title: Patient-reported symptoms are independent of disease severity in patients with primary varicose veins.
abstract: The objective of this paper is to explore patterns of incompetence and disease distribution in patients with chronic venous disorders and to correlate this with CEAP (Clinical, Etiologic, Anatomic and Pathologic) classification and presenting symptoms to determine which features of chronic venous disorder (CVD) could be used to guide a patient pathway for referral and treatment. Consecutive patients attending a one-stop venous clinic at a university teaching hospital were recruited over a 12-month period. Patients were clinically assessed, assigned CEAP scores, duplex-scanned and categorized. Data were analyzed to identify associations between symptomatology and disease. Four hundred twenty-four limbs were divided into groups A (C2-3) (339) and B (C4-6) (85). The number of men, mean patient age, varicose vein diameter and quality-of-life score (Aberdeen Varicose Vein Questionnaire - AVVS) were significantly higher in group B (P < 0.01). Ache occurred more commonly in group A and in women (P < 0.01). Ache and pain were seen more frequently with saphenofemoral junction reflux (P < 0.05). Group A women were more likely to be offered surgical intervention while men were managed conservatively (P < 0.05). In conclusion, CVD symptoms are independent of disease severity assessed by CEAP score. Advanced disease is associated with larger venous diameters, older age and corresponds to a poorer quality of life. Objective markers such as CEAP, Venous Clinical Severity Score and AVVS should be used in determining a patient pathway for referral and treatment of CVD.
authors.affiliation: St George's Vascular Institute, St George's Healthcare NHS Trust, London SW17 0QT, UK. allan.m.conway@doctors.org.uk
authors.forename: A M
authors.initials: AM
authors.lastname: Conway
authors.forename: I M
authors.initials: IM
authors.lastname: Nordon
authors.forename: R J
authors.initials: RJ
authors.lastname: Hinchliffe
authors.forename: M M
authors.initials: MM
authors.lastname: Thompson
authors.forename: I M
authors.initials: IM
authors.lastname: Loftus
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D019091:Critical Pathways; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012017:Referral and Consultation; D057566:Self Report; D012720:Severity of Illness Index; D014463:Ultrasonography; D014648:Varicose Veins / Q000145:classification / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D055815:Young Adult