Truncal varicose vein diameter and patient-reported outcome measures

Abstract

Background Varicose veins and chronic venous disease are common, and some funding bodies ration treatment based on a minimum diameter of the incompetent truncal vein. This study assessed the effect of maximum vein diameter on clinical status and patient symptoms. Methods A prospective observational cohort study of patients presenting with symptomatic varicose veins to a tertiary referral public hospital vascular clinic between January 2011 and July 2012. Patients underwent standardized assessment with venous duplex ultrasonography, and completed questionnaires assessing quality of life (QoL) and symptoms (Aberdeen Varicose Vein Questionnaire, EuroQol Five Domain QoL assessment and EuroQol visual analogue scale). Clinical scores (Venous Clinical Severity Score (VCSS) and Clinical Etiologic Anatomic Pathophysiologic (CEAP) class) were also calculated. Regression analysis was used to investigate the relationship between QoL, symptoms and vein diameter. Results Some 330 patients were assessed before surgery. The median maximum vein diameter was 7·0 (i.q.r. 5·3–9·2) mm overall, 7·9 (6·0–9·8) mm for great saphenous vein and 6·0 (5·2–8·9) mm for small saphenous vein. In linear regression analysis, vein diameter was shown to have a significant association with VCSS (P = 0·041). For every 1‐mm increase in vein diameter, there was a 2·75‐fold increase in risk of being in CEAP class C4 compared with C2. No other QoL or symptom measures were related to vein diameter. Conclusion Incompetent truncal vein diameter was associated with increasing VCSS, but not a variety of other varicose vein disease‐specific and generic patient‐reported outcome measures.

Is Size Important? The French Experience

“…With this large sample, the authors have been able to confirm a correlation previously described by Lane et al 2 between the diameter of the GSV and both clinical class and venous symptoms. They have also shown a correlation between GSV diameter and proximal extent of reflux.…”

Vein Size and Disease Severity in Chronic Venous Diseases

“…To address the above concern, Lane et al assessed the association of maximum vein diameter and clinical severity score with quality of living score in 330 patients. 3 They did not observe any significant association between maximum vein diameter and clinical stage of the disease. Our study had a large population of 6,350 patients and included patients with varicosities of all vein sizes.…”

“…In several countries such as UK, health care professionals consider a threshold of > 3 mm or even 4.5 mm diameter of afflicted veins to qualify the patient for treatment. 3,4,18 The treatment approach for reflux in smaller veins is different and difficult when compared with truncal veins. 19,20 The currently followed screening approach is inappropriate in several instances when patients have symptomatic varicose veins without truncal reflux.…”

“…Based on a retrospective study in 330 patients with CVD, Lane et al have reported that there was no significant association between larger vein diameter and clinical severity, etiology, anatomy, and pathophysiology (CEAP) classes of CVD. 3 The role of reflux in veins with smaller diameter in the development of skin changes and leg ulceration is unknown. We have analyzed the relationship between the size of veins with blood reflux and clinical manifestations such as hyperpigmentation, thrombophlebitis, cellulitis, and ulceration.…”

Comment On “Vein Size and Disease Severity in Chronic Venous Disease” by Radhakrishnan et al

“…10 For this reason, patients with reflux solely in the small superficial veins are usually neglected and may not be considered for treatment. 11 However, it is known from previous reports that that there may not be a significant difference in the symptoms of patients with and without duplex ultrasound confirmed functional venous disease. 12 In addition, a recently published study demonstrated that there is no significant association between truncal varicose vein diameter and patients clinical stage, symptoms, and quality-of-life measurements.…”