INTEGRATING PATIENT-REPORTED OUTCOMES AND FUNCTIONAL TESTING IN VARICOSE VEIN EVALUATION: A CASE STUDY

Highlights

• This case highlights the need for questionnaires targeting functional limitations in chronic venous disorders.
• This case shows the gap in assessment; the functional tests are often under-evaluated.
• This article highlights the need for more scores and scales evaluating functional concerns rather than cosmetic.

Background. Varicose veins (VV), being a chronic venous disorder, affect up to 40% adult population. While considerable attention has been given to anatomical and cosmetic concerns, functional limitations and quality of life issues remain underreported.

Aim. To evaluate functional impairments in a patient with VV using validated tools available for assessment.

Case Presentation. A 49-year-old female presented with nocturnal leg cramps, limb heaviness, occasional burning in the right lateral leg, and was unable to do her chores. She confirmed a history of VV diagnosed 8 years ago. During the clinical examination, she was classified as CEAP C3, and duplex ultrasound also confirmed reflux in the great saphenous vein lasting more than 2 seconds. Functional assessment included the CIVIQ-14, VEINES-QoL/Sym, and 6-minute walk test (6MWT). Scores suggested moderate impairment in functional mobility, psychosocial well-being, and walking endurance, with a 6MWT distance of 340 m, which is below age-expected values.

Management and Outcome. The patient was advised to start physiotherapy as soon as possible, including compression therapy, exercises, and a mobility regimen. Following initiation of physiotherapy, her symptoms improved considerably, reflected in reduced heaviness, loss of burning sensation and improved 6MWT performance at follow-up after 3 months.

Discussion. This case illustrates that the functional impact of VV is more than a cosmetic concern. Patient-reported outcome measures and mobility testing (objective walking tests) supplement the information provided by clinical and imaging data, enabling a comprehensive understanding of disease burden. Implementation of such scoring systems as a part of routine assessments could help in personalized therapy and patient-tailored care.

1. Nash R. ABC of arterial and venous disease. Varicose Veins. BMJ 2000;320:1391-4.

2. Youn YJ, Lee J. Chronic venous insufficiency and varicose veins of the lower extremities. Korean J Intern Med. 2019 Mar;34(2):269-283.

3. Yetkin E, Kutlu Karadag M, Ileri M, Atak R, Erdil N, Tekin G, Ozyasar M, Ozturk S. Venous leg symptoms, ecchymosis, and coldness in patients with peripheral varicose vein: A multicenter assessment and validation study (VEIN-VIOLET study). Vascular. 2021 Oct;29(5):767-775.

4. Launois R, Le Moine JG, Lozano FS, Mansilha A. Construction and international validation of CIVIQ-14 (a short form of CIVIQ-20), a new questionnaire with a stable factorial structure. Qual Life Res. 2012 Aug;21(6):1051-8. doi: 10.1007/s11136-011-0008-3. Epub 2011 Sep 25. PMID: 21947689.

5. Robert Launois, Health-related quality-of-life scales specific for chronic venous disorders of the lower limbs, Journal of Vascular Surgery and venous lymphatic disorders, Volume 3, Issue 2p219-227.e3April 2015

6. Ozberk S, Karadibak D, Polat M. Predictors of exercise capacity in chronic venous disease patients. Phlebology. 2019;35(3):190-198. doi:10.1177/0268355519870895

7. Papathanasiou J e al, Six-minute walk test: A tool for assessing mobility in frail subjects, Journal of Frailty, Sarcopenia and Falls, FSF | December 2016 | Vol. 1, No. 4 | 73-76.

8. M.A. Anwar, T.R. Lane, A.H. Davies, I.J. Franklin, Complications of radiofrequency ablation of varicose veins, Phlebology, 27 (Suppl. 1) (2012), pp. 34-39

9. A. Puggioni, M. Kalra, M. Carmo, G. Mozes, P. Gloviczki, Endovenous laser therapy and radiofrequency ablation of the great saphenous vein: analysis of early efficacy and complications, J Vasc Surg, 42 (2005), pp. 488-493

10. R.J. Winterborn, C.R. Corbett, Treatment of varicose veins: the present and the future–a questionnaire survey, Ann R Coll Surg Engl, 90 (2008), pp. 561-564

11. Jin HY, Ohe HJ, Hwang JK, Kim SD, Kim JY, Park SC, Kim JI, Won YS, Yun SS, Moon IS. Radiofrequency ablation of varicose veins improves venous clinical severity score despite failure of complete closure of the saphenous vein after 1 year. Asian J Surg. 2017 Jan;40(1):48-54. doi: 10.1016/j.asjsur.2016.03.004. Epub 2016 Jul 1. PMID: 27378121.