Venous disease classifications and generic and disease-specific quality of life questionnaires: which, why, and when to use?

Vanessa Prado dos Santos André Brito Queiroz About the authors

The multiplicity of acronyms and concepts related to venous disease is an indication of the complexity involved. The term chronic venous disease (CVD) encompasses the many different signs and symptoms of venous disease.11 Beebe-Dimmer JL, Pfeifer JR, Engle JS, Schottenfeld D. The epidemiology of chronic venous insufficiency and varicose veins. Ann Epidemiol. 2005;15(3):175-84. http://dx.doi.org/10.1016/j.annepidem.2004.05.015. PMid:15723761.
http://dx.doi.org/10.1016/j.annepidem.20...
,22 Maffei FHA, Castro Santos MER. Insuficiência Venosa Crônica: Conceito, prevalência, etiopatogenia e fisiopatologia. In: Maffei FHA, Yoshida WB, Rollo HA, et al. editores. Doenças vasculares periféricas. 5ª ed. vol. 2. Rio de Janeiro: Guanabara Koogan; 2016. p. 2020-37. In turn, chronic venous insufficiency (CVI) refers to disease of greater severity, with CEAP classes from C3 to C6, taking in presentations ranging from edema to ulceration.11 Beebe-Dimmer JL, Pfeifer JR, Engle JS, Schottenfeld D. The epidemiology of chronic venous insufficiency and varicose veins. Ann Epidemiol. 2005;15(3):175-84. http://dx.doi.org/10.1016/j.annepidem.2004.05.015. PMid:15723761.
http://dx.doi.org/10.1016/j.annepidem.20...
,22 Maffei FHA, Castro Santos MER. Insuficiência Venosa Crônica: Conceito, prevalência, etiopatogenia e fisiopatologia. In: Maffei FHA, Yoshida WB, Rollo HA, et al. editores. Doenças vasculares periféricas. 5ª ed. vol. 2. Rio de Janeiro: Guanabara Koogan; 2016. p. 2020-37. However, some authors reserve the term CVI for cases with damage to the skin and subcutaneous tissues, defining CVI as CEAP classes C4 to C6.33 Bergan JJ, Schmid-Schönbein GW, Smith PD, Nicolaides AN, Boisseau MR, Eklof B. Chronic venous disease. N Engl J Med. 2006;355(5):488-98. http://dx.doi.org/10.1056/NEJMra055289. PMid:16885552.
http://dx.doi.org/10.1056/NEJMra055289...
A number of different venous disease classifications have been proposed to help with diagnosis, treatment, and follow-up. The CEAP classification, revised in 2004, covers the many different signs of venous involvement, within the dimensions C (clinical signs); E (etiologic classification); A (anatomic distribution), and P (pathophysiologic dysfunction)44 Beebe HG, Bergan JJ, Bergqvist D, et al. Classification and grading of chronic venous disease in the lower limbs. A consensus statement. Eur J Vasc Endovasc Surg. 1996;12(4):487-92. http://dx.doi.org/10.1016/S1078-5884(96)80019-0. PMid:8980442.
http://dx.doi.org/10.1016/S1078-5884(96)...
,55 Eklöf B, Rutherford RB, Bergan JJ, et al. Revision of CEAP classification for Chronic Venous disorders: Consensus statement. J Vasc Surg. 2004;40(6):1248-52. http://dx.doi.org/10.1016/j.jvs.2004.09.027. PMid:15622385.
http://dx.doi.org/10.1016/j.jvs.2004.09....
(Table 1). The authors of this classification discuss the term “disease”, proposing that the lower CEAP classes should be referred to as chronic venous disorders.55 Eklöf B, Rutherford RB, Bergan JJ, et al. Revision of CEAP classification for Chronic Venous disorders: Consensus statement. J Vasc Surg. 2004;40(6):1248-52. http://dx.doi.org/10.1016/j.jvs.2004.09.027. PMid:15622385.
http://dx.doi.org/10.1016/j.jvs.2004.09....
