Validation of the new venous severity scoring system in varicose vein surgery☆

Abstract 

Objectives

We performed this observational study to validate the three components of a new venous severity scoring (VSS) system, ie, venous clinical severity score (VCSS), venous segmental disease score (VSDS), and venous disability score (VDS), and to evaluate VCSS, VDS, and CEAP clinical class and score in quantifying outcome of varicose vein surgery.

Patients and methods

The study included 45 patients who underwent superficial venous surgery in 48 legs with primary varicose veins. Venous color duplex scanning, clinical examination, and a questionnaire were used preoperatively and at 6 weeks and 6 months postoperatively to assign VSS and CEAP clinical class and score.

Results

CEAP clinical score, VCSS, and VDS demonstrated a linear association with CEAP clinical class (P < .001, P < .001, P = .002, respectively). Good correlation among all severity scores was found, particularly between CEAP clinical score and VCSS (r = 0.94; P < .001). CEAP clinical score was also highly correlated with CEAP clinical class (r = 0.84; P < .001) and VDS (r = 0.70; P < .001). Similarly, VCSS correlated with CEAP clinical class (r = 0.83; P < .001) and also VDS (r = 0.72; P < .001). The anatomic severity marker VSDS demonstrated a weak correlation with clinical severity indicators VCSS (r = 0.29; P = .048) and VDS (r = 0.31; P = .03) but not with age, gender, or CEAP clinical class and score. Six months after surgery the median (interquartile range) percent change in VCSS (73%; range, 50%-100%) and CEAP clinical score (70%; range, 50%-100%) were both significantly greater (P < .001) than the corresponding change in CEAP clinical class (17%; range, 0%-50%). In legs with high VDS at baseline, median (interquartile range) percent change in VDS was 100% (range, 50%-100%), significantly greater (P < .001) than the corresponding change in CEAP clinical class (0%; range, 0%-17%).

Conclusions

Venous severity scores are significantly higher in advanced venous disease, demonstrating correlation with anatomic extent. Both venous clinical severity scores, VCSS and CEAP clinical score, are equally sensitive and significantly better for measuring changes in response to superficial venous surgery than is the already in use CEAP clinical class. VDS demonstrated comparable and even better performance. Although the assignment of CEAP clinical class might be adequate for daily clinical purposes, venous severity scoring systems should be used in clinical studies to quantify venous outcome.