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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).

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., (© 2023. The Author(s).)

Abstract: To review the various quality of life (QoL) scales specific for chronic venous diseases (CVDs) and provide guidance and a reference for researchers to select the ideal measurement scale before studying QoL in patients with CVDs.The EBSCO, Ovid, PubMed, Wanfang, and CNKI databases were searched for the keywords "vein," "quality of life," and "scale/questionnaire," and various scales used to measure QoL in patients with CVDs. The QoL aspects were investigated and researched, and then, the search results were screened and summarized.A total of 10 major scales related to the QoL in patients with CVDs were included. The scales differed in dimension, reliability, validity, scoring method, evaluation method, and scope of application.The investigator should select the chronic venous disease QoL scale according to the research purpose and subjects, and then implement the scale to compare the specific aspects of QoL in patients with different CVDs., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Objective: Patient-reported outcome measures (PROMs) are increasingly used to measure symptoms and treatment effects, and a short PROM is more user friendly. The aim of this study was to test whether a Swedish seven-item version of the PROM used in the Vascular Quality Initiative Varicose Vein Registry can be used to measure quality of life in a Swedish cohort of patients with superficial venous insufficiency (SVI) equally well as the 26-item Swedish version of the Venous Insufficiency Epidemiological and Economic Study on Quality of Life/Symptoms (VEINES-QOL/Sym-S) and measure treatment effect., Methods: Consecutive patients with SVI and Clinical-Etiology-Anatomy-Pathophysiology (CEAP) clinical class ≥C2 were recruited at three private clinics and one county hospital between January 2018 and October 2019. The patients were asked to answer both the VEINES-QOL/Sym-S and the Swedish seven-item version, called VARIShort, at two assessment points, baseline (cohort 1, 252 patients) and 1 week later (cohort 2, 138 patients), and the VARIShort at baseline and 8 weeks after an endovenous procedure (cohort 3, 106 patients). The mean age was 58.3 years (range, 20-93 years), 61.4 years (range, 20-93 years), and 57.2 years (range, 20-89 years) in cohorts 1, 2, and 3, respectively; the majority were female (59%, 55%, and 64%), and most were CEAP C4 (39%, 46%, and 38%). The VARIShort was evaluated with regard to its validity, test-retest reliability, internal consistency reliability, sensitivity, and responsiveness., Results: There was a strong correlation between the VEINES-QOL-S and the VARIShort (r s  = -0.819; P < .001). The VARIShort showed both excellent internal consistency with Cronbach's α of 0.93 and a high response to clinical change as measured with Cohen's d, overall score of 1.17., Conclusions: The Swedish seven-item PROM, the VARIShort, may be used for assessment of symptoms of SVI and outcome after treatment in Swedish SVI patients. The short PROM shows degree of SVI symptom impact on quality of life in the same manner as the 26-item VEINES-QOL/Sym-S., (Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.)

Chronic ulcers of the lower extremities are one of the most common medical problems encountered in western societies. The prevalence of leg ulcers is estimated to be 0.5-1.0% of the German population and is clearly associated with age. Therefore, in an aging society chronic leg ulcers are an important health issue with respect to increased morbidity and healthcare costs. The most frequent causes of leg ulcers are chronic venous insufficiency, peripheral arterial occlusive disease and diabetes mellitus. Efficient treatment necessitates an exact diagnosis and a close interdisciplinary collaboration. Affected patients often require instructions regarding self-help and support for competent nursing and prophylaxis. Therapeutic strategies, especially in the geriatric setting, aim to maintain the quality of life through preservation of patient mobility and autonomy.

Background: Patients' adherence to elastic compression stockings is difficult to evaluate, and therefore we create a short self-questionnaire and validate its psychometric properties., Methods: We reduce the questions with Varimed rotation analysis, evaluate its internal consistency using Cronbach's alpha test and its external validity by comparison to electronic thermic captors. Receiver operating characteristic (ROC) analysis was used to determine a threshold and determine its sensitivity and specificity., Results: The initial questionnaire was reduced from 22 to 5 questions rated from 0 to 4. The internal consistency and its external validity are good, and the ROC analysis shows that values > 3 correspond to poor compliance with a sensitivity of 88.1% and a specificity of 63.1%., Conclusion: The adherence score is valid for the detection of patients poorly compliant to the wearing of elastic compression. Its small number of questions makes it a suitable for a screening in everyday practice.

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.

Background: Scientific and financial investments in chronic cerebrospinal venous insufficiency (CCSVI) research have been made to address both the hope for and scepticism over this interventional strategy for MS. Despite limited evidence in support of the CCSVI hypothesis, the funding of clinical research was responsive to a demand by the public rarely seen in the history of medicine. We characterize patient perspectives about the CCSVI research trajectory, with particular attention to its impact on other non-pharmaceutical areas of MS research with a focus on stem cell interventions., Methods: Semi-structured interviews with 20 MS patients across Canada who did not have CCSVI interventions. Interviews were analysed for recurring themes and individual variations using the constant comparative approach., Results: Participants had a critical view of the divestment of funds from longstanding research to support CCSVI trials. They retain a sense of optimism, however, about emerging evidence for stem cell interventions for MS, and highlight the need for greater caution and conscientious communication of advances in medicine and science., Conclusions: The unrealized hopes for CCSVI challenged but did not undermine the resilience of patient communities. The narrative that unfolded highlights the importance of drawing a socially-minded space for public participation in science.

Introduction: The use of a venoactive drug is considered an important component of medical treatment of chronic venous disease (CVD), although the efficacy of certain venoactive drugs (VADs) on one or more individual leg symptoms or signs may have not been extensively studied to justify a strong recommendation in guidelines on CVD. The aim of this systematic review and meta-analysis was to study the effectiveness of the micronized purified flavonoid fraction (MPFF, Daflon®) across the spectrum of defined venous symptoms, signs, quality of life (QoL) and treatment assessment by the physician., Evidence Acquisition: On September 9, 2017, a systematic review of the databases MEDLINE, Scopus and Cochrane Central was performed, supplemented by hand searching, to identify randomized double-blind placebo-controlled trials on MPFF in patients with CVD., Evidence Synthesis: The main outcome measures were the individual and global symptoms, leg edema and redness, skin changes, QoL and evaluation of the overall effectiveness of the treatment by the physician. The effectiveness of MPFF compared with placebo was expressed as risk ratio (RR) or standardized mean difference (SMD) with 95% confidence interval (CI). Trial quality of evidence was graded using the GRADE system., Results: We identified 7 trials, mostly with low risk of bias, involving 1,692 patients. On qualitative analysis, MPFF significantly improved nine defined leg symptoms, including pain, heaviness, feeling of swelling, cramps, paresthesia, burning sensation, and pruritus (itching), but also functional discomfort compared with placebo, leg redness, skin changes and QoL. On quantitative analysis, MPFF compared with placebo, assessed as a categorical variable, reduced leg pain (RR 0.53, P=0.0001, NNT=4.2), heaviness (RR 0.35, P<0.00001, NNT=2.0), feeling of swelling (RR 0.39, P<0.00001, NNT=3.1), cramps (RR 0.51, P=0.02, NNT=4.8), paresthesia (RR 0.45, P=0.03, NNT=3.5), and functional discomfort (RR 0.41, P=0.0004, NNT=3.0). Similarly, MPFF compared with placebo, assessed as a continuous variable reduced pain (SMD -0.25, 95% CI -0.38 to -0.11), heaviness (SMD -0.80, 95% CI -1.05 to -0.54), feeling of swelling (SMD -0.99, 95% CI -1.25 to -0.73), burning sensation (SMD -0.46, 95% CI -0.78 to -0.14), cramps (SMD -0.46, 95% CI -0.78 to -0.14), and functional discomfort (SMD -0.87, 95% CI -1.13 to -0.61). Regarding objective assessments of leg edema, the use of MPFF compared with placebo reduced ankle circumference (SMD -0.59, 95% CI -1.15 to -0.02), and leg redness (SMD -0.32, 95% CI -0.56 to -0.07, RR 0.50, P=0.03, NNT=3.6), improved skin changes (RR 0.18, P=0.0003, NNT=1.6) and quality of life (SMD -0.21, 95% CI -0.37 to -0.04) and was associated with clinical improvement as assessed by the physician (RR 0.28, P<0.00001, NNT=2.5). Heterogeneity was mostly minimal. The existing evidence where sufficient was mostly of high quality., Conclusions: Based on high quality evidence, MPFF is highly effective in improving leg symptoms, edema and quality of life in patients with CVD.

