Do varicose veins affect quality of life? Results of an international population-based study

Purpose. This study assessed the impact of varicose veins (VV) on quality o f life (QOL) and patient-reported symptoms. Methods. A cross-sectional population-based study was held in 166 general p ractices and 116 specialist clinics for venous disorders of the leg in Belg ium, Canada (Quebec), France, and Italy. Study subjects included a sample o f 259 reference patients without VV (CEAP class 0 or 1) and 1054 patients w ith VV who were classified as having VV alone (367; 34.8%), VV with edema ( 125; 11.9%), VV with skin changes (431; 40.9%), VV with healed ulcer (100; 9.5%), and VV with active ulcer (31; 2.9%). The main outcome measure was ge neric and disease-specific QOL, as measured by means of the Short-Form Heal th Survey-36 (SF-36) and the VEINES-QOL scale, and patient-reported symptom s as measured by the VEINES-SYM scale. Results. In patients with VV, age-standardized mean SF-36 physical (PCS) an d mental (MCS) scores were 45.6 and 46.1 in men and 44.2 and 43.2 in women, respectively, compared with population norms of 50. PCS scores decreased a ccording to increasing severity of concomitant venous disease, with the low est mean scores of 37.3 and 35.5 found in patients with VV and active ulcer . However, adjusted analyses showed no statistically significant difference s between patients with VV alone and patients without VV for PCS (0.0), MCS (1.0), VEINES-QOL (-0.1), or VEINES-SYM (0.0) scores. In comparison with p atients without VV, the largest differences were seen in patients with VV a nd edema (PCS, VEINES-QOL, and VEINES-SYM score differences of -1.8, -2.5, and -2.9, respectively) and in patients with VV and ulceration (differences of -3.3, -3.4, and -2.7, respectively). The high prevalence of major sympt oms of venous disorders in patients in CEAP class 0 or I being treated for venous disorders (76.1% of patients had heaviness, aching legs, or swelling ) might have contributed to the impairment of QOL in the reference group. Conclusion: Results indicate that impairment in physical QOL in patients wi th VV is associated with concomitant venous; disease, rather than the prese nce of VV per se. Findings concerning QOL in patients with VV can only be r eliably interpreted when concomitant venous disease is taken into account. In patients with VV alone, the objectives of cosmetic improvement and the i mprovement of QOL should be considered separately.