The Venous Clinical Severity Score (VCSS), revised in 2010, is used to monitor the symptoms of CVD and measure its severity and does not include telangiectasies or reticular veins66 Rutherford RB, Padberg FT Jr, Comerota AJ, Kistner RL, Meissner MH, Moneta GL. Venous severity scoring: An adjunct to venous outcome assessment. J Vasc Surg. 2000;31(6):1307-12. http://dx.doi.org/10.1067/mva.2000.107094. PMid:10842165.
http://dx.doi.org/10.1067/mva.2000.10709...
,77 Vasquez MA, Rabe E, McLafferty RB, et al. Revision of the venous clinical severity score: Venous outcomes consensus statement: Special communication of the American Venous Forum Ad Hoc Outcomes Working Group. J Vasc Surg. 2010;52(5):1387-96. http://dx.doi.org/10.1016/j.jvs.2010.06.161. PMid:20875713.
http://dx.doi.org/10.1016/j.jvs.2010.06....
(Table 2). Clinical CVD classifications are used to guide diagnostic investigation, monitor disease progression, and evaluate treatment results. Notwithstanding, a patient who has been classified as CEAP 5 may exhibit clinical improvement, but remain at the same classification after treatment despite this improvement. Considering the complexity of the venous disease, it is clear that there are multiple different situations in which we need additional criteria to evaluate disease progression. The literature proposes employing the VCSS and CEAP in conjunction and suggests that quality of life (QoL) questionnaires should also be used.77 Vasquez MA, Rabe E, McLafferty RB, et al. Revision of the venous clinical severity score: Venous outcomes consensus statement: Special communication of the American Venous Forum Ad Hoc Outcomes Working Group. J Vasc Surg. 2010;52(5):1387-96. http://dx.doi.org/10.1016/j.jvs.2010.06.161. PMid:20875713.
http://dx.doi.org/10.1016/j.jvs.2010.06....
Regardless of whether the case is a disorder, disease, or insufficiency, the symptoms and signs of a compromised venous system impact on people’s QoL.88 Leal J, Mansilha A. Como avaliar o impacto da doença venosa crónica na qualidade de vida. Angiol Cir Vasc. 2010;6(4):173-87.,99 Catarinella FS, Nieman FHM, Wittens CHA. An overview of the most commonly used venous quality of life and clinical outcome measurements. J Vasc Surg: Venous and Lym Dis. 2015;3(3):333-40. http://dx.doi.org/10.1016/j.jvsv.2014.09.003. PMid:26992316.
http://dx.doi.org/10.1016/j.jvsv.2014.09...
Concern with aspects related to QoL is a growing part of the healthcare debate. The World Health Organization (WHO) defines QoL as “an individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns.”1010 World Health Organization. Division of Mental Health and Prevention of Substance Abuse. WHOQOL: measuring quality of life. Introducing the WHOQOL instruments. Geneva: WHO; 1997. p. 1-13. So, in addition to the classifications already mentioned, what QoL questionnaires have been proposed for venous disease? In healthcare, QoL may be related to general condition and studied using generic questionnaires or it may be related to certain diseases and assessed using disease-specific instruments.88 Leal J, Mansilha A. Como avaliar o impacto da doença venosa crónica na qualidade de vida. Angiol Cir Vasc. 2010;6(4):173-87.,99 Catarinella FS, Nieman FHM, Wittens CHA. An overview of the most commonly used venous quality of life and clinical outcome measurements. J Vasc Surg: Venous and Lym Dis. 2015;3(3):333-40. http://dx.doi.org/10.1016/j.jvsv.2014.09.003. PMid:26992316.
http://dx.doi.org/10.1016/j.jvsv.2014.09...
,1111 Moura RMF, Gonçalves GS, Navarro TP, Britto RR, Dias RC. Adaptação transcultural do questionário VEINES/QOL-SYM: avaliação da qualidade de vida e sintomas na doença venosa crônica. J Vasc Bras. 2011;10(1):17-25. http://dx.doi.org/10.1590/S1677-54492011000100004.
http://dx.doi.org/10.1590/S1677-54492011...