Objectives: The traditional surgical approach to the treatment of the superficial venous insufficiency requires at least 12 h of post-operative monitoring and this often means the necessity of an overnight hospitalization. The introduction of new, less invasive techniques (i.e endovenous laser ablation) reduces the hospitalization stay in a Day Surgery setting. However, the increasing skills of the operators and the patient's selection, allows to propose endovenous laser ablation in an Outpatient setting. The aim of this study is to evaluate the activity of a single high-volume center., Method: We enrolled 112 consecutive patients with great sapehous vein insufficiency and indication to endothermal laser ablation, 57 operations (51%) were performed in Day Surgery setting and 55 (49%) in Outpatient setting according to endovascular laser ablation's criteria. Past medical history, CEAP classification, VCSS score, type of symptoms and intervention's data were collected. Post-operative results (success and complications rates, patient's functional and aesthetic satisfaction) were evaluated at 7 and 30 days after intervention. A QoL questionnaire (CIVIQ) was submitted to the patients 30 days after surgery., Results: We did not observe a statistically significant difference between the two groups concerning treatment results and complications onset. The QoL assessment did not differed significantly, except for over 65-year old patients undergoing outpatient treatment that showed a better QoL compared to those undergoing the same treatment in Day Surgery (p 0.05)., Conclusions: The endothermal laser ablation technique allows a safe, comfortable and faster management of the venous disease in Outpatient setting. This would further reduce the costs of the treatment while preserving the functional and aesthetic results and the low complication rate of the Day Surgery setting., (Copyright © 2018 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.)

Introduction: Pharmacotherapy occupies one of the leading places in comprehensive treatment of lower-limb chronic venous diseases (CVD) and their complications. At the same time, there are not so many therapeutic agents intended for treatment of CVD and possessing evidence-based efficacy. Sulodexide (registered in Russia as Vessel Due F) is a drug with a confirmed therapeutic effect in patients with a moderately severe course of chronic venous disease or its late stages. However, the experience of using it in Russia for treatment of patients presenting with initial manifestations of chronic venous insufficiency (CVI) is still scarce., Patients and Methods: The data concerning the use of Vessel Due F in the routine practice of treating CVD in Russian patients were collected and assessed within the framework of the ACVEDUCT programme. This observational prospective non-controlled multicentre programme included patients routinely prescribed by their attending physician Vessel Due F as a solution for injections and/or soft capsules in accordance with the registered in the Russian Federation instruction for use. A total of 2,263 patients took part in the programme., Results: The majority of the patients prescribed sulodexide were diagnosed as having CEAP class C3 (38.4%) and class C4 (35.6%) CVD. Treatment was accompanied and followed by a decrease in the symptoms' severity observed in 56.4% of patients and a decrease in the number of symptoms in 42.8% of patients (thus positive dynamics was totally noted in 99.2%), with the effect of taking the drug commencing to manifest itself in patients as early as on day 15-20 of treatment. The highest rate of regression of symptoms of CVD was observed in 30-to-40-year-old patients. A statistically significant positive correlation was revealed between efficacy and the duration of treatment, the use of capsules during the term of follow up, with a negative correlation revealed between efficacy of treatment and the patient's age at which the diagnosis had been made, the stage according the CEAP classification, the total number of symptoms, a combination of risk factors., Conclusions: Sulodexide proved to be an effective, safe, well-tolerated and pathogenetically substantiated pharmacological agent for treatment of patients presenting with lower-limb CVI and should therefore be recommended for patients at early stages of formation of CVD. Patients suffering from venous trophic ulcers require higher doses and prolonged administration of the drug.

The purpose of the study was to evaluate efficacy of Diosmin (Phlebodia 600, Innothera, France) in treatment of patients presenting with class C0s-C3 chronic venous diseases (CVD) according to the CEAP classification. Presented herein are the results of a prospective observational study aimed at assessing the outcomes of two-month administration of Phlebodia 600 (600 mg diosmin) in patients suffering from class C0s-C3 CVD according to the CEAP classification. The study comprised a total of 868 patients, including 175 (20.2%) men and 693 (79.8%) women. Of these, 866 patients completed the study according to the protocol. Amongst the 868 followed-up patients, 851 (98.0%) subjects strictly adhered to the physician's prescription and stopped taking the drug without violation of the regimen and dosing of diosmin. The main drug dosage regimen of diosmin was 1 tablet once a day in 851/868 (98.04%) patients. Satisfaction with treatment with diosmin was reported as 'excellent' by 46.7 % of patients (95% CI: 43.3-50.0) and by 49.4% of physicians (95%: CI 46.1-52.7), being rated as 'good' by 45.0% of patients (95 % CI: 41.7-48.4) patients and by 43.6% of physicians (95% CI: 40.3-47.0). The score for the quality of life of patients according to the CIVIQ-20 scale at the first follow-up visit amounted to 45.4±15.4 points (median 43.0 points). At the second follow-up visit, this parameter improved dramatically, dropping to the level of 35.6±11.5 points (median 33.0 points). By the third follow-up visit, the positive dynamics of the parameters preserved continued, averagely amounting to 28.9±8.7 points (median 26.0 points). A decrease in the circumference of the left and right crura (by 0.39±0.74 and by 0.36±0.75 cm, respectively) was observed at the second follow-up visit. The difference of the malleolar measurements between the first and third follow-up visits amounted to 7.2±9.4 mm and 6.6±9.7 mm for the right and left crus, respectively (p<0.001). The number of patients with a reported feeling of heaviness in the legs statistically significantly decreased from 97.6% at the stage of enrollment into the study to 73.0% after 2 months of therapy, that of those with painful sensations from 84.5 to 55.3%, those with complaints of swelling (oedemas) of the lower limbs from 83.9 to 56.8%, with complaints of convulsions from 71.2 to 35.7%, with complaints of sensation of tingling from 63.4 to 34.1%, respectively. Hence, a statistically significant improvement of the patients' condition was observed as early as 30 days after the beginning of treatment. By day 60, the positive effect of the carried out therapy continued to grow. Safety and good tolerance of the drug were noted, which was confirmed by low incidence of undesirable events and high adherence to treatment.

Aim: To test the psychometric properties of the Croatian version of the Chronic Venous Insufficiency Quality of Life (CIVIQ) Questionnaire and to assess the quality of life in patients with chronic venous disorders of all stages., Methods: This cross-sectional study performed between 2014 and 2015 in a private family practice assessed the factorial validity, cross-sectional validity, and reliability of the Croatian CIVIQ 20-item questionnaire completed by 428 adult patients (78% women) with chronic venous disorders classified according to the Clinical-Etiologic-Anatomic-Pathophysiologic (CEAP) C classification as stages C1-C6., Results: Median patient age was 52 years (5th-95th percentile, 30-77). The distribution according to the clinical stages of chronic venous disorders was as follows: C1 (n=78, 18%), C2 (n=192, 45%), C3 (n=53, 12%), C4 (n=44, 10%), C5 (n=13, 3%), and C6 (n=48, 11%). The CIVIQ-20 factorial structure was unstable, and six items were excluded from the analysis to test the psychometric properties of the shortened version (CIVIQ-14). CIVIQ-14 has three dimensions (physical, psychological, and pain). Internal consistency reliability is high for the entire CIVIQ-14 (Cronbach α=0.92) and for all CIVIQ-14 dimensions (α≥0.80). The median quality of life significantly decreased with higher CEAP C stages as follows: C1/C2 (86, 50-100); C3/C4 (75, 36-98); C5/C6 (67, 31-95) (P<0.001). Post-hoc analysis showed a higher quality of life in C1/C2 than in other groups (P<0.001)., Conclusion: The shortened CIVIQ-14 version is useful for assessing the quality of life in patients with chronic venous disorders in everyday clinical practice. To achieve a stable validated instrument, we recommend a cross-cultural validation of items that have loadings on more than one factor.

