CC BY
32USC 616.14-007.63
QUALITY OF LIFE OF PATIENTS WITH THE LOWER EXTREMITIES VARICOSE VEINS
V. N. Nikolenko1'2,1. A. Vinokurov1, S. N. Odinokova1, G. V. Mnatsakanyan1, R. Kh. Belkharoeva1
11. M. Sechenov First Moscow State Medical University, Moscow, Russia 2 Lomonosov Moscow State University, Moscow, Russia
Abstract
Introduction. The wide prevalence of the lower extremities varicose veins and the variety of methods for its surgical correction, necessitate a comparative assessment of the quality of life of patients after various methods of surgical treatment.
The aim is to assess the quality of life of patients with the lower extremities varicose veins, depending on the surgical treatment method.
Materials and methods. This study included 94 patients with the lower extremities varicose veins of stage C2 - C4 according to CEAP. 28 (30%) men and 66 (70%) women aged 23 to 78 years. Patients were divided into 3 groups depending on the type of surgical intervention: 30 people - phlebectomy, 34 people -Endovenous Laser Ablation, 30 people - Endovenous Radiofrequency Obliteration. To assess the quality of life, the CIVIQ2 questionnaire was used, translated into Russian, and adapted for patients.
Results and conclusions. Before surgery, 60% of patients experience the pain of varying intensity in the lower extremities in everyday life; 76% of patients report physical activity limitations; 26% report violations of the psychoemotional state against the background of varicose veins; 35% of patients experience social discomfort.
On the 1st day after phlebectomy, there is a deterioration in the quality of life indicators: physical activity and psychoemotional state. Pain is reduced, and social activity does not change.
The use of endovenous methods demonstrates the following dynamics in the quality of life of patients on the first day after treatment: ail increase in pain indicators, physical activity, lack of dynamics in the psycho-emotional state, and an increase in the rate of restriction of social activity. In 3 month period, all methods to varying degrees demonstrate positive dynamics concerning improving the quality of life of patients.
Keywords: varicose disease, chronic venous insufficiency, quality of life assessment, phlebectomy, Endovenous Laser Ablation, Endovenous Radiofrequency Obliteration.
TOMOHKY БУТУ ВАРИКОЗ МЕНЕН ООРУГАНДАРДЫН
ЖАШОО САЛАТЫ
В.Николенко1'2, И.А.Винокуров1, С.Н.Одинокова1, Г.В.Мнацаканян1, Р.Х. Белхароева1
'И.М.Сеченов атындагы Биринчи Москва Мамлекеттик Медицина Университети, Москва, Россия;
2Ломоносов атындагы Москва мамлекеттик университети, Москва, Россия.
Реферат
Аннотация
Актуалдуулугу. Теменку буттардын варикоздук кенейиши жана аны хирургиялык жол менен оцдоонун ар кандай ыкмалары хирургиялык дарылоонун ар кандай ыкмаларынан кийин бейтаптардын жашоо сапатын салыштырмалуу баалоону талап кылат.
Максаты - хирургиялык дарылоо ыкмасына жараша, теменку учу-колу варикоздук оорусу бар бейтаптардын жашоо сапатын баалоо.
Материалдар жана ыкмалар. Бул изилдееге СЕАР боюнча С2 - С4 стадиясынын теменку
Address for Correspondence: Saniia Odinokova Post-graduate student of the Hospital Surgery Department and assistant of the Human Anatomy Department (I. M. Sechenov First Moscow State Medical University). E-mail: saniya odinokova&mail.ru Tel.: 8(985)9755105
учу-колу менен варикоздук веналары бар 94 бейтап кирген. 23 жаштан 78 жашка чейинки 28 (30%) эркек жана 66 (70%) аял. Бейтаптар хирургиялык кийлигишуу туруно жараша 3 топко болунушту: 30 адам - флебэктомия, 34 адам - Эндовеноздук Лазердик Абляция, 30 адам - Эндовеноздук Радиожыштык Облитерациясы. Жашоонун сапатын баалоо учун С1УК32 анкетасы колдонулуп, орус тилине которулуп, бейтаптарга ылайыкташтырылды.
