Relationship between signs, symptoms, reflux, and quality of life in patients with chronic venous disease

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Michel PERRIN, Benoît ARNOULD*
*Perrin M, Arnould B.
Relationship between signs,
symptoms, reflux, and
quality of life in patients
with chronic venous
disease. Paper presented
at the American Venous
Forum Congress.

Background: Quality of life (QoL) of patients suffering from chronic venous disease (CVD) has been shown to be globally impaired. Little is known about the individual impact of clinical parameters on the QoL of patients with CVD.

Objective: To assess the impact of demographic data, clinical data, signs, and symptoms on the QoL of patients with CVD.

Methods: Patients: Symptomatic patients, diagnosed as CEAP clinical class 0 to 4, aged over 18 years, male or female, of any race, wearing compression stockings or not, were enrolled in the study.

Reflux assessment: Detection by means of pocket Doppler, confirmed by photoplethysmography.

Symptom assessment: Sensation of swelling, cramps, and leg heaviness using a 4-point scale (0 = absent to 3 = severe), pain using a 10-cm visual analog scale (VAS). Edema: By measuring leg circumference.
Quality of Life: Using the Global Index (from 0= bad QoL to 100= excellent QoL) of the CIVIQ questionnaire (20 severity items).

Statistical analysis: A multivariate linear regression model was used to assess the specific contribution of each factor to the level of QoL.

Results: The database included 3516 observations for which the clinical and the QoL data were completed. Patients were mostly Caucasian (77.9%), female (81.1%), with mean age 45.5±12.3 years, mean BMI 26.1±6.47, mean duration of CVD 12.4±9.8 years. Venous reflux was found in 46.6% and CEAP distribution C0s-C1 in 21.1%, C2 in 40.5%, and C3-4 in 36%.
Age, female gender, BMI, ankle perimeter, presence of reflux, and assignment to a severe CEAP clinical class had a slight impact on QoL, with minor change in the CIVIQ global score. In contrast, symptoms, particularly heaviness and pain, were found to seriously affect patients’ QoL. (Table I)

Conclusion: This study demonstrates that symptoms usually attributed to CVD are the factors with the most negative influence on the patients’ QoL. This suggests that a treatment reducing symptoms might improve the QoL of symptomatic patients, even in the absence of detectable reflux or signs.