Objective This study was planned and implemented to evaluate the effect of socio-demographic characteristics and clinical findings on the quality of life of patients with chronic venous insufficiency. Methods The sample of this cross-sectional study consisted of 163 patients that presented with the diagnosis of chronic venous insufficiency to the cardiovascular surgery clinic of an education and research hospital in the west of Turkey. The data were collected during face-to-face interviews using a personal information form, clinical, etiology, anatomy, pathophysiology classification, venous insufficiency epidemiological and economic study-quality of life/symptoms scales and the Short Form-36. Descriptive statistics as well as univariate and multivariate analyses were used to analyze the data. Results The chronic venous insufficiency patients were found to have a low quality of life. Advanced age, higher body mass index, longer working times, being on regular medication, hypertension and presence of pigmentation according to the clinical, etiology, anatomy, pathophysiology classification were found to be associated with a reduced physical score in SF-36. Furthermore, longer weekly working hours and presence of pigmentation reduced the Venous Insufficiency Epidemiological and Economic Study-Quality of Life/Symptoms scores. Undertaking physical exercise at twice and more than twice a week increased the overall physical scores in SF-36. Conclusions The results of the study showed that the quality of life of chronic venous insufficiency patients are affected by not only physical characteristics, working hours and physical activity but also presence of edema and pigmentation.

Objective: The purpose of our study was to evaluate both clinical and laboratory efficacy of sulodexide given at a daily dose of 500 lipasemic units (LSU) in patients presenting with class C3-C4 chronic venous insufficiency (CVI) according to the CEAP classification., Patients and Methods: The study included a total of 25 patients diagnosed with C3-C4 CVI and prescribed to receive sulodexide at a daily dose of 500 LSU for 90 days. Efficacy was comprehensively controlled by the following tools: the disease-specific Chronic Venous Insufficiency Quality of Life Questionnaire (CIVIQ), visual-analogue methods of assessment separate symptoms; the Venous Clinical Severity Score (VCSS), as well as ultrasonographic determination of the thickness of subcutaneous fat and crural fascia. Amongst the key laboratory indices determined by means of the ELISA test were the levels of interleukin-1 alpha (IL-1α), interleukin-1 beta (IL-1β), matrix metalloproteinases-2 and -9 (MMP-2, MMP-9), vascular endothelial growth factor A (VEGF-A), vasopressin and endothelin., Results and Discussion: Of the initially enrolled 25 subjects, twenty-two patients completed the study and were taken as 100%. The 90-day treatment yielded favourable results manifesting themselves in complete disappearance of convulsions in the calf muscles detected at the first visit in 22.7% of patients (p=0.0485), a significant reduction in the frequency of complaints of decreased tolerance to static loads from 27.3 to 9.1% (p=0.2404). The volume of the crus of the control lower extremity decreased from 134.18±14. 92 to 128.42±12.46 cm3 (p=0.0006), subcutaneous fat thickness at the fixed point decreased from 1.50±0.53 to 1.32±0.46 cm (p=0.0007), and fascial thickness decreased from 0.14±0.7 to 0.11±0.04 (p=0.0359). Pain syndrome according to the visual analogue scale (VAS) decreased from 36.45±25.60 to 17.50±19.27 mm (p=0.0002). The global index of quality of life (GIQoL) according to the CIVIQ-20 increased by 27.7% compared with the baseline level (p = 0.0001), the VCSS index decreased from 6.00±1.83 to 4.86±2.05 points (p=0.0002). as for the laboratory markers of endothelial dysfunction, there was a significant decrease in the levels of MMP-2 - from 178.53±36.30 to 176.35±36.67 ng/ml (p=0.0152), MMP-9 - from 90.84±20.41 to 89.78±20.32 ng/ml (p=0.0394), and that of endothelin - from 0.42±0.10 to 0.39±0.10 fmol/ml., Conclusion: Sulodexide exerting a statistically significant clinical and endothelium-protecting effect turned out to be an effective drug for treatment of initial forms of chronic venous insufficiency of lower limbs.

Introduction: Chronic venous disease (CVD) of the lower limbs is a common problem. It is more prevalent in women than in men and has a significant impact on patients' quality of life (QoL) and on the healthcare system. The aim of this study was to evaluate the efficacy of sulodexide in adult patients with CVD of the lower limbs and its effect on patients' QoL., Methods: Patients with CVD were treated with sulodexide [250 LSU (lipasemic units) twice daily] for 3 months in a setting of real-life clinical practice. The endpoints of this observational non-comparative, open-label prospective study were the clinical efficacy of sulodexide (evaluated by scoring objective and subjective symptoms with a Likert-type scale) and the impact of sulodexide therapy on patients' QoL [assessed using the chronic venous insufficiency quality of life questionnaire (CIVIQ)]., Results: The study included 450 patients (mean age 46.9 ± 10.5 years, range 17-78 years). A greater percentage of patients were female (65.4%). Three months of treatment with sulodexide significantly improved all objective and subjective symptoms (p < 0.0001). Overall, patients reported a significant improvement in all QoL scores (p < 0.0001). Adverse events were spontaneously reported by two patients (one case of epigastric pain and one of gastric pain with vomiting)., Conclusion: Oral sulodexide significantly improves both objective and subjective symptoms, as well as functional and psychological aspects of QoL in patients with CVD., Funding: No funding or sponsorship was received for this study. Sponsorship for article processing charges and open access fees was provided by Alfa Wassermann.

Purpose: The main purpose of this study was to evaluate the influence of any of the four domains of the QoL score in CVD patients of classes C0-C4 and to analyze the correlation between the QoL and types of treatment modalities, and an additional aim of the present study was to compare QoL levels of patients with CVD and healthy participants and was to examine the factors associated with QoL in CVD patients., Methods: The sample was composed of 501 patients with primary superficial venous reflux (28.5 % male and 71.5 % female) who answered 100 % of the questions in the World Health Organization Quality of Life (WHOQoL-BREF) questionnaire. After a clinical and duplex examination, the patients were categorized as C0-C4, according to the CEAP classification. The relationships between WHOQoL-BREF domains and gender, age, occupation, BMI, the clinical classes of the CEAP classification and four different treatment modalities according to guideline were analyzed., Results: For the WHOQOL-BREF test battery, the patients with CVD had worse values, as compared with the control group participants. The differences were significant for the physical (77.81 ± 12.75 vs. 59.18 ± 12.90, p < 0.001), the psychological (74.78 ± 11.37 vs. 60.21 ± 14.70, p < 0.001), the social relationships (76.56 ± 13.56 vs. 63.07 ± 21.37, p < 0.001) and the environmental (70.27 ± 13.36 vs. 50.16 ± 11.39, p < 0.001) health scores. The patients with CVD had worse WHOQOL-BREF scores at initial, compared with the 6-month follow-up scores., Conclusion: This study shows that in spite of undergoing therapy, the subsequent QoL scores did not improve significantly, indicating that CVD continued to negatively affect the patient's life.

Aims and Objectives: The aim was to describe the experience of living with varicose veins classified according CEAP (clinical class, aetiology, anatomy, pathophysiology) as C4 (eczema or thrombophlebitis) and management of the disease in daily life., Background: Primary chronic venous insufficiencies with varicose veins are a relatively common condition among both men and women. Several studies have shown that quality of life improved after treatment of varicose veins compared to before treatment. This suggests that patients with a milder form of varicose veins such as C4 experience a negative influence on their quality of life before treatment., Design: This is an explorative qualitative study with a phenomenological approach., Method: A purposive sample was used, and 12 in-depth interviews were conducted with persons having superficial venous insufficiency classified C4. A descriptive phenomenological analysis was performed., Results: The essence of the phenomenon of living with varicose veins classified C4 and management of the disease in daily life meant adapting to a life with varicose veins and relieve discomfort from legs with an unfavourable appearance. Coping with discomfort involved dealing with the disease emotionally and finding strategies that helped to relieve symptoms; however, living with 'repulsive' legs was seen as embarrassing, and many found the need to hide their condition., Conclusion: Patients with varicose veins classified C4 had notable symptoms of the disease that affected daily living. This in turn required the use of different coping strategies to manage symptoms, and significant adjustments related to activities and social life were made., Relevance to Clinical Practice: It seems desirable that patients with varicose veins receive treatment at an earlier stage of the disease and are familiar with the tools and solutions available to alleviate symptoms and avoid a negative impact on daily life., (© 2015 John Wiley & Sons Ltd.)