The World Health Organization Instrument to Assess Quality of Life (WHOQOL) and 36-item Short-Form Health Survey (SF-36) questionnaires are both generic instruments for studying QoL, while the Chronic Venous Insufficiency Questionnaire (CIVIQ), the Venous Insufficiency Epidemiological and Economic Study/Quality of Life-Symptoms (VEINES/QoL-Sym), the Aberdeen Varicose Vein Questionnaire (AVVQ), and the Charing Cross Venous Ulceration Questionnaire (CXVUQ) are all specific to QoL in CVD88 Leal J, Mansilha A. Como avaliar o impacto da doença venosa crónica na qualidade de vida. Angiol Cir Vasc. 2010;6(4):173-87.,99 Catarinella FS, Nieman FHM, Wittens CHA. An overview of the most commonly used venous quality of life and clinical outcome measurements. J Vasc Surg: Venous and Lym Dis. 2015;3(3):333-40. http://dx.doi.org/10.1016/j.jvsv.2014.09.003. PMid:26992316.
http://dx.doi.org/10.1016/j.jvsv.2014.09...
,1212 Fleck MPA, Louzada S, Xavier M, et al. Aplicação da versão em português do instrumento de avaliação de qualidade de vida da Organização Mundial da Saúde (WHOQOL-100). Rev Saude Publica. 1999;33(2):198-205. http://dx.doi.org/10.1590/S0034-89101999000200012. PMid:10413938.
http://dx.doi.org/10.1590/S0034-89101999...
,1313 Jenkinson C, Coulter A, Wright L. Short form 36 (SF 36) health survey questionnaire: normative data for adults of working age. BMJ. 1993;306(6890):1437-40. http://dx.doi.org/10.1136/bmj.306.6890.1437. PMid:8518639.
http://dx.doi.org/10.1136/bmj.306.6890.1...
(Table 3). The WHOQOL-100 has 100 questions distributed across six domains: physical health, psychological, level of independence, social relations, environment, and spirituality/religion/personal beliefs.1010 World Health Organization. Division of Mental Health and Prevention of Substance Abuse. WHOQOL: measuring quality of life. Introducing the WHOQOL instruments. Geneva: WHO; 1997. p. 1-13.,1212 Fleck MPA, Louzada S, Xavier M, et al. Aplicação da versão em português do instrumento de avaliação de qualidade de vida da Organização Mundial da Saúde (WHOQOL-100). Rev Saude Publica. 1999;33(2):198-205. http://dx.doi.org/10.1590/S0034-89101999000200012. PMid:10413938.
http://dx.doi.org/10.1590/S0034-89101999...
,1414 Fleck MPA, Leal OF, Louzada S, et al. Desenvolvimento da versão em português do instrumento de avaliação de qualidade de vida da OMS (WHOQOL-100). Rev Bras Psiquiatr. 1999;21(1):19-28. http://dx.doi.org/10.1590/S1516-44461999000100006.
http://dx.doi.org/10.1590/S1516-44461999...
The SF-36 is a generic questionnaire that assesses physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, and mental health and also compares current health with health 1 year previously.1515 Ciconelli RM. Tradução para o português e validação do questionário de avaliação de qualidade de vida “Medical Outcomes Study 36-ItemShort- Form Health Survey (SF-36)” [tese]. São Paulo: Escola Paulista de Medicina da Universidade Federal de São Paulo; 1997.,1616 Ware JE, Gandek B. Overview of the SF-36 health survey and the International Quality of Life Assessment (IQOLA) project. J Clin Epidemiol. 1998;51(11):903-12. The generic questionnaires revealed a need to assess the impact on QoL of specific diseases. The CIVIQ, VEINES, AVVQ, and CXVUQ are questionnaires specifically designed for venous disease.88 Leal J, Mansilha A. Como avaliar o impacto da doença venosa crónica na qualidade de vida. Angiol Cir Vasc. 2010;6(4):173-87.,99 Catarinella FS, Nieman FHM, Wittens CHA. An overview of the most commonly used venous quality of life and clinical outcome measurements. J Vasc Surg: Venous and Lym Dis. 2015;3(3):333-40. http://dx.doi.org/10.1016/j.jvsv.2014.09.003. PMid:26992316.
http://dx.doi.org/10.1016/j.jvsv.2014.09...
