Innovations, validations and limitations in assessing chronic venous disorder

Abstract

Chronic venous disorder (CVD) is common affecting 30-40% of the general population. The symptoms include pain, ambulatory discomfort and cosmetic embarrassment with signs of varicose veins, gaiter pigmentation and leg ulceration. The post-thrombotic syndrome (PTS) occurs as the aftermath of a deep vein thrombosis. Standard evaluation tools are used to assess CVD so that the severity of disease and the beneficial effects of treatment can be recorded. This is an essential ingredient for all controlled trials. Measurements of effectiveness allow different treatments, similar treatments between different hospitals and the natural history of untreated disease to be assessed and compared. Cost is an important component of a cost-effective analysis. This thesis provides a critical analysis on the ways in which patients are assessed with novel suggestions for improvement. The aim of this work is to examine the following scoring systems/questionnaires and to provide evidence as to how they can be improved: 1. The clinical part of the CEAP classification 2. The venous clinical severity score 3. The Aberdeen varicose vein questionnaire 4. The Villalta scale The following haemodynamic tests will also be assessed together with novel applications: 1. Duplex 2. Air-plethysmography Normal controls, patients with primary CVD and patients with PTS are the subjects used in this research. Most belong to 2 controlled trials. The first compares endovenous laser ablation (EVLA) with ultrasound-guided foam sclerotherapy (UGFS) and the second compares stockings of different lengths and compression strengths in treating PTS patients. The main innovations in assessment are the saphenous treatment score, the saphenous pulse and the venous filling time to 90% of the venous volume (VFT90) in the identification of patients with mild clinical disease. The main validation is the clinical and haemodynamic correlations with the Villalta scale, and the main limitation is the use of the C of CEAP in the assessment of clinical severity.