Натыйжалар жана тыянактар. Операциядан мурун 60% пациенттер кунумдук т5фмушта томонку учтардагы ар кандай интенсивдуулукту сезишет; Бейтаптардын 76% физикалык активдуулуктун чектелгендигин айтышат; 26% варикоздук тамырлардын фонунда психоэмоционалдык абалды бузгандыгы женунде билдиришет; Бейтаптардын 35% социалдык ыцгайсыздыкты сезишет.
Флебэктомиядан кийинки 1-куну жашоо сапатынын корсеткучтеру начарлайт: физикалык активдуулук жана психоэмоционалдык абал. Оору азайып, коомдук активдуулук озгербейт.
Эндовеноздук ыкмаларды колдонуу дарылануудан кийинки биринчи куну пациенттердин жашоо сапатында темонкудой динамиканы корсетет: оору корсоткучторунун жогорулашы, физикалык активдуулук, психо-эмоционалдык абалда динамиканын жоктугу жана чектее ченинин жогорулашы. коомдук иштин. 3 айлыктын журушундо, ар кандай децгээлдеги бардык ыкмалар бейтаптардын жашоо сапатын жакшыртуу боюнча оц динамиканы керсетет.
Ачкыч сездвр: варикоз оору су, венанын енекет жетишсиздиги, жашоо сапатын баалоо, флебэктомия, эндовеноздук лазердик абляция, эндовеноздук радиожыштыктын облитерациясы.
КАЧЕСТВО ЖИЗНИ ПАЦИЕНТОВ С ВАРИКОЗНЫМ РАСШИРЕНИЕМ ВЕН НИЖНИХ КОНЕЧНОСТЕЙ
В.Н. Николенко1'2, И.А. Винокуров1, С.Н. Одинокова1, Г.В. Мнацаканян1, Р.Х. Белхароева1
1 Первый Московский государственный медицинский университет им. И. М. Сеченова, Москва, Россия
2 Московский государственный университет им. М.В. Ломоносова, Москва, Россия.
Аннотация
Актуальность. Широкая распространенность варикозного расширения вен нижних конечностей и разнообразие методов его хирургической коррекции обусловливают необходимость сравнительной оценки качества жизни пациентов после различных методов хирургического лечения.
Цель - оценка качества жизни пациентов с варикозным расширением вен нижних конечностей в зависимости от хирургического метода лечения.
Материалы и методы. В исследование были включены 94 пациента с варикозным расширением вен нижних конечностей С2 - С4 стадии по СЕАР. 28 (30%) мужчин и 66 (70%) женщин в возрасте от 23 до 78 лет. Пациенты были разделены на 3 группы в зависимости от вида оперативного вмешательства: 30 человек - флебэктомия, 34 человека - эндовенозная лазерная абляция, 30 человек -эндовенозная радиочастотная облитерация. Для оценки качества жизни использовалась анкета С1У1(^2, переведенная на русский язык и адаптированная для пациентов.
Итоги и выводы. Перед операцией 60% пациентов испытывают боли различной интенсивности в нижних конечностях в повседневной жизни; 76% пациентов сообщают об ограничениях физической активности; 26% сообщают о нарушениях психоэмоционального состояния на фоне варикозного расширения вен; 35% пациентов испытывают социальный дискомфорт.
На 1-е сутки после флебэктомии наблюдается ухудшение показателей качества жизни: физической активности и психоэмоционального состояния. Уменьшается боль, а социальная активность не меняется.
Использование эндовенозных методов демонстрирует следующую динамику качества жизни пациентов в первые сутки после лечения: повышение показателей боли, физической активности, отсутствие динамики психоэмоционального состояния, увеличение скорости ограничения, социальной активности. Через 3 месяца все методы в той или иной степени демонстрируют положительную динамику в плане улучшения качества жизни пациентов.
Ключевые слова: варикозная болезнь, хроническая венозная недостаточность, оценка качества жизни, флебэктомия, эндовенозная лазерная абляция, эндовенозная радиочастотная облитерация.