The CIVIQ and the VEINES/QoL-Sym assess venous disease in general and the AVVQ and the CXVUQ deal with specific aspects of CVD.88 Leal J, Mansilha A. Como avaliar o impacto da doença venosa crónica na qualidade de vida. Angiol Cir Vasc. 2010;6(4):173-87.,99 Catarinella FS, Nieman FHM, Wittens CHA. An overview of the most commonly used venous quality of life and clinical outcome measurements. J Vasc Surg: Venous and Lym Dis. 2015;3(3):333-40. http://dx.doi.org/10.1016/j.jvsv.2014.09.003. PMid:26992316.
http://dx.doi.org/10.1016/j.jvsv.2014.09...
The CIVIQ-20 focuses on the physical, psychological, social, and pain dimensions, with questions that cover daily activities, sleeping, pain, and irritability.88 Leal J, Mansilha A. Como avaliar o impacto da doença venosa crónica na qualidade de vida. Angiol Cir Vasc. 2010;6(4):173-87.,99 Catarinella FS, Nieman FHM, Wittens CHA. An overview of the most commonly used venous quality of life and clinical outcome measurements. J Vasc Surg: Venous and Lym Dis. 2015;3(3):333-40. http://dx.doi.org/10.1016/j.jvsv.2014.09.003. PMid:26992316.
http://dx.doi.org/10.1016/j.jvsv.2014.09...
,1717 Launois R, Mansilha A, Lozano F. Linguistic validation of the 20 item-chronic venous disease quality-of-life questionnaire (CIVIQ-20). Phlebology. 2014;29(7):484-7. http://dx.doi.org/10.1177/0268355513479582. PMid:23563648.
http://dx.doi.org/10.1177/02683555134795...
The VEINES/QoL-Sym questionnaire comprises two scales: the VEINES-QoL, which covers QOL in CVD, and the VEINES-Sym, which evaluates CVD symptoms1818 Kahn SR, Lamping DL, Ducruet T, et al. VEINES QOL/Sym questionnaire was a reliable and valid disease-specific quality of life measure for deep venous thrombosis. J Clin Epidemiol. 2006;59(10):1049-56. http://dx.doi.org/10.1016/j.jclinepi.2005.10.016. PMid:16980144.
http://dx.doi.org/10.1016/j.jclinepi.200...
, and has been translated and adapted for use in Brazil.1111 Moura RMF, Gonçalves GS, Navarro TP, Britto RR, Dias RC. Adaptação transcultural do questionário VEINES/QOL-SYM: avaliação da qualidade de vida e sintomas na doença venosa crônica. J Vasc Bras. 2011;10(1):17-25. http://dx.doi.org/10.1590/S1677-54492011000100004.
http://dx.doi.org/10.1590/S1677-54492011...
The AVVQ was developed to assess QOL in patients with varicose veins and includes a diagram of the lower limbs on which the patient draws.88 Leal J, Mansilha A. Como avaliar o impacto da doença venosa crónica na qualidade de vida. Angiol Cir Vasc. 2010;6(4):173-87.,99 Catarinella FS, Nieman FHM, Wittens CHA. An overview of the most commonly used venous quality of life and clinical outcome measurements. J Vasc Surg: Venous and Lym Dis. 2015;3(3):333-40. http://dx.doi.org/10.1016/j.jvsv.2014.09.003. PMid:26992316.
http://dx.doi.org/10.1016/j.jvsv.2014.09...
