Factors influencing the choice of treatment modality for individual patients with varicose veins

Abstract

INTRODUCTION There is evidence of effectiveness for a range of different treatment modalities for varicose veins but limited information about factors that influence treatment choice for individual patients. METHODS A postal survey was sent to 438 UK members of the Vascular Society of Great Britain and Ireland. RESULTS Overall, 251 responses were received (response rate 57%). A total of 222 respondents treated varicose veins using conventional surgery (84%), endothermal ablation (82%) and foam sclerotherapy (68%). The clinical pattern of veins appeared to have the greatest influence on treatment choice. This was followed by guidance from the National Institute for Health and Care Excellence, patient expectations, facilities, cost and whether treatment was carried out in the public or private sector. Respondents were asked to indicate whether each of 13 clinical 'scenarios' (eg very extensive varicose veins in both legs) would influence them towards or against using specified treatment modalities. 'Consensus' was defined as ≥80% of responses either towards or against any treatment modality; and disagreement as 41-59% both towards and against any modality (i.e. ∼50:50 split). There was consensus towards using endothermal ablation for truncal reflux, towards UGFS for localised varicose veins and towards conventional surgery for large, extensive, bilateral veins. There was consensus against UGFS for large truncal veins, and against surgery for obese patients and those with a history of venous thromboembolism. There were important disagreements about the influence of large or extensive veins, about whether patients were obese or slim and about a prior history of venous thromboembolism. CONCLUSIONS Conventional surgery is still widely available in the UK. Disagreements about treatment choice in different clinical scenarios suggest substantial variation in the treatments patients are offered. Attention to identifying subgroups in trials would help to guide treatment choice for individual patients.

An algorithm combining VVSYmQ® and VCSS scores may help to predict disease severity in C2 patients

“…For physicians in the United Kingdom, there is a trend toward conventional surgery over endothermal ablation, presumably attributed to financial concerns within the NHS. 15 In the US, the variability in venous disease treatment has been attributed to a lack of uniformity in insurance policies. 2 Similarly, in China, a survey of venous surgeons found that the majority of practitioners endorse reimbursement and patient health insurance as significant factors in their treatment algorithms.…”

Needs of standardisation in reporting a venous lower limb ultrasound exam for the assessment of varicose veins

“…Indeed, according to the NICE guideline, the DUS exam is necessary to confirm the diagnosis of primary or recurrent varicose veins, and to determine whether the cause of venous reflux is treatable according to the recommended treatments offered by the NICE guidelines (first endothermal ablation, then ultrasound-guided foam sclerotherapy and, when both are unsuitable, open repair surgery). 2 Therefore, in the UK, the DUS report usually includes the presence and distribution of truncal venous reflux, the diameter and course of incompetent veins, the distance of incompetent veins from the skin, as well as the presence and diameter of incompetent perforator veins. However, the diameter of the latest is mainly reported in those centres where their treatment is considered.…”

Effects of KED peptide on connexin and sirutin expression in atherosclerosis and restinosis in elderly people

“…КЕD позволяет улучшить кровообращение в тканях мозга, нормализовать память, усилить интеллектуальные способности [8,9]. При назначении пептида установлено повышение резистентности микрососудов кожного покрова у пациентов, имеющих в анамнезе гиповитаминоз [10,11]. Дополнительно выявлен процесс нормализации циркуляции крови по капиллярам у крыс, болеющих пародонтитом, при введении пептида KED в виде инъекций [8].…”