Objectives: The study aim was to confirm the factorial structure of the short (14 item) version of the ChronIc Venous Insufficiency quality of life Questionnaire (CIVIQ-14) using the Vein Consult Program (VCP) results., Methods: The international VCP study sought to evaluate the impact of chronic venous disease (CVD) on health care costs and quality of life (QoL). The factorial structure of the CIVIQ-14 was evaluated using two methods: exploratory factor analysis (EFA) to calculate the probabilities of items and dimensions remaining stable and to study the dimensionality of the scale using explained variance criteria, followed by confirmatory factor analysis (CFA) to confirm the original three dimensional structure and investigate alternative models that may have arisen from the dimensionality analysis. We also used the VCP results to evaluate the psychometric properties of the questionnaire and conducted subgroup analyses on countries with validated translations., Results: A total of 47,149 questionnaires from 17 countries were available in the VCP. EFA revealed both items and dimensions as 100% stable. Dimensionality analysis showed that a two factor approach could be considered. CFA revealed the CIVIQ-14 three dimensional structure to be acceptable while rejecting the two dimensional model. Psychometric analysis confirmed the construct validity, internal consistency, and known groups validity of the CIVIQ-14. The results of subgroup analyses were consistent with those of the primary analysis., Conclusions: CFA of VCP data supported the factorial structure of the CIVIQ-14. The analysis corroborates the wide use of CIVIQ-14 as a valid instrument for reporting QoL in CVD patients., (Copyright © 2015 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.)

Presented herein is experience in diagnosis and treatment of chronic diseases of lower-limb veins in a total of 242 children and adolescents. The authors used CEAP classification; C1 class was more often encountered in children. Treatment included surgical interventions, sclerotherapy, laser coagulation of pathological veins of lower extremities. Therapeutic outcomes were satisfactory in all patients, with no complications observed. It was determined that in paediatric phlebological practice prevailing are class C1 chronic venous diseases; characteristic is high concern of both the patient and parents. A timely commenced conservative program of treatment for children makes it possible to improve quality of life in class C1 and C2 chronic venous diseases. Laser coagulation of varicose saphenous veins of lower limbs in children makes it possible to remove pathological vessels, significantly improving quality of life of patients and shortening the terms of hospitalization twofold. Application of transcutaneous laser coagulation (Nd:YAG, 1064 nm) and microfoam sclerotherapy in children makes it possible to completely remove class C1 varicose veins, improving quality of life.

Objective: We conducted a systematic review of the literature about quality-of-life (QOL) scales in chronic venous disorders (CVDs) comprising leg ulcers to identify the respective advantages and deficits of existing tools., Methods: A research protocol was built following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and the PICO (population, intervention, comparator, and outcome) criteria. The following databases were screened: MEDLINE, SCOPUS, EMBASE, CINHAL, and Cochrane. Psychometric and linguistic validation studies in English were included, as were clinical trials that have used QOL scales in CVDs. The data search was up to date as of October 31, 2013., Results: Inclusion criteria were met in 103 of the 511 recorded references, in which 10 scales were identified: two for the full spectrum of CVDs, three for patients with CVDs without leg ulceration, four for leg ulcers, and one exclusively for patients with varicose veins. Among them, the ChronIc Venous Insufficiency Questionnaire (CIVIQ), Aberdeen Varicose Vein Questionnaire (AVVQ), and VEnous INsufficiency Epidemiological and Economic Study on Quality of Life (VEINES-QOL) scales were the most highly used according to the literature, and CIVIQ and VEINES-QOL were the most extensively validated scales and had the longest iterative validation process. A total of 31 psychometric and linguistic validations of the 10 QOL scales and 66 clinical trials that have used these scales were identified. The validation studies were based on acceptability, content validity, construct validity, reliability, and responsiveness. The clinical trials were composed of 25 randomized controlled trials and 41 observational studies. Only the randomized controlled trials are considered in the present article., Conclusions: This systematic review confirmed that CVDs have an important effect on QOL. The majority of the studies addressed the application rather than the validation of the 10 identified scales. Two scales, CIVIQ and VEINES-QOL, emerged as being thoroughly validated instruments, although factorial stability was not demonstrated for the VEINES-QOL. Our findings confirm a paucity of validation studies., (Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)

The quality of life (QoL) in patients with advanced venous insufficiency (including venous stasis ulcers, skin discoloration, stasis eczema, and lipodermatosclerosis) assessed using the Clinical Etiological Anatomical Pathophysiological (CEAP) and Venous Clinical Severity Score (VCSS) classifications is presented. Also, disease features such as: intensity of pain, edema and inflammatory response that exerted the most profound effect on different domains of QoL are reported. The global QoL in patients with lower leg venous ulcerations was relatively similar to that observed in other patients with chronic venous insufficiency. The presence of venous ulcerations was associated with lower QoL in a Physical domain. Significant correlations were found between pain intensity and the values of Physical, Physiological, Level of Independence and Environmental domains, between edema intensity and Social domain as well as between the intensity of inflammatory response and Physical and Spiritual domains.

Chronic pelvic pain accounts for approximately 10% of outpatient gynecologic visits and among the varied causes, pelvic congestion syndrome is second only to endometriosis in frequency. Manifestations may include pelvic pain, dyspareunia, dysuria, and dysmenorrhea as well as external varices and a number of psychosocial symptoms. Although a variety of treatments have been proposed-including pharmacologic ovarian suppression, hysterectomy with or without oophorectomy, and ovarian vein resection-transcatheter embolization is the least invasive and most efficacious management option. Complete or partial symptom improvement has been reported in 68.2-100% of patients and there has been a consistent reduction in visual analog pain scores after treatment. Based upon these results, recommendation of either pharmacotherapy or other surgical procedures is difficult to justify. However, it is also clear that 6-31.8% of patients do not get substantial relief from pelvic venous embolization. Potential explanations for an inadequate response to treatment include patient variability, procedural variability, and inadequate outcome measures. The latter are particularly important and future investigation should focus on the development of disease-specific quality of life measures as well as identifying those aspects of the procedure, such as choice of embolic agents and extent of embolization, associated with the best clinical outcomes., (© The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.)

Background: The geriatric population aged 80 years and older with severe manifestations of chronic venous disease face diminishing therapeutic options. Self-applied compression is often not possible because of frailty or arthritis. Significant limb swelling diminishes mobility, affects independent living, and precipitates institutionalization. Limb ulceration and pain diminish quality of life at a time when it is paramount. Cellulitis uniquely poses septicemic risk in this age group. Family caregivers are often able to continue home care if the intensity of care can be reduced. Iliac vein stenting may have a role as it appears to be safe and effective in this advanced stage of life., Methods: Patients who had failed to respond to compression and desired palliation of continuing severe chronic venous disease symptoms were considered for iliac vein stenting. Intravascular ultrasound-guided stenting was carried out under fluoroscopy without venography in case of allergy to contrast material or decreased renal function. General anesthesia was used for better cardiopulmonary control., Results: A total of 107 limbs (12 bilateral) were treated with iliac vein stents during a 13-year period, representing 5% of all stented limbs. Median age was 83 years (80-96 years), and 10 were ≥ 90 years; 59% were post-thrombotic. Clinical, etiologic, anatomic, and pathologic classification was as follows: C2 (with pain), 3%; C3, 32%; C4, 33%; C5, 5%; and C6, 27%. Concurrent saphenous ablation was carried out in 28% when saphenous reflux was considered ancillary and not the main disease. There was no mortality. Reintervention was required in 20% of limbs for nonocclusive stent malfunction; 2% of stents occluded. Primary and primary-assisted duplex patency rates at 5 years were 52% and 90%, respectively. The visual analog scale score of pain improved from median 4 (0-9) to 0 (0-10) after stenting (P < .0001). Pain was completely relieved in 43% of limbs. Cumulative improvement in the pain score of at least 3 points was 71% at 6 years. Swelling (grade 0, none; grade 1, pitting; grade 2, ankle edema; grade 3, gross) improved from median 3 (0-3) to 1 (0-3) (P < .0001). Swelling completely resolved in 25% of limbs. Cumulative improvement of at least one grade of swelling (examination) was 63% at 6 years; 70% of limbs (n = 33) with prior cellulitis were relieved of recurrence after stent placement; 61% of active ulcers healed, and 37% of patients were able to discard stockings (P < .001)., Conclusions: Iliac vein stenting appears to offer a safe and effective option in octogenarians and nonagenarians when compression fails, is difficult, or is impossible., (Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)