Introduction
Varicose veins of the lower extremities is a pathology of superficial veins, accompanied by valve failure and impaired blood flow. The prevalence of the disease is very high. According to various authors, about 89% of women and 66% of men of working age from among the inhabitants of developed countries suffer from varicose veins to varying degrees [1,2,3]. In Russia, various forms of varicose veins are observed in 35 million people, and 15% of them have trophic skin changes, open or recurrent trophic ulcers [4].
In industrialized countries, the annual total cost of treating varicose veins of the lower extremities ranges from 1% to 3% of the total health budget. The medical and social significance is because the working and socially active age group of the population is subject to the disease.
It is known that varicose veins of the lower extremities do not affect life expectancy. The main goal of the treatment of this disease is to maintain an acceptable quality of life and to enable the patient to continue their normal activities [3 ].
The main function of the quality of life indicator is to assess the effectiveness of the treatment performed: to determine the advantages of one method of surgical treatment over another or to compare different therapeutic techniques. Besides, this indicator can be used for further monitoring of the patient after the treatment is provided [5,6].
As part of this original study, we assessed the quality of life of patients with varicose veins before treatment, and also compared the quality of life of patients after performing phlebectomy, endovenous laser coagulation, and radiofrequency obliteration.
Materials and methods
The study participants and settings
This study was carried out based on a private medical clinic in Moscow. The study included 94 patients suffering from varicose veins of the lower extremities of stage C2 - C4 according to CEAP.
A total of 94 people were included in the study, of which 28 (30%) were men and 66 (70%) were women. The patients' age ranged from 23 to 78 years. The average age was 50 ± 14 years.
Study design / protocol
Before treatment, patients presented with standard complaints typical of varicose veins. The full range of complaints is shown in Figure 1. The presence of varicose veins disturbed 94 (100%) patients. Also, in all groups, the majority had telangiectasias and reticular veins ("spider veins"). Pain in the lower extremities was noted by 20 (66%) patients from the first group, 18 (52%) from the second, and 28 (93%) from the third group. Trophic disorders of the skin in the form of ulcers or venous eczema were present in 26% of patients from the first and third groups and 29% from the second group.
trophic disorders discoloration of the skin itchy skin varicose veins spider veins edema pain convulsions Heavy legs
■ Group 3 ■ Group 2 ■ Group 1
Figure 1. Patient complaints.
The patients underwent various surgical interventions aimed at eliminating vertical reflux. Also, in the presence of varicose inflows, in addition to the main one, a miniflebectomy procedure or foam sclerotherapy was performed.
Depending on the method of eliminating stem reflux from the volume of treated patients, three groups were formed: patients who underwent phlebectomy -30 people; patients who underwent endovenous laser
Table 1. Associated diseases.
coagulation - 34 people; patients who underwent radiofrequency obliteration - 30 people. All patients signed informed consent before participating in the study.
In addition to the underlying disease, some patients were found to have comorbidities shown in Table 1. The presence of these diseases could affect the results of the analysis of the patients' quality of life.
Accompanying illnesses n=94 100%
Arterial hypertension 18 19
Ischemic heart disease 12 13
Atherosclerosis 10 10
Type 2 diabetes mellitus 4 4
Chronic gastritis 38 40
Chronic duodenitis 22 23
Chronic esophagitis 6 6
Chronic pancreatitis 4 4
Flat feet 50 53
Gonarthrosis 10 10
COPD 2 2
According to the data in the table, it can be noted that most often from this sample of patients, varicose veins of the lower extremities is accompanied by the pathology of the musculoskeletal system, in particular, flat feet (53%). It is a well-known fact that in the presence of a flat foot, the work of the muscular-venous pump worsens, which leads to venous hypertension and negatively affects the vessel wall, causing its varicose expansion.
Study intruments
Evaluation of the quality of life of patients with varicose veins was carried out using a specific questionnaire CIVIQ2 before surgery [7], on the first day after, and after 3 months. The questionnaire was translated into Russian and adapted for patients. Each question has a 5-point system of answers, where 1 - no violations, 5 - serious violations.
