Systemspecific Questionnaires

Correct and consistent clinical diagnosis and subsequent classification are vital before addressing the post-treatment phase with disease-specific questionnaires. The CEAP (Clinical-Etiology-Anatomic-Pathophysiologic) classification was developed in 1994 and was translated into several languages and adopted worldwide by the vascular community.

The CEAP system, however, is not easily translated into a quantifiable scoring system; for this a Venous Clinical Severity Score (VCSS) and a Venous Segmental Disease Score (VSDS) was proposed.12 In summary the VCSS grades 10 clinical characteristics from absent to severe (see Table

34.1). The VSDS assesses the anatomical and pathophysi-ogical characteristics of CEAP. The scores are allocated to 11 venous segments with reflux and/or obstruction based on venous imaging. In addition a Venous Disability Score (VDS) has been published with the intention of measuring the degree of impairment in daily activities.

To allow the comparison of different treatments or results from different publications there is a need for standardization of the severity of the venous disease being studied. These scoring systems are an adjunct to the current armamentarium and are to be recommended for use in future venous outcome assessment studies. These studies are as yet to be applied to a large multicenter study of patients with varicose veins.

Currently there are three system- or disease-specific instruments for measurement of health-related quality of life in patients with chronic venous disease of the lower limb that can be applied to patients with varicose veins (see Table 34.2).

Disease-Specific Studies Aberdeen Varicose Vein Score

This initially was designed as a postal questionnaire. Published in 1993, it surveyed 373 patients with varicose veins selected from a hospital and general practice setting. A comparison group was made up of a random sample of 900 members of the general population selected from the electoral register of Aberdeen. They were sent a similar questionnaire without the condition-specific tool. The validity of the questionnaire was shown by a high correlation with the SF-36 health profile; the perceived health of patients with varicose veins was significantly lower than that of the general population.13

In 1999 the Aberdeen Varicose Vein questionnaire (AVVQ) was used to determine the quality of life of patients with varicose veins both before and after surgery.16 This was a prospective consecutive cohort of 137 patients with primary varicose veins (recurrent veins, deep venous disease, and an

System-Specific Questionnaires TABLE 34.2 Disease-Specific Studies on the Quality of Life in Patients with Chronic Venous Disease

TABLE 34.3 Aberdeen Varicose Vein Symptom Severity Scores (AVVSSS) in Patients with Primary Varicose Veins Pre- and Postsurgery

Name and year Language Patients evaluated Summary

System-Specific Questionnaires TABLE 34.2 Disease-Specific Studies on the Quality of Life in Patients with Chronic Venous Disease

Name and year Language Patients evaluated Summary

Aberdeen Varicose Vein

English

Varicose veins and chronic venous disease

Grid used to score the extent of the varicosities

Questionnaire (AVVQ) 199313

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