tratamento de pequenas veias superficiais. Estas diretrizes destinam-se a auxiliar na tomada de decisões clínicas de médicos assistentes e gestores de saúde. A decisão de seguir uma recomendação de diretriz deve ser feita pelo médico responsável caso a caso, levando em consideração a condição específica do paciente, bem como recursos locais, regulamentos, leis e recomendações de prática clínica.

Systematic literature review and expert meeting report on health-related quality of life in chronic venous disease.

INTRODUCTION: Chronic venous disease (CVD) can lead to considerable morbidity and impact health-related quality of life (HRQoL). The aim of this review was twofold: (i) to provide a deeper understanding of how CVD affects HRQoL (physical, psychological and social functioning), and (ii) to review the impact of evidence-based veno-active drugs (VADs) on HRQoL. EVIDENCE ACQUISITION: For the effect of CVD on HRQoL, information was gathered during an Expert Consensus Meeting, during which data were presented from both the patient and physician perspective assessed with validated quality-of-life measures. For the impact of VADs on HRQoL, a systematic literature review was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic databases were searched for real world evidence or randomized-controlled trials (RCT) vs. placebo, reporting data on the influence of VADs on HRQoL in patients with CVD. EVIDENCE SYNTHESIS: CVD can negatively affect daily life in a number of areas related to pain, physical function and social activities. The impact of CVD on HRQoL begins early in the disease and for patients the emotional burden of the disease is as high as the physical burden. In contrast, physicians tend to overestimate the physical impact. The database search yielded 184 unique records, of which 19 studies reporting on VADs and HRQoL in patients with CVD met the inclusion criteria (13 observational and 6 RCTs). Micronized purified flavonoid fraction (MPFF) was the most represented agent, associated with 12/19 studies (2 RCTs and 10 observational). Of the 6 RCTs, only MPFF, aminaphthone and low-dose diosmin provided statistically significant evidence for improvement on HRQoL compared with placebo; for the other VADs improvements in HRQoL were not statistically different from placebo. MPFF was also associated with improvements in HRQoL in the observational studies, across all CEAP clinical classes, as monotherapy or in combination with other conservative therapy, and for all aspects of HRQoL: physical, psychological, and social. Real-world data for the other VADs were scarce. Ruscus extract, sulodexide and a semi-synthetic diosmin were each represented by a single observational study and these limited data were associated with statistically significant improvements compared with baseline in overall and subdomain scores across the range of CEAP clinical classes. CONCLUSIONS: CVD can impair patients' HRQoL significantly at all stages of the disease. MPFF has the greatest evidence base of clinical use in both RCT and real-world observational studies for effectiveness on HRQoL and is recognized by international guidelines. The complete video presentation of the work is available online at www.minervamedica.it (Supplementary Digital Material 1: Supplementary Video 1, 5 min, 194 MB).

Quality of Life in Chronic Venous Disease: Bridging the Gap Between Patients and Physicians.

Chronic venous disease (CVD) has a negative impact on patients' quality of life (QoL). This was demonstrated in the recent Patient Journey on CVD study, which examined QoL in patients with early- and advanced-stage CVD (Clinical, Etiological, Anatomical and Pathophysiological classification C0 to C4), and the gaps between the way in which physicians and patients viewed the impact of CVD on QoL. The study was conducted in five countries (Brazil, China, Czech Republic, Italy and Russia) and included 100 patients with CVD and 60 CVD specialists. Patients completed the 14-item Chronic Venous Insufficiency Questionnaire (CIVIQ-14) to assess their QoL, and all patients and physicians were questioned during a 60-minute qualitative structured interview, focusing on four key dimensions-physical symptoms, aesthetics/appearance, emotional impact and impact on relationships. The study found that physicians tended to focus more on physical symptoms than on other impacts of CVD and rarely measured QoL in clinical practice. Patients were significantly less satisfied with the management of their QoL than physicians perceived them to be. About 25% of patients with CVD reported disturbed sleep, but physicians did not routinely ask them how CVD affected their sleep. These data reinforce the importance of physicians obtaining information about the impact of CVD on all aspects of the patient's life, including sleep and QoL. Evidence from randomised controlled trials and real-world studies demonstrates that some veno-active drugs, particularly micronised purified flavonoid fraction, can positively impact QoL in patients with CVD.