,1919 Garratt AM, Macdonald LM, Ruta DA, Russell IT, Buckingham JK, Krukowski ZH. Towards measurements of outcome for patients with varicose veins. Qual Health Care. 1993;2(1):5-10. http://dx.doi.org/10.1136/qshc.2.1.5. PMid:10132081.
http://dx.doi.org/10.1136/qshc.2.1.5...
,2020 Leal FJ, Couto RC, Pitta GBB, et al. Tradução e adaptação cultural do Questionário Aberdeen para Veias Varicosas. J Vasc Bras. 2012;11(1):34-42. http://dx.doi.org/10.1590/S1677-54492012000100007.
http://dx.doi.org/10.1590/S1677-54492012...
The CXVUQ is designed to assess QOL in patients with active venous ulcers.2121 Smith JJ, Guest MG, Greenhalgh RM, Davies AH. Measuring the quality of life in patients with venous ulcers. J Vasc Surg. 2000;31(4):642-9. http://dx.doi.org/10.1067/mva.2000.104103. PMid:10753271.
http://dx.doi.org/10.1067/mva.2000.10410...
,2222 Couto RC, Leal FJ, Pitta GBB, Bezerra RCB, Segundo WSS, Porto TM. Tradução e adaptação cultural do Charing Cross Venous Ulcer Questionnaire – Brasil. J Vasc Bras. 2012;11(2):102-7. http://dx.doi.org/10.1590/S1677-54492012000200006.
http://dx.doi.org/10.1590/S1677-54492012...
Specific questionnaires provide more detailed information when used in conjunction with generic ones.88 Leal J, Mansilha A. Como avaliar o impacto da doença venosa crónica na qualidade de vida. Angiol Cir Vasc. 2010;6(4):173-87. While it may be difficult to apply a clinical classification and administer both a generic and a specific questionnaire in routine practice, knowing all of the different classification and questionnaires puts us in a position to decide which to adopt to the benefit of our practice. Currently, clinical classifications are the most frequently employed when discussing CVD and have demonstrated associations with QoL.88 Leal J, Mansilha A. Como avaliar o impacto da doença venosa crónica na qualidade de vida. Angiol Cir Vasc. 2010;6(4):173-87. Specific QoL questionnaires have been translated, adapted, and validated for use in Brazil. If we chose to employ these instruments, the patient can fill out a QoL questionnaire in the waiting room and we can apply one of the clinical classifications during the consultation. We will thus be able to monitor the venous diseases that we meet in our routine practice and assess their impact on our patients’ daily lives.

Table 1
Revised Clinical-Etiology-Anatomy-Pathophysiology (CEAP) Classification.55 Eklöf B, Rutherford RB, Bergan JJ, et al. Revision of CEAP classification for Chronic Venous disorders: Consensus statement. J Vasc Surg. 2004;40(6):1248-52. http://dx.doi.org/10.1016/j.jvs.2004.09.027. PMid:15622385.
http://dx.doi.org/10.1016/j.jvs.2004.09....

Table 2
Revised Venous Clinical Severity Score (VCSS).77 Vasquez MA, Rabe E, McLafferty RB, et al. Revision of the venous clinical severity score: Venous outcomes consensus statement: Special communication of the American Venous Forum Ad Hoc Outcomes Working Group. J Vasc Surg. 2010;52(5):1387-96. http://dx.doi.org/10.1016/j.jvs.2010.06.161. PMid:20875713.
http://dx.doi.org/10.1016/j.jvs.2010.06....

Table 3
Summary of generic and CVD-specific quality of life questionnaires.

  • Financial support: None.
  • The study was carried out at Complexo Hospitalar Universitário Professor Edgard Santos (UFBA), Salvador, BA, Brazil.

References

  • 1
    Beebe-Dimmer JL, Pfeifer JR, Engle JS, Schottenfeld D. The epidemiology of chronic venous insufficiency and varicose veins. Ann Epidemiol. 2005;15(3):175-84. http://dx.doi.org/10.1016/j.annepidem.2004.05.015 PMid:15723761.
