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A Journal on Phlebology
Acta Phlebologica 2012 August;13(2):93-9
Varicose veins and severity of chronic venous disorder
Lattimer C. R. 1, 2, Kalodiki E. 1, 2, Azzam M. 2, Geroulakos G. 1, 2
1 Imperial College, London, UK
2 Josef Pflug Vascular Laboratory, Ealing Hospital, Middlesex, UK
AIM:Question 1 of the Aberdeen varicose vein questionnaire (AVVQ) uses grids to assess the distribution of varicose veins (VVs), and question 2 of the venous clinical severity score (VCSS) grades their extent as 1=scattered, 2=thigh or calf, and 3=thigh & calf. The aim of this study was to quantify VVs with these questions and compare the results with validated measurements of severity: C of CEAP, great saphenous vein (GSV) diameter and the venous filling index (VFI) and venous filling time to 90% of the venous volume (VFT90) using air-plethysmography.
METHODS:One hundred consecutive patients (100 legs), 41 male, 46 unilateral, awaiting endovenous treatment for GSV reflux were retrieved from our database. The median age, AVVQ, VCSS, refluxing GSV diameter, VFI and VFT90 was 46 (21-78) years, 21 (1-53), 6 (2-20), 7 (4-12) mm, 4.9 (0.9-17.8) mL/sec and 18.9 (7-76.1) sec respectively. The C class stratification was: C2=34,C3=14,C4a=29,C4b=9,C5=7,C6=7.
RESULTS: There was no significant correlation (Spearman) between VV assessment using the AVVQ (question 1) against the VCSS (r=0.004), C part of CEAP (r=0.09) GSV diameter (r=0.05) nor the VFI (r=0.1). However, there were significant associations in VV assessment (Mann-Whitney U test) between each grade of VCSS (question 2) compared to GSV diameter (P=0.03, P=0.08), VFI (P=0.001, P=0.044) and VFT90 (P=0.002, P=0.425).
CONCLUSION:Quantification of VVs using the AVVQ and the VCSS are unable to discriminate patients with severe clinical disease. However, VV quantification using the VCSS was statistically related to hemodynamic parameters. Varicose veins are a marker of chronic venous disorder but their extent may not relate to clinical severity.