Items 1-4 characterize the pain;
Items 5,6,7,9 - physical condition;
Items 12 - 20 - psychological state;
Items 8,10,11 - social violations.
After receiving a written version of the questionnaire, a database was formed. The statistical analysis was carried out with the help of IBM SPSS. The p-values of 0.05 were considered as statistically important.
Results
Quality of life of patients before phlebo-surgical treatment
The main results of studying the quality of life of patients before surgery are shown in Table 2.
According to Table 2, varicose veins of the lower extremities significantly affects and worsens the quality of life of patients. This is emphasized by the presence of pain in 60% of daily activities of varying degrees of intensity associated with the progression of varicose veins. In groups of patients, moderate and mild pain syndromes prevail. The pain of very strong intensity disturbed 4% of patients in total. Most likely, in addition to varicose symptoms, the severity of pain was also influenced by concomitant diseases of patients, in particular, pathology of the musculoskeletal system, which was registered in
63% of patients.
Restrictions on physical activity were observed in total in 76% of patients, with a moderate degree of restrictions prevailing in all three groups. Patients noted both in static and dynamic loads. Decreased physical activity against the background of varicose veins can be associated with concomitant pain and chronic venous insufficiency symptoms, which harm the work of the muscular-venous pump and aggravate venous congestion.
The quality of life of patients with varicose veins of the lower extremities was also reduced in the psychological aspect. 26% of patients noted mild and moderate disorders of the psychological state against the background of varicose veins. Of course, this is primarily due to the symptoms of chronic
venous insufficiency, fear of disease progression, and the development of characteristic complications. Also, the aesthetic moment played an important role in terms of psychological discomfort.
In total, 35% of patients experienced social discomfort. Moreover, 15% faced strong and very strong social restrictions. First of all, this is due to trophic disorders of the skin, limiting social activity to one degree or another. Most often, these complications arise in a socially burdened population group with many concomitant diseases (diabetes mellitus, obesity, arterial hypertension), which aggravates the course of varicose veins. It should be noted that this group of patients is prone to a long period of not seeking medical help, ensuring the progression of the disease by their actions.
Table 2. Quality of life br patients with varicose veins before surgical treatment.
Main characteristics The degree Group 1 n=30 Group 2 n=34 Group 3 n=30 Total n=94
Pain no 10 (33%) 16 (47%) 12 (40%) 38 (40%)
easy 4 (13%) 8 (24%) 5 (17%) 17(18%)
moderate 9 (30%) 7 (21%) 7 (23%) 23 (24%)
strong 6 (20%) 2 (6%) 4 (13%) 12 (13%)
very strong 1 (3%) 1 (3%) 2 (7%) 4 (4%)
Physical activity no limits 8 (27%) 9 (26%) 6 (20%) 23 (24%)
light restrictions 3 (10%) 2 (6%) 5 (17%) 10 (10%)
moderate restrictions 15 (50%) 18 (53%) 14 (47%) 47 (51%)
strong restrictions 4 (13%) 3 (9%) 4 (13%) 11 (12%)
very strong restrictions - 2 (6%) 1 (3%) 3 (3%)
Psychological state not broken 22 (73%) 27 (79%) 21 (70%) 70 (74%)
slightly broken 3 (10%) 3 (9%) 5 (17%) 11 (12%)
moderately disturbed 5 (17%) 4 (12%) 4 (13%) 13 (14%)
severely disturbed - - - -
very badly disturbed - - - -
Social activity no limits 20 (67%) 23 (68%) 18 (60%) 61 (65%)
light restrictions 3 (10%) 3 (9%) 1 (3%) 7 (7%)
moderate restrictions 2 (7%) 4 (12%) 6 (20%) 12 (13%)
strong restrictions 3 (10%) 1 (3%) 4 (13%) 8 (9%)
very strong restrictions 2 (7%) 3 (9%) 1 (3%) 6 (6%)
identical. In the long-term period, there is a decrease in the number of patients with restrictions on social activity due to varicose veins from 34% to 23%, while strong and very strong restrictions have not been registered.