Objectives: This work was presented as a poster in the American Venous Forum 25th Annual Meeting; 28 February 2013; Phoenix, Arizona, USA. Quality of life (QoL) is an important outcome measure in the treatment for chronic venous disease. The Aberdeen Varicose Vein Questionnaire (AVVQ) and the ChronIc Venous Insufficiency quality of life Questionnaire (CIVIQ-14) are two validated disease-specific QoL questionnaires in current use. The aim of this study is to evaluate the relationship between the AVVQ and the CIVIQ-14 to enable better comparison between studies and to compare these disease-specific QoL tools with generic QoL and clinician-driven tools., Methods: Adults attending our institution for management of their varicose veins completed the AVVQ, CIVIQ-14 and EuroQol-5D (EQ-5D). Clinical data, CEAP classification and the Venous Clinical Severity Score (VCSS) were collected. The relationship between the AVVQ and CIVIQ-14 scores was analysed using Spearman's correlation. The AVVQ and CIVIQ-14 scores were also analysed with a generic QoL tool (EQ-5D) and a clinician-driven tool, the VCSS., Results: One hundred patients, mean age 57.5 (44 males; 56 females), participated in the study. The median AVVQ score was 21.9 (range 0-74) and the median CIVIQ-14 score was 30 (range 0-89). A strong correlation was demonstrated between the AVVQ and CIVIQ-14 scores (r = 0.8; p < 0.0001). Strong correlation was maintained for patients with C1-3 disease (r = 0.7; p < 0.0001) and C4-6 disease (r = 0.8; p < 0.0001). The VCSS correlated strongly with the AVVQ and CIVIQ-14 scores (r = 0.7; p < 0.0001 and r = 0.7; p < 0.0001, respectively). Both the AVVQ and CIVIQ-14 scores correlated well with the EQ-5D score (r = -0.5; p < 0.0001 and r = -0.7; p < 0.0001, respectively)., Conclusions: This study demonstrates that there is good correlation between two widely used varicose vein specific QoL tools (AVVQ and CIVIQ-14) across the whole spectrum of disease severity. Strong correlation exists between these disease-specific QoL tools and generic and clinician-driven tools. Our findings confirm valid comparisons between studies using either disease-specific QoL tool., (© The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.)

Aim: Several studies have demonstrated the effective antithrombotic action of mesoglycan to treat chronic venous disease (CVD). The study aimed to assess clinical and quality of life (QoL) (CIVIQ 20 questionnaire) improvements in mesoglycan-treated patients with clinical, etiological, anatomical and pathophysiological (CEAP) stages 2 and 3., Methods: The open, multicentre, uncontrolled, observational, prospective study involved treating patients with 50 mg x 2/day mesoglycan for 2 months and measuring improvement to lower-limb edema and QoL in the Global, Physical, Pain, Psychological, and Social Dimensions of the Chronic Venous Disease Quality-of-Life Questionnaire (CIVIQ 20) at the first, baseline visit (V1), at the end of treatment (V2) and 2 (V3) and 4 months after treatment completion (V4). At the last visit (V4), patient disease status was assessed objectively (by the treating physician) and subjectively (by the patient). The study population was divided into three groups: 1) patients with only varicose veins; 2) patients with only lower-limb edema; 3) patients with varicose veins and edema (ITT population)., Results: Seventy-five centers enrolled 1066 patients (ITT population); 914 patients completed the study. Mesoglycan treatment produced significant improvement of edema and lower-limb circumference at every visit, in both patients with edema alone and those with edema and varicose veins (paired sample t-test P<0.001). QoL improved significantly in all questionnaire dimensions in all three patient groups even after treatment was concluded (V2). Improvement continued up to the end of the study observation period (V4) (paired sample t-test P<0.001). Objective clinical improvement of the underlying CVD was found in 76.82% of patients with varicose veins alone, in 82.83% of patients with edema alone, and in 76.7% of patients with varicose veins and edema. Patients' own subjective assessment of improvement was 82.0%, 79.39% and 79.39% respectively for the three groups., Conclusion: Results showed mesoglycan treatment to improve QoL significantly in patients with CVD as measured by a specific questionnaire like the CIVIQ 20. The extent of average edema reduction observed at the last visit (4 months after the end of drug treatment), suggests mesoglycan might have an etiological role, modifying the physiological factors underlying CVD and not just affording temporary improvement of symptoms.

Objectives: To get to know the influence of the four domains of the Chronic Lower Limb Venous Insufficiency Questionnaire (CIVIQ) on the quality of life (QoL) of patients with primary superficial venous incompetence, and their behaviour in relation to age, gender, occupation, body mass index (BMI), and also with respect to the clinical and anatomical classes of the CEAP., Material and Methods: The sample was composed of 468 patients with primary superficial venous reflux (135 male and 333 female) who answered 100% of the questions in the Short Form-12 (SF12) and CIVIQ questionnaires. After a clinical and duplex examination, the patients were categorized as C0-6, Ep, As, Ap or As,p and Pr according to the CEAP classification. The relationships between CIVIQ domains and gender, age, occupation, BMI, and the clinical and anatomical classes of the CEAP classification were analyzed., Results: Men reported better QoL than women (33.2 vs. 46.3) and this was also true for each of the CIVIQ's domains (p < .00). Pain (50.6) and physical restriction (45.3) were the dimensions with a greater influence on QoL, whereas social (41.7) and psychological (38.1) dimensions had a lesser influence. Patients aged between 45 and 64, household activities, and patients with C2-3 clinical classes were the patient groups with the worst scores in all the CIVIQ dimensions and those where significant differences were found. The BMI and anatomical distribution of the reflux had no influence on the QoL., Conclusions: Pain and physical restriction were the CIVIQ domains with greater influence on the QoL of patients with primary superficial venous reflux. Age increase (up to 64 years), female gender, household activities, and C2-3 CEAP clinical class were the main factors associated with the worst QoL perception., (Copyright © 2014 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.)

Aim: The rates of pregnant women with functional symptoms of venous insufficiency who accepted or refused to wear therapeutic compression stockings were evaluated and compared in relation to their clinical evolution and their compliance levels., Methods: The observational study was conducted in pregnant women between 4 and 28 weeks of amenorrhea presenting a CEAP C0S to C3S venous disease. Therapeutic compression stockings (BSN medical, UltraSheer Maternity stockings, 15-20 mmHg) were offered to pregnant women satisfying the inclusion criteria during routine check visits, and both groups of patients (those who accepted as well as those who refused) were followed up until the end of the pregnancy. The clinical profiles of both groups and the evolution of the venous insufficiency were monitored and compared. The women were requested to indicate pain and further quality of life parameter by means of a specific questionnaire (CIVIQ)., Results: Ninety-eight women were included in the study and followed up; 30.6% (N.=30) of the women refused to wear compression stockings (Wr), 69.4% accepted 10.6% were not compliant to a daily wear (Wanc) and 58.8% wore them every day (Wac). Leg pain was more prominent in case of the Wac group (49.5 ± 21.3) than in case of the Wanc (42.1 ± 20.4) and Wr groups (36.6 ± 18). Their global quality also decreased (48.8 ± 15.7 vs. 43.6 ± 16.1 and 36.6 ± 15.6). Regular use of compression stockings led to decrease of pain (Wac -17 ± 10.1 vs. Wanc -10.3 ± 10.5 vs. Wr -4.2 ± 9.8 [P < 0.0001]) and enhanced total quality of life (Wac 13.5 ± 9.6 vs. Wanc 10.7 ± 11.3 vs. Wr -3.3 ± 9.4 [P < 0.0001). Similar results were observed on the CIVIQ subscale (pain, psychological, social, physical impact of legs' pain on women quality of life)., Conclusion: In daily practice, more than two third of the pregnant women accepted to wear compression stockings. The use of compression stockings reduced the legs pain and increased the quality of life of pregnant women.

Varicose veins are common and cause extensive morbidity; however, the value of treatment is under-appreciated. Many procedures allow the treatment of varicose veins with minimal cost and extensive literature supporting differing minimally invasive approaches. In this article, we investigate the current literature regarding treatment options, clinical outcome and the cost-benefit economics associated with varicose vein treatment. The practice of defining clinical outcome with quality of life (QOL) assessment is explained to provide valid concepts of treatment success beyond occlusion rates.

