Venous leg ulcer in the context of chronic venous disease.

OBJECTIVES: Chronic venous disease (CVD) is a frequent disorder with a high socioeconomic impact. Little is known about the possible differences between healed ulcer (C5 group) and active ulcer (C6 group) in terms of disease severity and quality of life (QoL). Our aim was to determine the possible differences in severity disease and QoL between the C5-C6 and C1 (control) group. METHODS: Data from a national, multicentre, observational and cross-sectional study (n = 1598) were used to compare three groups of CVD: C1 (n = 243), C5 (n = 136) and C6 (n = 70). CVD severity was assessed with the Venous Clinical Severity Score (VCSS) and QoL with the Short Form 12 Health Survey (SF-12) and Chronic Lower Limb Venous Insufficiency Questionnaire (CIVIQ-20). RESULTS: Patients with active ulcers had a higher mean total VCSS than patients with healed ulcers (P < 0.05). Both SF-12 and CIVIQ-20 QoL questionnaires indicated a poorer QoL in patients with ulcers than in those with C1 (P < 0.05). Compared with the C5 group, patients with active ulcers (C6) had lower QoL scores, but the differences were not statistically significant. CONCLUSIONS: Patients with venous leg ulcers (C5-C6) are associated with high severity and poor QoL. However, the healing of a leg ulcer did not contribute to improvement of QoL.

Quality of life in patients with chronic venous disease: influence of the socio-demographical and clinical factors.

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.

Determinantes de la gravedad en la insuficiencia venosa crónica. Estudio C-VIVES / Determining factors of the severity of chronic venous insufficiency. C-VIVES study

Introducción: La evaluación de la insuficiencia venosa crónica (IVC) puede medirse mediante escalas de gravedad venosa. Sin embargo, los factores individuales que la condicionan no están bien descritos. El objetivo del estudio es conocer las características sociodemográficas y clínicas de una muestra de pacientes portadores de IVC para permitir la búsqueda de los factores que incrementan la gravedad de la misma. Material y método: Estudio promovido por la Sociedad Española de Angiología y Cirugía Vascular en colaboración con otras sociedades científicas españolas sobre 1.560 pacientes con IVC y a los que se han aplicado 2 instrumentos: clasificación clínica CEAP y Venous Clinical Severity Score (VCSS). Resultados: La distribución de pacientes por estadios clínicos fue: C0, 3,3%; C1, 15,6%; C2, 21,0%, C3, 22,9%; C4, 23,6%; C5, 8,7%; C6, 4,5%. La puntuación VCSS para toda la cohorte fue de 0,89 ± 0,53, siendo superior a la media en 4 de los 10 atributos medidos: dolor (1,59 ± 0,75), venas varicosas (1,80 ± 0,74), edema (1,40 ± 0,89), y pigmentación (1,05 ± 0,98). A mayor CEAP le corresponde mayor puntuación VCSS. En el análisis por subgrupos destacan como factores de gravedad el género, varón, edad, peso, sedentarismo, antecedentes personales y familiares de enfermedad venosa. En el análisis de regresión múltiple, los determinantes fundamentales de gravedad son: 1) edad; 2) antecedente de trombosis venosa superficial o profunda, y 3) peso del paciente. Conclusiones: Existe una relación positiva entre CEAP y VCSS. El análisis por subgrupos define factores fuertes y débiles de gravedad, que quedan clarificados mediante regresión múltiple(AU)

Introduction: Chronic venous insufficiency (CVI) can be evaluated using venous clinical severity scores. However, the individual factors that may lead to this condition have not been well described. The objective of this study is to analyse the sociodemographic and clinical characteristics of sample of patients who suffer from CVI in order determine the factors that increase the severity of their condition. Material and method: A study, promoted by the Spanish Society of Angiology and Vascular Surgery in collaboration with other scientific societies, was conducted on 1,560 patients with CVI using two measurement tools: CEAP (clinical grade, etiology, anatomy, pathophysiology) classification and Venous Clinical Severity Score (VCSS). Results: The patient distribution by clinical status (C0 to C5) was: C0: 3.3%; C1: 15.6%; C2: 21.0%, C3: 22.9%; C4: 23.6%; C5: 8.7%; C6: 4.5%. The VCSS score for the whole cohort was 0.89 ± 0.53, being greater than the mean in four of the ten measurements attributed to: pain (1.59 ± 0.75), varicose veins (1.80 ± 0.74), oedema (1.40 ± 0.89), and pigmentation (1.05 ± 0.98). A higher CEAP corresponded to a higher VCSS. In the analysis by subgroups, the risk severity factors were associated with, being male, weight, being sedentary, personal and family history of venous disease. In the multiple regression analysis, the main determining factors were: 1) age; 2) history of superficial of deep venous thrombosis; and 3) patient weight. Conclusions: There is a positive relationship between CEAP and VCSS. The analysis by sub-groups defines strong and weak factors of severity, that are made clear using multiple regression analysis(AU)

Chronic venous disease in Spain: doctor-patient correlation.

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.

Criterios de derivación entre niveles asistenciales de pacientes con patología vascular. Documento de consenso semFYC-SEACV / Criteria for between-care-level referrals of patients with vascular disease. semFYC-SEACV consensus document

La Sociedad Española de Medicina Familiar y Comunitaria (semFYC) y la Sociedad Española de Angiología y Cirugía Vascular (SEACV) han elaborado, mediante un grupo de trabajo conjunto, un documento de derivación entre niveles asistenciales de los pacientes con las principales patologías vasculares: enfermedad arterial periférica, insuficiencia venosa y pie diabético. Se han definido las responsabilidades y habilidades requeridas de cada nivel asistencial y también los criterios de derivación mutua, así como los de priorización. La elaboración de este documento consensuado pretende aportar una herramienta eficiente que asegure la continuidad en la asistencia sanitaria, respetando siempre las particularidades y necesidades específicas de cada zona sanitaria(AU)

The Spanish Society of Family and Community Medicine (semFYC) and the Spanish Society of Angiology and Vascular Surgery (SEACV), through a Joint Working Group, have prepared a document on between care-level referrals of patients with the main vascular diseases; peripheral arterial disease, venous insufficiency, and diabetic foot. The responsibilities and skills required at each care level have been defined, as well as the criteria for mutual referral and how to prioritise them. The preparation of this consensus document attempt to provide an efficient tool that may ensure the continuity of health care, always respecting the specific characteristics and needs of each health care area(AU)