    » http://dx.doi.org/10.1016/j.annepidem.2004.05.015
  • 2
    Maffei FHA, Castro Santos MER. Insuficiência Venosa Crônica: Conceito, prevalência, etiopatogenia e fisiopatologia. In: Maffei FHA, Yoshida WB, Rollo HA, et al. editores. Doenças vasculares periféricas. 5ª ed. vol. 2. Rio de Janeiro: Guanabara Koogan; 2016. p. 2020-37.
  • 3
    Bergan JJ, Schmid-Schönbein GW, Smith PD, Nicolaides AN, Boisseau MR, Eklof B. Chronic venous disease. N Engl J Med. 2006;355(5):488-98. http://dx.doi.org/10.1056/NEJMra055289 PMid:16885552.
    » http://dx.doi.org/10.1056/NEJMra055289
  • 4
    Beebe HG, Bergan JJ, Bergqvist D, et al. Classification and grading of chronic venous disease in the lower limbs. A consensus statement. Eur J Vasc Endovasc Surg. 1996;12(4):487-92. http://dx.doi.org/10.1016/S1078-5884(96)80019-0 PMid:8980442.
    » http://dx.doi.org/10.1016/S1078-5884(96)80019-0
  • 5
    Eklöf B, Rutherford RB, Bergan JJ, et al. Revision of CEAP classification for Chronic Venous disorders: Consensus statement. J Vasc Surg. 2004;40(6):1248-52. http://dx.doi.org/10.1016/j.jvs.2004.09.027 PMid:15622385.
    » http://dx.doi.org/10.1016/j.jvs.2004.09.027
  • 6
    Rutherford RB, Padberg FT Jr, Comerota AJ, Kistner RL, Meissner MH, Moneta GL. Venous severity scoring: An adjunct to venous outcome assessment. J Vasc Surg. 2000;31(6):1307-12. http://dx.doi.org/10.1067/mva.2000.107094 PMid:10842165.
    » http://dx.doi.org/10.1067/mva.2000.107094
  • 7
    Vasquez MA, Rabe E, McLafferty RB, et al. Revision of the venous clinical severity score: Venous outcomes consensus statement: Special communication of the American Venous Forum Ad Hoc Outcomes Working Group. J Vasc Surg. 2010;52(5):1387-96. http://dx.doi.org/10.1016/j.jvs.2010.06.161 PMid:20875713.
    » http://dx.doi.org/10.1016/j.jvs.2010.06.161
  • 8
    Leal J, Mansilha A. Como avaliar o impacto da doença venosa crónica na qualidade de vida. Angiol Cir Vasc. 2010;6(4):173-87.
  • 9
    Catarinella FS, Nieman FHM, Wittens CHA. An overview of the most commonly used venous quality of life and clinical outcome measurements. J Vasc Surg: Venous and Lym Dis. 2015;3(3):333-40. http://dx.doi.org/10.1016/j.jvsv.2014.09.003 PMid:26992316.
    » http://dx.doi.org/10.1016/j.jvsv.2014.09.003
  • 10
    World Health Organization. Division of Mental Health and Prevention of Substance Abuse. WHOQOL: measuring quality of life. Introducing the WHOQOL instruments. Geneva: WHO; 1997. p. 1-13.
  • 11
    Moura RMF, Gonçalves GS, Navarro TP, Britto RR, Dias RC. Adaptação transcultural do questionário VEINES/QOL-SYM: avaliação da qualidade de vida e sintomas na doença venosa crônica. J Vasc Bras. 2011;10(1):17-25. http://dx.doi.org/10.1590/S1677-54492011000100004
    » http://dx.doi.org/10.1590/S1677-54492011000100004
  • 12
    Fleck MPA, Louzada S, Xavier M, et al. Aplicação da versão em português do instrumento de avaliação de qualidade de vida da Organização Mundial da Saúde (WHOQOL-100). Rev Saude Publica. 1999;33(2):198-205. http://dx.doi.org/10.1590/S0034-89101999000200012 PMid:10413938.