The First Latin American Consensus on Superficial and Perforating Venous Mapping.

With the aim of obtaining a map which is useful as a diagnostic tool and therapeutical orientation, complementing the written report of duplex ultrasound venous study, Latin-American Scientific Societies of Phlebology, Vascular Surgery and Vascular Imaging were invited to participate, through their regional representatives, to the First Consensus of Superficial and Perforating Venous Mapping. A consensus process using a modified Delphi method was carried out. An International Working Group was formed, which developed a Prototype of the Venous Mapping that worked as a starting point for consensus, and was presented in a first virtual meeting of 54 experts (societies' representatives) when the methodology was explained. For the consensus process, two rounds of self-administrated questionnaires with feedback were used. In the first questionnaire a 100% consensus was obtained in the 15 statements (an agreement range of 85.2% to 100%) In the analysis of qualitative data, three categories according to the actions to implement were identified - actions which involved no action, minor changes and major changes. This analysis was used to build the second questionnaire, which reached a consensus in its six statements (agreement range of 87.1% to 98.1%). A final consensus on every field proposed was established with the approval of all the experts consulted and it was presented at a third online meeting. The document of the superficial and perforating venous mapping reached by consensus is presented hereafter.

Brazilian guidelines on chronic venous disease of the Brazilian Society of Angiology and Vascular Surgery / Diretriz brasileira de doença venosa crônica da Sociedade Brasileira de Angiologia e de Cirurgia Vascular

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.

Resumo A Sociedade Brasileira de Angiologia e de Cirurgia Vascular organizou uma comissão para fornecer novas recomendações baseadas em evidências sobre questões críticas de atendimento ao paciente com insuficiência venosa crônica. São abordados aqui os temas de classificação, diagnóstico, tratamento conservador, tratamento invasivo e tratamento de pequenos vasos. Esta última série está muito relacionada à atividade de angiologistas e cirurgiões vasculares, que possuem forte atuação no tratamento de pequenas veias superficiais. Estas diretrizes destinam-se a auxiliar na tomada de decisões clínicas de médicos assistentes e gestores de saúde. A decisão de seguir uma recomendação de diretriz deve ser feita pelo médico responsável caso a caso, levando em consideração a condição específica do paciente, bem como recursos locais, regulamentos, leis e recomendações de prática clínica.

The impact of lower limb chronic venous disease on quality of life: patient and physician perspectives.

Aim: This research compared patient and physician perceptions of quality of life (QoL) in C0-4 chronic venous disease (CVD). Methods: Qualitative standardized phone interviews were conducted with 100 patients and 60 specialists from Brazil, China, the Czech Republic, Italy and Russia. Results: In addition to the impact of physical symptoms on QoL, patient interviews revealed a high aesthetic and emotional burden of C0-4 CVD that contributes to social isolation and affects relationships. Physicians were aware of the physical impact but underestimated the other implications of CVD on their patients' QoL. Conclusion: Healthcare professional awareness of the overall impact of CVD on QoL needs improvement. All aspects of QoL should be assessed in order to manage CVD effectively.

Chronic venous disease (CVD) is a progressive condition that occurs when the functioning of the veins, which are blood vessels that move blood back to the heart, is compromised, leading to swelling and other physical changes in the legs. CVD can be debilitating to those who suffer from it, so the authors surveyed 100 people with CVD as well as 60 physicians who treat them to understand more about the impact of this disease. The authors found that CVD affects people not only physically but also aesthetically and emotionally, which impacts on relationships and leads to social isolation. Physicians are aware of the physical impact of CVD but often underestimate other burdens their patients might experience, so the authors suggest that physicians consult their patients on these aspects when treating them.

Body dysmorphic disorder in patients with telangiectasias.