Purpose: The aim of this qualitative study was to describe the lived experience of chronic venous insufficiency (CVI) sufferers and to explore how this chronic disease affected their health-related quality of life., Subjects and Setting: Participants included persons with a history of venous insufficiency and leg ulcers or active venous insufficiency patients. The research setting was a hospital-based outpatient wound care clinic in a small naval community approximately 1 hour from Seattle, Washington. A convenience sample of 10 patients participated in the study; 6 were women and their mean age was 66 years. Nine were white and 1 was African American, and all were currently retired, disabled, or unemployed., Instrument: A 9-item interview guide was developed consisting of open-ended questions intended to elicit the lived experiences of persons with CVI., Methods: Respondents participated in 1 focus group or individual interviews. Interpretive phenomenological analysis was used to guide data collection and analysis. Three patients participated in individual interviews and 7 patients participated in a 1-hour focus group. Data obtained from personal interviews were handwritten and data from focus group were audio-recorded. Audio-recorded data from focus group participation were transcribed, analyzed, and compared with the handwritten interviews using interpretive phenomenological analysis., Results: Four themes identifying the various emotional, physical, and social implications of living with CVI were identified. They were (1) knowledge deficit, (2) discomfort, (3) inconvenience, and (4) coping. Participants identified concerns with knowledge deficits surrounding CVI among nonwound specialized providers. Physical discomfort and issues around the inconvenience presented by the frequency of physician visits and the nature of the treatments for CVI were also noted as a great concern among all participants. Participants provided insight into the importance of a strong social network of friends and family as well as the importance of a good relationship with your medical providers to assist sufferers in coping with the disease process., Conclusion: Participants cited knowledge deficits regarding CVI among nonspecialized health care providers and the discomfort, pain, and inconvenience of suffering from CVI as contributors to poor health-related quality of life. Participants described family, friends, and caregiver relationships as being especially important in helping them cope with the disease process.

Background: The objective of this study was to develop a clear-cut, objective system for prioritization of patients on the waiting list for varicose vein surgery, to enable organization of access to the health service., Methods: During earlier phases, we selected which variables should be taken into account for the prioritization scale, such as clinical presentation, varicose vein size, complications, work situation, and influence on quality of life. In the last phase, to determine the relative weight of each variable, structured surveys (personal interviews or by e-mail) were performed of the convenience samples from the groups related to the healthcare process, including patients, relatives, and healthcare professionals., Results: The structured survey we utilized was administered to a sample of 762 subjects that included 290 patients, 99 relatives, 179 general practitioners, 32 nurses, and 162 vascular surgeons. The final score included clinical manifestations (46.1% of relative importance), size of the varicose veins (8.2%), complications (18.3%), influence on quality of life (18.2%), and aggravating work factors (9.2%)., Conclusions: The prioritization system agreed upon by all the groups involved could allow for objective and transparent prioritization and lead to the rationalization of access to varicose vein surgery for patients on the waiting list., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: Increasing numbers of patients are raising their voice in online forums. This shift is welcome as an act of patient autonomy, reflected in the term "expert patient". At the same time, there is considerable concern that patients can be easily misguided by pseudoscientific research and debate. Little is known about the sources of information used in health-related online forums, how users apply this information, and how they behave in such forums., Objective: The intent of the study was to identify (1) the sources of information used in online health-related forums, and (2) the roles and behavior of active forum visitors in introducing and disseminating this information., Methods: This observational study used the largest German multiple sclerosis (MS) online forum as a database, analyzing the user debate about the recently proposed and controversial Chronic Cerebrospinal Venous Insufficiency (CCSVI) hypothesis. After extracting all posts and then filtering relevant CCSVI posts between 01 January 2008 and 17 August 2012, we first identified hyperlinks to scientific publications and other information sources used or referenced in the posts. Employing k-means clustering, we then analyzed the users' preference for sources of information and their general posting habits., Results: Of 139,912 posts from 11,997 threads, 8628 posts discussed or at least mentioned CCSVI. We detected hyperlinks pointing to CCSVI-related scientific publications in 31 posts. In contrast, 2829 different URLs were posted to the forum, most frequently referring to social media, such as YouTube or Facebook. We identified a total of 6 different roles of hyperlink posters including Social Media Fans, Organization Followers, and Balanced Source Users. Apart from the large and nonspecific residual category of the "average user", several specific behavior patterns were identified, such as the small but relevant groups of CCSVI-Focused Responders or CCSVI Activators., Conclusions: The bulk of the observed contributions were not based on scientific results, but on various social media sources. These sources seem to contain mostly opinions and personal experience. A small group of people with distinct behavioral patterns played a core role in fuelling the discussion about CCSVI., Competing Interests: Conflicts of Interest: None declared.

Chronic diseases permanently influence on quality of life. One of them is chronic venous disease (CVD). According to The World Health Organisation (WHO) it concerns amlost 80-83.6% of adult population of the world. As most of chronic diseases CVD is not only a medical problem but also social and financial one. This paper is an overview about impact of CVD on Qol and methods of its evaluations.

Objective: Venoplasty has been proposed, alongside the theory of chronic cerebrospinal venous insufficiency (CCSVI), as a treatment for multiple sclerosis (MS). Despite concerns about its efficacy and safety, thousands of patients have undergone the procedure. This paper analyses YouTube videos where patients have shared their treatment experiences., Methods: Content analysis on the 100 most viewed videos from over 4000 identified in a search for 'CCSVI', and qualitative thematic analysis on popular 'channels' demonstrating patients' experiences., Results: Videos adopt an overwhelmingly positive stance towards CCSVI; many were uploaded by patients and present pre- and/or post-treatment experiences. Patients demonstrate rather than merely describe their symptoms, performing tests on themselves before and after treatment to quantify improvement. Videos combine medical terminology and tests with personal experiences of living with MS., Conclusion: Social media technologies provide patients with novel opportunities for advocating for particular treatments; generating alternative forms of 'evidence' built on a hybrid of personal experience and medical knowledge., Practice Implications: Healthcare practitioners need to engage with new digital forms of content, including online social media. Instead of disregarding sources not considered 'evidence-based', practitioners should enhance their understanding of what 'experiential-evidence' is deemed significant to patients, particularly in contested areas of healthcare., (Copyright © 2013 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.)

Objective: To assess the efficacy of Kinesio taping (KT) on venous symptoms, quality of life, severity, pain, edema, range of ankle motion (ROAM), and peripheral muscle myoelectrical activity in lower limbs of postmenopausal women with mild chronic venous insufficiency (CVI)., Design: Double-blinded randomized controlled trial with concealed allocation., Setting: Clinical setting., Participants: Consecutive postmenopausal women (N=123; age range, 62-67y) with early-stage CVI. None of the participants withdrew because of adverse effects., Intervention: Participants were randomly assigned to an experimental group for standardized KT application for external gastrocnemius (EG) and internal gastrocnemius (IG) muscle enhancement and ankle function correction or a placebo control group for sham KT application. Both interventions were performed 3 times a week during a 4-week period., Main Outcome Measures: Venous symptoms, CVI severity, pain, leg volume, gastrocnemius electromyographic data, ROAM, and quality of life were recorded at baseline and after treatment., Results: The experimental group evidenced significant improvements in pain distribution, venous claudication, swelling, heaviness, muscle cramps, pruritus, and CVI severity score (P≤.042). Both groups reported significant reductions in pain (experimental group: 95% confidence interval [CI], 1.6 to 2.1; control group: 95% CI, -0.2 to 0.3). There were no significant changes in either group in quality of life, leg volume, or ROAM. The experimental group showed significant improvements in root mean square signals (right leg: EG 95% CI, 2.99-5.84; IG 95% CI, 1.02-3.42; left leg: EG 95% CI, 3.00-6.25; IG 95% CI, 3.29-5.3) and peak maximum contraction (right leg: EG 95% CI, 4.8-22.7; IG 95% CI, 2.67-24.62; left leg: EG 95% CI, 2.37-20.44; IG 95% CI, 2.55-25.53), which were not changed in controls., Conclusions: KT may reduce venous symptoms, pain, and their severity and enhance gastrocnemius muscle activity, but its effects on quality of life, edema, and ROAM remain uncertain. KT may have a placebo effect on venous pain., (Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Some multiple sclerosis (MS) patients reported an improvement after percutaneous transluminal angioplasty (PTA) for chronic cerebrospinal venous insufficiency (CCSVI), despite the lack of correspondence with objective outcome scores. The objective was to assess neurologic and quality of life scores before and after PTA for CCSVI in an observational study after a self-decided approach. 44 consecutive MS patients (21/23 M/F; median age 43 years, SD 9.8) who underwent PTA were evaluated before endovascular treatment for CCSVI and after 12 months. Neurologic outcome was assessed with EDSS, the annualized relapse rate (ARR) and frequency of new lesions at MRI after PTA. Quality of life was evaluated through the MSQoL-54 questionnaire. No modification in the ARR (p = 0.829), worsening of disability status (p = 0.002) and new lesions at MRI in 29.6 % of patients were found, in contrast to an improvement both in physical and mental domains of MSQoL-54 (p = 0.003). Multiple logistic regression showed EDSS score before PTA to be predictor of an increase of >10 points in MSQoL-54 mental domain (OR 0.52, 95 % CI, 0.31-0.89, p = 0.018). Spontaneously performed approach to CCSVI does not improve clinical and MRI parameters, despite frequent subjective perception of quality of life improvement.

