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      A prospective study of venous hemodynamics and quality of live at least five years after varicose vein stripping

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          Abstract

          PURPOSE: To assess venous hemodynamics and quality of life at lest five years after varicose vein stripping. METHODS: We conducted a prospective study with 39 patients (63 limbs) with primary lower limbs varicose veins. Preoperatively, all patients were subjected to clinical evaluation, duplex ultrassound, air plethysmography (APG), and CIVIQ questionnaire of quality of life. By APG, venous filling index (VFI), ejection fraction (EF), and residual volume fraction (RVF) were determined. CIVIQ addresses four domains in course of 20 questions, including states of physical, social, and psychological well-being, and pain level. Varicose veins were treated by standard venous stripping. At least five years after surgery (77.9 ± 10.9 months), patients were reassessed and had clinical examination, duplex ultrasound, APG, and CIVIQ repeated. No late follow-up data was available for 24 patients. RESULTS: Preoperative and late postoperative VFI levels were similar, whereas EF (P=0.05) and RVF (P=0.01), as hemodynamic variables, significantly improved following surgery. In the late postoperative period, overall CIVIQ scores were significantly lower (P=0.005), as were scores in all four domains: pain (P=0.001), physical (P=0.007), social (P=0.008), and psychological (P= 0.05). CONCLUSION: In a small prospective cohort, improvements in venous hemodynamics and in quality of life of patients submitted to standard varicose veins stripping were maintained five years after the procedure.

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          Most cited references30

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          The epidemiology of chronic venous insufficiency and varicose veins.

          Chronic venous disease is a common condition presenting to physicians in Western Europe and the United States. This article provides a comprehensive review of the published literature in the English language, from 1942 to the present, and focuses on the prevalence of chronic venous insufficiency and varicose veins, as well as the involved risk factors. Prevalence estimates vary widely by geographic location, with the highest reported rates in Western countries. Reports of prevalence of chronic venous insufficiency vary from < 1% to 40% in females and from < 1% to 17% in males. Prevalence estimates for varicose veins are higher, <1% to 73% in females and 2% to 56% in males. The reported ranges in prevalence estimations presumably reflect differences in the population distribution of risk factors, accuracy in application of diagnostic criteria, and the quality and availability of medical diagnostic and treatment resources. Established risk factors include older age, female gender, pregnancy, family history of venous disease, obesity, and occupations associated with orthostasis. Yet, there are several factors that are not well documented, such as diet, physical activity and exogenous hormone use, which may be important in the development of chronic venous disease and its clinical manifestations.
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            Construction and validation of a quality of life questionnaire in chronic lower limb venous insufficiency (CIVIQ).

            Quality of life may be considerably reduced in patients who are suffering from chronic lower limb venous insufficiency, although existing generic quality of life instruments (NHP, SF-36 or SIP) cannot completely identify their specific complaints. The Chronic Venous Insufficiency Questionnaire (CIVIQ) has been developed by iterative process. First, a pilot group of 20 patients was used to identify a number of important features of quality of life affected by venous insufficiency, other than physical symptoms of discomfort. A second study involving 2,001 subjects was used to reduce the number of items. Subjects were asked to score both the severity of their problems and the importance they attributed to each problem on a 5-point Likert scale. The importance items found in patients with venous insufficiency were subjected to factorial analyses (PCA, PAF). The final version is a 20-item self-administered questionnaire which explores four dimensions: psychological, physical and social functioning and pain. Internal consistency of the questionnaire was validated for each dimension (Cronbach's alpha > 0.820 for three out of four factors). Reproducibility was confirmed in a 60 patient test-retest study. Pearson's correlation coefficients for both the four dimension subscales and for the global score at 2-week intervals were greater than 0.940. Finally, the questionnaire was tested in a randomized clinical trial of 934 patients in order to assess responsiveness and the convergent validity of the instrument, together with the patient's own quality of life. This study demonstrated that convergence was valid: Pearson's correlation coefficients between clinical score differences and quality of life score differences were small (from 0.199-0.564) but were statistically different from 0 (p 0.80). Reliability, face, content, construct validity and responsiveness were also determined for this specific quality of life questionnaire relating to venous insufficiency. Results suggest that this questionnaire may be used with confidence to assess quality of life in clinical trials on chronic venous insufficiency.
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              Towards measurement of outcome for patients with varicose veins.

              To develop a valid and reliable outcome measure for patients with varicose veins. Postal questionnaire survey of patients with varicose veins. Surgical outpatient departments and training general practices in Grampian region. 373 patients, 287 of whom had just been referred to hospital for their varicose veins and 86 who had just consulted a general practitioner for this condition and, for comparison, a random sample of 900 members of the general population. Content validity, internal consistency, and criterion validity. 281(76%) patients (mean age 45.8; 76% female) and 542(60%) of the general population (mean age 47.9; 54% female) responded. The questionnaire had good internal consistency as measured by item-total correlations. Factor analysis identified four important health factors: pain and dysfunction, cosmetic appearance, extent of varicosity and complications. The validity of the questionnaire was demonstrated by a high correlation with the SF-36 health profile, which is a general measure of patients' health. The perceived health of patients with varicose veins, as measured by the SF-36, was significantly lower than that of the sample of the general population adjusted for age and a lower proportion of women. A clinically derived questionnaire can provide a valid and reliable tool to assess the perceived health of patients with varicose veins. The questionnaire may be used to justify surgical treatment of varicose veins.
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                Author and article information

                Journal
                acb
                Acta Cirúrgica Brasileira
                Acta Cir. Bras.
                Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia (São Paulo, SP, Brazil )
                0102-8650
                1678-2674
                November 2013
                : 28
                : 11
                : 794-799
                Affiliations
                [01] orgnameUniversity of Sao Paulo (USP) orgdiv1Faculty of Medicine of Ribeirao Preto orgdiv2Department of Surgery and Anatomy Brazil
                [02] orgnameUSP orgdiv1Faculty of Medicine of Ribeirao Preto orgdiv2Department of Surgery and Anatomy
                [03] orgnameUSP orgdiv1Faculty of Medicine of Ribeirao Preto orgdiv2Department of Surgery and Anatomy
                [04] orgnameUSP orgdiv1Faculty of Medicine of Ribeirao Preto orgdiv2Department of Surgery and Anatomy Brazil
                Article
                S0102-86502013001100009 S0102-8650(13)02801100009
                10.1590/S0102-86502013001100009
                603e4b23-2154-4302-890c-0c507a63b650

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 24 July 2013
                : 22 October 2013
                : 23 September 2013
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 30, Pages: 6
                Product

                SciELO Brazil

                Categories
                Original Articles

                Plethysmography,Stripping,Varicose Veins,Quality of Life,Surgery

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