BACKGROUND: Chronic venous disease (CVD) patients can present with a spectrum of clinical manifestations ranging from severe ulcerations, thrombosis, and varicose vein hemorrhage to milder ones such as telangiectasias. Some CVD patients have a minimal degree of telangiectasias that are almost invisible to the physician. In spite of successful treatment of these telangiectasias, there are patients that might insist on continuing treatment, focusing excessive attention on what they perceive to be persistent telangiectasias that, in their opinion, must be removed. In these cases, one might be facing a possible body dysmorphic disorder (BDD) diagnosis. METHODS: This is a multicentric study performed in 223 patients with telangiectasias (C1s) seeking treatment; the Body Dysmorphic Disorder Questionnaire (BDDQ) was answered in private by all the patients. Furthermore, each questionnaire was evaluated in accordance with the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) criteria for BDD. RESULTS: From a consecutive sample of 223 patients, 38 patients had criteria for BDD according to the DSM-V; indicating that the prevalence of BDD in patients with telangiectasias is 17%. CONCLUSIONS: Telangiectasias can be a stress trigger that changes the way patients perceive their own appearance. BDD patients tend to focus their attention excessively upon these types of veins and demand unnecessary treatment for minimal telangiectasias in order to diminish their discomfort with their physical appearance. Body dysmorphic disorder occurs in patients with limbs with C1s disease in considerable proportion and, upon evaluation, these patients should be referred to a psychiatrist. The initiation of any treatment for telangiectasias prior to the psychiatric assessment should be avoided.

The 2020 update of the CEAP classification system and reporting standards.

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.

A sonographic study of thigh telangiectasias.

Introduction To date, there are limited descriptive data on the ultrasonographic characteristics of reticular and perforator veins associated with telangiectasias of the thigh. Objectives Evaluate the prevalence, anatomic correlations of reticular and perforator veins associated with lateral thigh telangiectasias. Methods This was a cohort study performed between June and December of 2014. Twenty-four female patients (43 limbs) with telangiectasias of the lateral thigh were evaluated by duplex ultrasound. Reticular and perforator veins were characterized according to valvular competency, vein diameter and connection with perforator veins at the thigh. Body mass index, current use of oral contraceptive, and history of pregnancy correlation data were also collected. A non-parametric Kruskal-Wallis test and a Student's t-test test were used for analysis. Results All 43 limbs had incompetent reticular veins underlying telangiectasias sites. A total of 20 incompetent perforator veins were found to be connected to the reticular veins. Obese and overweight patients had a higher prevalence of incompetent perforator veins and larger reticular veins when compared to those with normal weight (P < 0.05). Lower extremities with telangiectasias had a higher frequency of total perforator veins (n = 33) and incompetent perforator veins (n = 16) than extremities without telangiectasias (p = 0.001). Conclusion Lateral thigh telangiectasias were associated with both incompetent reticular and perforator veins. Obese and overweight patients were especially affected.

Change in perception of sclerotherapy results after exposure to pre-post intervention photographs.

Objective: To evaluate patients' self-perception of cosmetic improvement before and after they were presented with pre- and postprocedure photographs after sclerotherapy with 75% dextrose. Methods: Treatments included sclerotherapy of reticular and varicose veins using 75% dextrose. All treated limbs were photographed and classified according to Clinical, Etiology, Anatomy, and Pathology classification and Venous Clinical Severity Score pre- and posttreatment. The patients were queried before and after viewing the photos during these visits and indicated if they were very unsatisfied, dissatisfied, satisfied, or very satisfied. Nonparametric kappa correlation coefficient and a Chi square test were used to measure associations among agreement (p < 0.05 indicated statistical significance). The paired Wilcoxon test was used to compare statistical differences in mean Venous Clinical Severity Scores measured at different times (p < 0.05 indicated statistical significance). Data were analyzed using STATA software (version 12). Results: Individuals were more satisfied with the results of sclerotherapy after exposure to images portraying their limbs two months after the procedure (p < 0.0028) [corrected]. This effect was maintained six months after sclerotherapy (p = 0.0027). Conclusion: Patient exposure to pre- and postsurgical photographs is a simple intervention with the potential of improving patient satisfaction up to six months after treatment with sclerotherapy