Objective: To assess possible links between fears of getting varicose veins and unknown great saphenous vein reflux with the prevalence and features of leg symptoms in healthy people and patients with varicose veins., Methods: Questionnaire and venous ultrasound in healthy volunteers and patients with great saphenous vein (GSV) incompetence., Results: Intensity of feelings of swelling and heaviness (S&H; scale 0-3) was 0.26 (±0.51) in healthy people without fears of varicose veins (n = 162), 0.56 (±0.72) in the presence of GSV reflux (n = 39, P = 0.001), 0.73 (±0.77) in the presence of fears of varicose veins (n = 43, P < 0.001), 0.95 (±0.98) in the presence of both findings (n = 10, P = 0.002) and 0.73 (±0.91) in patients (n = 40, P < 0.001). Intensity of S&H was higher in women (P < 0.001) and in the presence of a family history of varicose veins (P = 0.003). Fears had a large influence on S&H (F = 12.38, P < 0.001) while GSV reflux was less important (F = 4.58, P = 0.033). Fears and GSV reflux were not related to each other (r = -0.01, P = 0.933). The prevalence of a crawling sensation was equal in all study groups and cramps were more frequent in volunteers than in patients with GSV reflux (P < 0.001)., Conclusions: Healthy people with fears of getting varicose veins experience feelings of leg S&H as frequently as subjects with previously unknown GSV incompetence and patients with manifest varicose veins.

Background: This was a psychometric validation of the short Chronic Venous Disease Quality of Life Questionnaire (CIVIQ-14) as quality of life (QOL) instrument for chronic venous disease (CVD) patients., Methods: Patients aged >18 years who had CVD in CEAP C stages C0s to C6 were included in the study. Diagnosis was made by general practitioners according to CVD symptoms and visual examination of the lower extremities. QOL was assessed with the self-administrated CIVIQ-14. The reliability, construct, and convergent validity of the CIVIQ-14 was estimated as well as QOL of CVD patients according to CEAP C stages., Results: The study comprised 2260 subjects who fully completed the CIVIQ-14. CIVIQ-14 had a high level of reliability, construct, and convergent validity, but the structure of its three dimensions (pain [P], physical [PHY], and psychological [PSY]) was suboptimal. After adjustment for age, body mass index, and number of CVD symptoms, CIVIQ -14 global, P, PHY, and PSY scores showed significant progressive reduction of QOL from CEAP class C0s to C6. These differences were present in both sexes. The progressive impairment of the QOL involved primarily the pain and the physical items. For all CEAP C classes, the P and PHY scores were lower than the PSY scores. Global scores for men and women were: 76.7 and 73.9 for C0s; 75.5 and 70.6 for C1; 67.8 and 64.5 for C2; 68.3 and 61.6 for C3; 60.7 and 54.6 for C4; 49.5 and 50.2 for C5; and 41.3 and 46.7 for C6., Conclusions: CVD in the lower extremities has a substantial effect on both physical and psychologic aspects of QOL, the physical aspects of QOL (P and PHY items) being more important. CIVIQ-14 is valuable in assessing QOL in CVD patients. Further investigations are necessary to confirm the stability of its two dimensions., (Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.)

Aim: Chronic venous disease (CVD) is a well-defined and known disorder which impact on related-health quality of life (QoL). However, individuals factors which determinate quality of life on CVD are not well defined. The purposes of this study were to describe the QoL in patients with CVD and examine socio-demographical and clinical factors which influence QoL METHODS: One thousand five hundred sixty patients with CVD were evaluated. We calculated for each patient two disease-specific severity scores: The "C" grade (clinical) of the CEAP classification and the Venous Clinical Severity Score (VCSS). Additionally, two QoL questionnaires were recorded: Short-Form Health Survey (SF-12) and Chronic Lower Limb Venous Insufficiency Questionnaire (CIVIQ-20). Two multivariate logistic regression analyses (SF-12 and CIVIQ-20 model) were conducted to determine whether demographic and clinical variables were independently associated with QoL., Results: Both QoL questionnaires indicated that the QoL decreased significantly (P<0.05) as the C grade of CEAP increased. Each increase of 0.10 in VCSS score represented 2% worsening in QoL as measured by CIVIQ-20. Three factors were strongly associated with poor QoL on SF-12: increasing age, prior superficial venous thrombosis (SVT) or prior deep venous thrombosis. In the specific disease CIVIQ-20 questionnaire three factors (higher age, prior SVT and higher weight) were strongly associated with decrease QoL., Conclusion: Increasing disease severity by VCSS is associated with reductions in QoL. Subgroup analysis indicates that there are several significant individual determinants of worsening QoL.

Background: Chronic cerebrospinal venous insufficiency (CCSVI) has been reported in multiple sclerosis (MS) yet its significance in relation to cognitive function is undetermined.This study measured the association between the presence and severity of CCSVI and cognitive impairment in patients with MS., Methods: CCSVI was assessed using extra-cranial and trans-cranial Doppler sonography in 109 MS patients (79 with relapsing-remitting, 23 with secondary-progressive and 7 with primary-progressive disease subtype). A subject was considered CCSVI-positive if ≥2 venous hemodynamic criteria were fulfilled. The Minimal Assessment of Cognitive Function in MS (MACFIMS) battery was administered assessing the full spectrum of cognitive domains known to be affected by MS. Depression was quantified using the Beck Depression Inventory Fast Screen (BDIFS). Partial correlations, analysis of variance (or covariance) and linear regression were used to examine the hypothesis that CCSVI status is related to cognition or depression after controlling for education and gender., Results: There were 64 (58.7%) patients who were considered CCSVI-positive. The regression models predicting venous hemodynamic insufficiency severity score were not statistically significant for any of the MACFIMS predictor variables. The analysis of variance tests showed a significant effect of CCSVI-positive diagnosis on cognitive ability in only one of the 10 MACFIMS outcomes, and that one was in the opposite direction of the tested hypothesis. There was no correspondence between CCSVI diagnosis and depression, as measured by the BDIFS., Conclusions: We find no evidence of an association between the presence and severity of CCSVI with cognitive impairment and depression in patients with MS.

Objective: To assess the safety and efficiency of steam vein sclerosis (SVS) of the great saphenous vein (GSV) in a multicentre open prospective cohort study., Design: 75 consecutive adult patients with GSV reflux, CEAP C2-C5 and vein diameter 4-13 mm., Methods: Patients treated using an SVS™ generator delivering homogenous pulses of superheated steam were followed up at 8 days and 1, 3, 6 and 12 months (clinical, duplex ultrasound, quality of life [QoL] with SF12)., Results: 88 veins were treated in 75 patients. At 6 months, 72/75 (96%) veins were obliterated (95% CI: 89-99) and Kaplan-Meier analysis found an obliteration rate of 96.1% at 12 months. QoL increased at 6 months for both the physical and mental components (p = 0.049 and p < 0.001 respectively). SVS was well tolerated: no major complications were reported. Adverse events occurred mainly at day 8 and incidents amounted to ecchymosis (n = 60) and pain (n = 7)., Conclusions: SVS achieved an obliteration rate similar to that of other thermal ablation techniques. It was well tolerated with minimal post-operative pain., (Copyright © 2013 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.)