Quality of life of patients undergoing endovenous laser coagulation
As well as patients of group 1, patients from group 2 were asked to fill out the CIVIQ2 questionnaire on the 1 st day after endovenous laser coagulation and at the follow-up examination after 3 months. We obtained the following results on the quality of life of patients after the procedure (Table 4)
Pain syndrome on the 1st day after performing the Table 3. Quality of life for patients after phlebectomy.
endovenous laser ablation increases from 54% to 73%. This fact is most likely due to the technique of the outpatient procedure, which is performed under local anesthesia. The "pillow" of anesthetic dissolves within a few hours, which causes the progression of pain at the puncture site and along the vein obliterated with the help of laser exposure. At this time, severe pain is predominant. 3 months after treatment, the number of patients with pain syndrome associated with WNK decreased to 30%.
On the 1st day, the dynamics of physical activity without restrictions increased from 26% to 35%, since after the endovenous procedure, the phlebologist recommends the most active physical activity to prevent deep vein thrombosis. In the long-
Main characteristics The degree Before treatment n=30 on the 1st day after surgery P 3 months after surgery P
Pain no 10 (33%) 13 (43%) 0.214 22 (73%) 0.002
easy 4 (13%) 2 (7%) 0.22 5 (17%) 0.333
moderate 9 (30%) 5 (17%) 0.112 2 (7%) 0.013
strong 6 (20%) 10 (33%) 0.129 1 (3%) 0.022
very strong 1 (3%) - - - -
Physical activity no limits 8 (27%) - 0.002 14 (47%) 0.057
light restrictions 3 (10%) 1 (3%) 0.138 6 (20%) 0.141
moderate 15 (50%) 10 (33%) 0.093 8 (27%) 0.036
restrictions
strong 4 (13%) 15 (50%) 0.002 2 (7%) 0.22
restrictions
very strong restrictions - 4 (13%) 0.023 - 0.5
Psychological state not broken 22 (73%) 15 (50%) 0.036 25 (83%) 0.117
slightly broken 3 (10%) 3 (10%) 0.5 3 (10%) 0.5
moderately disturbed 5 (17%) 6 (20%) 0.383 2 (7%) 0.119
severely disturbed - 6 (20%) 0.006 - -
very badly disturbed - - - - -
Social activity no limits 20 (67%) 19 (63%) 0.373 23 (77%) 0.196
light restrictions 3 (10%) 4 (13%) 0.359 3 (10%) 0.5
moderate 2 (7%) 4 (13%) 0.22 4 (13%) 0.221
restrictions
strong 3 (10%) 2 (7%) 0.339 - 0.04
restrictions
very strong 2 (7%) 1 (3%) 0.24 - 0.073
restrictions
term period, there is a decrease in the number of patients with discomfort during physical activity to 41%, and in most cases, mild and moderate physical activity restrictions have been registered.
The psycho-emotional state of the patients, undisturbed against the background of varicose veins, on the 1st day after the operation was practically similar to the initial indicator and equal to 74%. Since EVLK is an outpatient procedure and is practically not perceived by many patients as an operation, perioperative anxiety practically does not increase. After 3 months, there is a stabilization of
the psychological picture in most patients, and disturbances of mental balance are observed in 18% of cases.
Showed restrictions on the social activity of patients on the 1st day after surgery was 42%. The majority of patients noted a slight limitation of social activity, which is associated with the need to constantly wear compression hosiery for the first two months. In the long-term period, there is a decrease in the number of patients with limited social activity due to varicose veins from 33% (before endovenous laser coagulation) to 18%, and very strong restrictions
Table 4. Quality of life for patients after endovenous laser ablation.
