Chronic venous insufficiency and lower limb ulceration : aetiology, treatment and provision of care
Study 1: Outcomes after superficial venous surgery 1a: Quality of life (QoL) after varicose vein (VV) surgery. 203 consecutive patients undergoing VV surgery completed the Aberdeen Varicose Vein Severity Score (AVSS) QoL questionnaire pre-operatively, 4 weeks, 6 months and 2 years post-operatively. VV surgery leads to a significant improvement in AVSS, sustained at 2 years. Patients having surgery for recurrent VV score worse at all time-points than patients with primary VV but still enjoy a significant improvement in QoL. 1b: The effect of long saphenous vein (LSV) stripping on QoL. 66 of the 203 patients in study 1a had pre- and post-operative venous duplex. Even in a specialised vascular unit where stripping is routinely attempted, only 25/66 (38%) had their LSV completely stripped to the level of the knee. Complete (as opposed to incomplete) stripping to the knee was associated with an additional improvement in AVSS above that seen in study 1a. In those with pre-operative deep venous reflux (DVR) complete stripping did not confer this additional advantage. 1c: The effect of long saphenous vein stripping on deep venous reflux (DVR). In 77 limbs of 62 patients from study 1b, complete stripping was associated with reversal of pre-operative superficial femoral and popliteal vein reflux. Incomplete stripping was associated with the development of DVR in previously normal deep veins. Study 2: Lower limb ulceration: delivery of care and aetiology. 2a: Delivery of care for lower limb ulceration. 128 patients were assessed at a one-stop leg ulcer clinic, 79% of whom had purely venous ulceration. 2b: Aetiology of CVU: thrombophilia. 41% of 88 patients with CVU had an identifiable thrombophilic abnormality. Thrombophilia was 3-20 times more common than in the general population, but similar to rates reported in patients with a first episode of venous thrombosis.