Objective: Thermal ablative techniques of varicose veins carry a risk of heat-related complications, including postoperative pain. Mechanochemical endovenous ablation (MOCA) might avoid these complications and reduce postoperative pain because of the absence of thermal energy. This study evaluated postoperative pain and quality of life after radiofrequency ablation (RFA) and MOCA for great saphenous vein (GSV) incompetence., Methods: Sixty-eight patients with unilateral GSV incompetence were treated with either RFA or MOCA in this prospective observational study. Patients monitored their pain for the first 14 postoperative days on a 100-mm visual analog scale (VAS). They also completed the general (RAND 36-Item Short-Form Health Survey) and disease-specific (Aberdeen Varicose Vein Questionnaire) quality of life questionnaires before and 6 weeks after treatment., Results: Patients treated with MOCA reported significantly less postoperative pain than patients treated with RFA during the first 14 days after treatment (4.8 ± 9.7 mm vs 18.6 ± 17.0 mm; P < .001) (mean VAS over 14 days). The lower postoperative pain score was associated with a significantly earlier return to normal activities (1.2 ± 1.8 vs 2.4 ± 2.8 days; P = .02) and work resumption (3.3 ± 4.7 vs 5.6 ± 5.8 days, respectively; P = .02). At 6 weeks, patients in both groups perceived an improved change in health status and an improved disease-specific quality of life., Conclusions: MOCA is associated with significantly less postoperative pain, faster recovery, and earlier work resumption compared with RFA in the treatment of GSV incompetence. MOCA and RFA are both related to a rapid improvement in quality of life., (Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.)

Aim: The present study aimed to demonstrate how the quality of life (QoL) perceived by patients with chronic venous disease (CVD) is correlated with the severity of their disease objectively assessed by primary care physician., Material and Methods: A total of 1560 patients with CVD were evaluated using four measurement instruments: CEAP clinical classification, Venous Clinical Severity Score (VCSS), SF-12 Health Survey and Chronic Lower Limb Venous Insufficiency Questionnaire (CIVIQ-20). Statistical correlations between these tools were analysed using Spearman's coefficient., Results: Patients were distributed in C0, 58 (3.7%); C1, 243 (15.6%); C2, 328 (21.0%); C3, 357 (22.9%); C4, 368 (23.6%); C5, 136 (8.7%); and C6, 70 (4.5%). The VCSS score for the whole cohort was 0.89 ± 0.53. The correlation between CEAP and VCSS was moderately strong (r = 0.69). The overall QoL scores measured by SF and CIVIQ were 56.84 ± 19.63 and 65.11 ± 14.35, respectively. The correlation between the two QoL questionnaires was very strong (r = 0.81). The correlations of the SF and CIVIQ with the VCSS were moderately strong (r = -0.47 and -0.48). The correlations between QoL questionnaires and CEAP were moderate and lower than those with VSCC., Conclusions: While there is correlation between VCSS, CEAP, modified CIVIQ and venous ultrasound findings, subgroup analysis indicates that this correlation is driven by different components of VCSS compared with the other venous assessment tools. Patients' opinions about their disease are correlated with those assessed by primary care physicians., (Copyright © 2012 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.)

Objective: Previous studies have correlated increasing great saphenous vein (GSV) diameter with increasing CEAP clinical classification. Some insurance carriers are currently using specific GSV diameters to determine coverage for treatment of axial venous insufficiency. The aim of this study was to investigate the correlation of patient quality of life (QOL) measures with GSV diameters in varicose vein patients with GSV reflux., Methods: Data were collected from the records of 91 patients prospectively enrolled in two varicose vein trials. The patients had symptomatic varicose veins with saphenofemoral junction and proximal GSV reflux. Maximum GSV diameter was measured on duplex ultrasound imaging, with the patient standing, within 5 cm of the saphenofemoral junction. Chronic Venous Insufficiency Questionnaire 2 (CIVIQ-2; Servier, Neuilly-sur-Seine, France), Venous Insufficiency Epidemiological and Economic Study (VEINES) Symptom (Sym) and QOL assessments, and the Venous Clinical Severity Score (VCSS) assessment were completed before treatment of GSV insufficiency. Demographic information, patient weight, height, and body mass index were collected. Correlations between pairs of data were done using Pearson product-moment and Spearman correlation coefficients., Results: The 91 study patients (19 men, 72 women) were a mean age of 45 years (range, 18-65 years). The mean GSV diameter was 6.7 mm (range, 2.2-14.1 mm). The mean VCSS score was 7.8 (range, 3-12). There was a weak correlation between increasing GSV diameter and VCSS (r=0.23; P=.03) and no correlation between GSV diameter and the CIVIQ-2 score (r=0.01), VEINES-QOL (r=-0.07), and VEINES-Sym (r=-0.1)., Conclusions: GSV diameter is a poor surrogate marker for assessing the effect of varicose veins on a patient's QOL; thus, using GSV diameter as a sole criterion for determining medical necessity for the treatment of GSV reflux is inappropriate. Further correlations between QOL measures and duplex-derived objective findings are warranted., (Copyright © 2012 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.)

Objectives: Venous insufficiency is present in a large number of postmenopausal women, increasing their risk of disability. The objective of this study was to determine the effects of myofascial release therapy and conventional kinesiotherapy on venous blood circulation, pain and quality of life in postmenopausal patients with venous insufficiency., Methods: A randomised controlled trial was undertaken. We enrolled 65 postmenopausal women with stage I or II venous insufficiency on the clinical, aetiological, anatomical and physiopathological (CEAP) scale of venous disorders, randomly assigning them to a control (n=32) or experimental (n=33) group. The control and experimental group patients underwent physical venous return therapy (kinesiotherapy) for a 10-week period, during which the experimental group patients also received 20 sessions of myofascial release therapy. Main outcome measures determined pre- and post-intervention were blood pressure, cell mass, intracellular water, basal metabolism, venous velocity, skin temperature, pain and quality of life., Results: Basal metabolism (P<0.047), intracellular water (P<0.041), diastolic blood pressure (P<0.046), venous blood flow velocity (P<0.048), pain (P<0.039) and emotional role (P<0.047) were significantly higher in the experimental group than in the control group after the 10-week treatment programme., Conclusion: The combination of myofascial release therapy and kinesiotherapy improves the venous return blood flow, pain and quality of life in postmenopausal women with venous insufficiency., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Aim: The aim of this study was to translate the VEINES-QOL/Sym questionnaire into Turkish, which is used mainly in Western European countries, and to study its reliability and validity., Methods: Standard "forward-backward" translation method was used to translate the questionnaire. The internal consistency was assessed with Cronbach's α, test-retest reliability was assessed with the intraclass correlation and Spearman-Brown coefficients. Validity was examined by correlation of VEINES-QOL/Sym with SF-36, Venous Clinical Severity (VCSS), and Venous Disability Scores (VDS)., Results: Out of 100 patients included (mean age 41.9 ± 12.5 years; 32% male, 68% female), 30 were given the questionnaire twice with 24-hour intervals for test-retest; a final completion rate of 99.2% was achieved. The Cronbach's α was 0.914. The Spearman-Brown coefficients and the intraclass correlation coefficients were 0.994, 0.988 and 0.966, 0.933 for VQOL and VSym scores, respectively. For the total quality of life and for several domains the correlations between VEINES-QOL/Sym and SF-36 were high, and significant. Inverse and significant correlations were observed with VCSS., Conclusion: Conclusively, the Turkish version of VEINSES-QOL/Sym questionnaire is reliable and valid; thus, it is highly recommended to use Turkish version of VEINSES-QOL/Sym to evaluate the quality of life and symptoms of patients with venous insufficiency in Turkey.

Venous symptoms and quality of life (QOL) of 78 patients (54 women, mean age 49,5±13,3 years) with primary superficial venous insufficiency (PSVI) were compared at one year after treatment with crossectomy and stripping (C/S, 56 patients) or endovenous laser ablation (EVLA, 22 patients) using the VEINES-QOL questionnaire. Both treatments significantly (p<0,001) improved the scores for venous symptoms (difference 10,6±9,9 and 9,9±8,2 score points for C/S and EVLA, respectively) and QOL (difference 10,3±8,7 and 8,4±6,6 score points for C/S and EVLA, respectively). No difference was found between treatments regarding symptoms or QOL improvement (p=0,30). We conclude that C/S and EVLA are equally effective in improving symptoms and QOL in PSVI.

Background: We report the outcome of 67 patients after endovascular treatment of chronic cerebro-spinal venous insufficiency in patients with multiple sclerosis. Material and methods For evaluating outcome, patients were divided into three groups with respective outcome after three, six and twelve months. Assessment of outcome was done by a disease-specific quality-of-life score that reflects the physical health (physical health composite, PHC) and mental health (mental health composite, MHC) by a score., Results: Improvement in PHC was significant (P < 0.05) in the three- and six-month groups. Improvement in MHC was only significant (P < 0.05) in the three-month group., Conclusion: In conclusion, we can state that the result of endovascular treatment seems to decay although the baseline is still higher than preoperative. To confirm this finding, this study needs to be reproduced in a larger patient population.