Main characteristics The degree Before treatment n=30 on the 1st day after surgery P 3 months after surgery P
Pain No 16 (47%) 10 (29%) 0.066 24 (71%) 0.024
Easy 8 (24%) 3 (9%) 0.05 5 (15%) 0.176
Moderate 7 (21%) 5 (17%) 0.338 3 (9%) 0.085
Strong 2 (6%) 15 (44%) 0.001 2 (6%) 0.5
very strong 1 (3%) 1 (3%) 0.5 - 0.085
Physical activity no limits 9 (26%) 12 (35%) 0.212 20 (59%) 0.004
light restrictions 2 (6%) 8 (24%) 0.021 9 (26%) 0.014
moderate restrictions 18 (53%) 11 (32%) 0.042 3 (9%) 0.001
strong restrictions 3 (9%) 2 (6%) 0.32 2 (6%) 0.32
very strong restrictions 2 (6%) 1 (3%) 0.276 - 0,076
Psychological state not broken 27 (79%) 25 (74%) 0.314 28 (83%) 0.338
slightly broken 3 (9%) 4 (12%) 0.344 2 (6%) 0.32
moderately disturbed 4 (12%) 4 (12%) 0.5 4 (12%) 0.5
severely disturbed - 1 (3%) 0.156 - -
very badly disturbed - - - - -
Social activity no limits 23 (68%) 20 (58%) 0.198 28 (82%) 0.094
light restrictions 3 (9%) 8 (24%) 0.05 3 (9%) 0.5
moderate restrictions 4 (12%) 2 (6%) 0.195 2 (6%) 0.195
strong restrictions 1 (3%) 1 (3%) 0.5 1 (3%) 0,5
very strong restrictions 3 (9%) 3 (9%) 0.5 - 0.04
have not been registered.
Quality of life of patients undergoing endovenous radiofrequency obliteration
Similar to the two previous groups, patients from the third group filled out the CIVIQ2 questionnaire on the 1 st day after performing RFR and at the follow-up examination after 3 months. We obtained the following results on the quality of life of patients after the procedure (Table 5)
Pain syndrome on the 1st day after performing endovenous radiofrequency obliteration increases from 60% to 73%. This fact, as with endovenous laser coagulation, is due to the technique of an outpatient procedure, which is performed under local anesthesia. The "pillow" of anesthetic dissolves within a few hours, which causes the progression of pain at the puncture site and along the vein obliterated with the help of laser exposure. At this time, moderately severe pain is predominant. 3 months after treatment, the number of patients with pain syndrome associated with varicose veins of the lower extremities decreased to 26%.
On the 1st day, physical activity without restrictions increased from 20% to 33%, since after performing the endovenous procedure, the phlebologist recommends the most active physical activity to prevent deep vein thrombosis. In the long term, there is a decrease in the number of patients with discomfort during exercise to 43%.
The index of disturbance of the mental balance of patients on the 1st day after the operation was slightly higher than the initial index and amounted to 33%. After 3 months, there is a stabilization of the psychological picture in most patients and a violation of the psychoemotional state against the background of varicose veins is observed in 20% of cases.
Showed restrictions on the social activity of patients on the 1st day after endovenous radiofrequency obliteration amounted to 47%. The majority of patients noted mild to moderate limitation of social activity, which is associated with the need to constantly wear compression hosiery for the first two months. In the long-term period, there is a decrease in the number of patients with limited social activity from 40% initially to 24%, with no very strong restrictions registered.
Discussion
Initially, the definition of the quality of life indicator in patients with varicose veins and concomitant chronic venous insufficiency was carried out using standard questionnaires. But general questionnaires do not reflect criteria specific for varicose patients for reducing satisfaction with life. In this regard, a separate questionnaire was developed specifically for these patients - CIVIQ1 (Chronic Venous Insufficiency Questionnaire - a questionnaire of chronic venous insufficiency). To date, a more advanced version of CIVIQ2 is used in practice [7,8]. CIVIQ2 - is a questionnaire consisting of 20 questions reflecting the general condition of the patient, the possibility of his work activity, the intensity of pain, and the completeness of self-service. Each item is assessed by the patient on a scale from 1 to 5. The higher the total indicator, the worse the patient's quality of life.
The pioneer of using this questionnaire is the international multicenter study RELIEF [9]. It compared the results of various therapies for chronic venous insufficiency.