    » http://dx.doi.org/10.1590/S0034-89101999000200012
  • 13
    Jenkinson C, Coulter A, Wright L. Short form 36 (SF 36) health survey questionnaire: normative data for adults of working age. BMJ. 1993;306(6890):1437-40. http://dx.doi.org/10.1136/bmj.306.6890.1437 PMid:8518639.
    » http://dx.doi.org/10.1136/bmj.306.6890.1437
  • 14
    Fleck MPA, Leal OF, Louzada S, et al. Desenvolvimento da versão em português do instrumento de avaliação de qualidade de vida da OMS (WHOQOL-100). Rev Bras Psiquiatr. 1999;21(1):19-28. http://dx.doi.org/10.1590/S1516-44461999000100006
    » http://dx.doi.org/10.1590/S1516-44461999000100006
  • 15
    Ciconelli RM. Tradução para o português e validação do questionário de avaliação de qualidade de vida “Medical Outcomes Study 36-ItemShort- Form Health Survey (SF-36)” [tese]. São Paulo: Escola Paulista de Medicina da Universidade Federal de São Paulo; 1997.
  • 16
    Ware JE, Gandek B. Overview of the SF-36 health survey and the International Quality of Life Assessment (IQOLA) project. J Clin Epidemiol. 1998;51(11):903-12.
  • 17
    Launois R, Mansilha A, Lozano F. Linguistic validation of the 20 item-chronic venous disease quality-of-life questionnaire (CIVIQ-20). Phlebology. 2014;29(7):484-7. http://dx.doi.org/10.1177/0268355513479582 PMid:23563648.
    » http://dx.doi.org/10.1177/0268355513479582
  • 18
    Kahn SR, Lamping DL, Ducruet T, et al. VEINES QOL/Sym questionnaire was a reliable and valid disease-specific quality of life measure for deep venous thrombosis. J Clin Epidemiol. 2006;59(10):1049-56. http://dx.doi.org/10.1016/j.jclinepi.2005.10.016 PMid:16980144.
    » http://dx.doi.org/10.1016/j.jclinepi.2005.10.016
  • 19
    Garratt AM, Macdonald LM, Ruta DA, Russell IT, Buckingham JK, Krukowski ZH. Towards measurements of outcome for patients with varicose veins. Qual Health Care. 1993;2(1):5-10. http://dx.doi.org/10.1136/qshc.2.1.5 PMid:10132081.
    » http://dx.doi.org/10.1136/qshc.2.1.5
  • 20
    Leal FJ, Couto RC, Pitta GBB, et al. Tradução e adaptação cultural do Questionário Aberdeen para Veias Varicosas. J Vasc Bras. 2012;11(1):34-42. http://dx.doi.org/10.1590/S1677-54492012000100007
    » http://dx.doi.org/10.1590/S1677-54492012000100007
  • 21
    Smith JJ, Guest MG, Greenhalgh RM, Davies AH. Measuring the quality of life in patients with venous ulcers. J Vasc Surg. 2000;31(4):642-9. http://dx.doi.org/10.1067/mva.2000.104103 PMid:10753271.
    » http://dx.doi.org/10.1067/mva.2000.104103
  • 22
    Couto RC, Leal FJ, Pitta GBB, Bezerra RCB, Segundo WSS, Porto TM. Tradução e adaptação cultural do Charing Cross Venous Ulcer Questionnaire – Brasil. J Vasc Bras. 2012;11(2):102-7. http://dx.doi.org/10.1590/S1677-54492012000200006
    » http://dx.doi.org/10.1590/S1677-54492012000200006

Publication Dates

  • Publication in this collection
    28 Nov 2019
  • Date of issue
    2019

History

  • Received
    23 Aug 2019
  • Accepted
    05 Sept 2019
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