Few studies that exist today are devoted to assessing the quality of life of people who underwent surgery on the veins of the lower extremities on an outpatient basis. Most of these are foreign studies, for example, Lurie compared the quality of life of 43 patients who underwent combined phlebectomy and 36 patients who underwent radiofrequency obliteration [10]. A higher level of quality of life was revealed in patients of the second group in the long-term period after surgery (after 2 years).
For Russian researchers, this problem continues to be a fairly new direction. In one study, the quality of life of patients with varicose veins of the lower extremities is assessed as a criterion for the effectiveness of treatment in a hospital setting [11]. In another work, Gorin S.M. compared the results of the quality of life of patients after combined phlebectomy and stem echosclerotherapy + crossectomy [12]. A similar study was led by Donskaya E.D. [13]. In both cases, in the early postoperative period, the advantage of echosclerotherapy + crossectomy is noted. However, no statistically significant differences were found in the long-term period.
In our study, we obtained new data characterizing
Table 5. Quality of life for patients after Endovenous Radiofrequency Obliteration.
Main characteristics The degree Before treatment n=30 on the 1st day after surgery P 3 months after surgery P
Pain no 12 (40%) 8 (27%) 0.145 22 (73%) 0.006
easy 5 (17%) 5 (17%) 0.5 6 (20%) 0.382
moderate 7 (23%) 10 (33%) 0.196 1 (3%) 0.012
strong 4 (13%) 7 (23%) 0.159 1 (3%) 0.079
very strong 2 (7%) - 0.073 - 0.072
Physical activity no limits 6 (20%) 12 (35%) 0.952 20 (59%) 0.002
light restrictions 5 (17%) 8 (24%) 0.177 9 (26%) 0.199
moderate restrictions 14 (47%) 11 (32%) 0.119 3 (9%) 0.001
strong restrictions 4 (13%) 2 (6%) 0.179 2 (6%) 0.179
very strong restrictions 1 (3%) 1 (3%) 0.5 - 0.172
Psychological state not broken 21 (70%) 20 (67%) 0.402 24 (80%) 0.187
slightly broken 5 (17%) 4(13%) 0.333 3 (10%) 0.215
moderately disturbed 4 (13%) 4(13%) 0.5 3 (10%) 0.358
severely disturbed - 2 (7%) 0.073 - -
very badly disturbed - - - - -
Social activity no limits 23 (68%) 16 (53%) 0.119 23 (76%) 0.246
light restrictions 3 (9%) 7 (23%) 0.23 3 (10%) 0.447
moderate restrictions 4 (12%) 4(13%) 0.454 2 (7%) 0.256
strong restrictions 1 (3%) 1 (3%) 0.5 2 (7%) 0.24
very strong restrictions 3 (9%) 2 (7%) 0.338 - 0.049
the quality of life of patients before and after surgical treatment of varicose veins, which can be used when choosing treatment tactics and in subsequent communication with the patient.
Conclusion
Varicose veins of the lower extremities is a pathological condition that significantly affects and worsens the quality of life of patients: 60% of patients experience the pain of varying intensity in the lower extremities in everyday life; 76% of
patients report limitations in physical activity; 26% note disorders of the psychoemotional state against the background of varicose veins; 35% of patients experience social discomfort.
Methods of phlebosurgical correction of varicose veins in different periods of treatment have different effects on the dynamics of indicators of the quality of life of patients:
- On the 1st day after phlebectomy, there is a deterioration in the quality of life indicators:
physical activity and psychoemotional state. Pain sensations decrease, and social activity practically does not change.
- The use of endovenous obliteration methods demonstrates a similar dynamics of the quality of life of patients on the first day after treatment: an increase in pain syndrome, physical activity, a lack of dynamics in the psychoemotional state, and an increase in the rate of restriction of social activity.
- In the long-term period, all methods to varying degrees demonstrate positive dynamics in terms of improving the quality of life of patients: the pain syndrome in the lower extremities decreases, the number of restrictions during physical exertion decreases, the psycho-emotional state improves and the indicator of social activity increases without restrictions.
The authors declare that there is no conflict of interest.
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