{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T14:57:15Z","timestamp":1781794635800,"version":"3.54.5"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T00:00:00Z","timestamp":1781481600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100016808","name":"Natural Science Foundation of Xiamen City","doi-asserted-by":"crossref","award":["3502Z20227153"],"award-info":[{"award-number":["3502Z20227153"]}],"id":[{"id":"10.13039\/100016808","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Lower extremity varicose veins (LEVV) significantly impair health-related quality of life (HRQoL), but comprehensive evidence on physiological and psychological determinants remains limited, especially in developing countries. This study aimed to identify independent predictors of disease-specific HRQoL in patients with primary LEVV.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross-sectional study was conducted from December 2023 to April 2025 at a university-affiliated hospital in China, enrolling 256 patients with primary LEVV (CEAP C2\u2013C6). HRQoL was assessed using the Aberdeen Varicose Vein Questionnaire (AVVQ). Clinical severity was measured by the Venous Clinical Severity Score (VCSS) and CEAP classification. Psychological status was evaluated using the Hospital Anxiety and Depression Scale (HADS). Stepwise multiple linear regression was performed to identify independent predictors of AVVQ scores.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The mean AVVQ score was 18.6\u202f\u00b1\u202f9.4, indicating moderate QoL impairment. Eight variables emerged as independent predictors in the final model (adjusted\n                      <jats:italic>R<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u202f=\u202f0.611,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001): higher VCSS (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f0.312), higher HADS-Anxiety score (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f0.224), advanced CEAP classification (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f0.198), higher HADS-Depression score (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f0.156), greater number of venous symptoms (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f0.142), higher BMI (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f0.128), absence of regular physical activity (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f\u22120.108), and bilateral involvement (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f0.096).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Quality of life in patients with lower extremity varicose veins is independently influenced by clinical severity, psychological distress (anxiety and depression), higher BMI, physical inactivity, symptom burden, and bilateral disease. These findings highlight the need for comprehensive management strategies that integrate psychological screening, weight control, and exercise prescription alongside conventional clinical care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1848120","type":"journal-article","created":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T15:58:29Z","timestamp":1781539109000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Factors influencing quality of life in patients with lower extremity varicose veins: a cross-sectional study"],"prefix":"10.3389","volume":"13","author":[{"given":"Liqin","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Nephrology, Zhongshan Hospital of Xiamen University, School of Medicine","place":["Xiamen University, Xiamen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Rare Diseases, Zhongshan Hospital of Xiamen University, School of Medicine","place":["Xiamen University, Xiamen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiuni","family":"Cai","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Zhongshan Hospital of Xiamen University, School of Medicine","place":["Xiamen University, Xiamen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fengxiong","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Foot and Ankle & Wound Healing, The First Affiliated Hospital of Guangdong Pharmaceutical University","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,15]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"056","DOI":"10.1055\/s-0038-1636522","article-title":"Varicose veins and lower extremity venous insufficiency","volume":"35","author":"DePopas","year":"2018","journal-title":"Semin Intervent Radiol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"648","DOI":"10.1007\/s00268-001-0283-1","article-title":"Risk indicators for varicose veins in forty- to sixty-year-olds in the Tampere varicose vein study","volume":"26","author":"Laurikka","year":"2002","journal-title":"World J Surg"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"212","DOI":"10.1016\/b978-0-323-90610-4.00021-5","article-title":"Pathophysiology of chronic venous disease","volume":"33","author":"Raffetto","year":"2014","journal-title":"Int Angiol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1248","DOI":"10.1016\/j.jvs.2004.09.027","article-title":"Revision of the CEAP classification for chronic venous disorders: consensus statement","volume":"40","author":"Ekl\u00f6f","year":"2004","journal-title":"J Vasc Surg"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1231","DOI":"10.1002\/bjs.6798","article-title":"Pathogenesis of primary varicose veins","volume":"96","author":"Lim","year":"2009","journal-title":"Br J Surg"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1258\/phleb.2007.007061","article-title":"Epidemiology of chronic venous disease","volume":"23","author":"Robertson","year":"2008","journal-title":"Phlebology"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"678","DOI":"10.1016\/j.ejvs.2015.02.007","article-title":"Editor\u2019s choice - Management of Chronic Venous Disease: clinical practice Guidelines of the European Society for Vascular Surgery (ESVS)","volume":"49","author":"Wittens","year":"2015","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1047","DOI":"10.1067\/mva.2003.168","article-title":"Quality of life in patients with chronic venous disease: San Diego population study","volume":"37","author":"Kaplan","year":"2003","journal-title":"J Vasc Surg"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"650","DOI":"10.1016\/j.jvs.2004.07.025","article-title":"Prevalence, risk factors, and clinical patterns of chronic venous disorders of lower limbs: a population-based study in France","volume":"40","author":"Carpentier","year":"2004","journal-title":"J Vasc Surg"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"480","DOI":"10.1016\/j.ejvs.2012.01.008","article-title":"The burden of depression in patients with symptomatic varicose veins","volume":"43","author":"Sritharan","year":"2012","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1016\/j.jvn.2015.01.003","article-title":"Chronic venous disease and venous leg ulcers: an evidence-based update","volume":"33","author":"Kelechi","year":"2015","journal-title":"J Vasc Nurs"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"641","DOI":"10.1067\/mva.2001.117333","article-title":"Do varicose veins affect quality of life? Results of an international population-based study","volume":"34","author":"Kurz","year":"2001","journal-title":"J Vasc Surg"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"290","DOI":"10.1016\/j.jdmv.2017.07.001","article-title":"Health related quality of life in chronic venous disease: systematic literature review","volume":"42","author":"Zenati","year":"2017","journal-title":"J Med Vasc"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"823","DOI":"10.1016\/j.jvs.2003.12.007","article-title":"Relationship between clinical classification of chronic venous disease and patient-reported quality of life: results from an international cohort study","volume":"39","author":"Kahn","year":"2004","journal-title":"J Vasc Surg"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1242","DOI":"10.1055\/s-0038-1655743","article-title":"Development and validation of a practical two-step prediction model and clinical risk score for post-thrombotic syndrome","volume":"118","author":"Amin","year":"2018","journal-title":"Thromb Haemost"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1016\/j.jclinepi.2007.11.008","article-title":"The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"61","author":"von Elm","year":"2008","journal-title":"J Clin Epidemiol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"499","DOI":"10.1207\/s15327906mbr2603_7","article-title":"How many subjects does it take to do a regression analysis","volume":"26","author":"Green","year":"1991","journal-title":"Multivariate Behav Res"},{"key":"ref18","volume-title":"Global Recommendations on Physical Activity for Health","year":"2010"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1387","DOI":"10.1016\/j.jvs.2010.06.161","article-title":"American venous forum ad hoc outcomes working group. Revision of the venous clinical severity score: venous outcomes consensus statement: special communication of the American venous forum ad hoc outcomes working group","volume":"52","author":"Vasquez","year":"2010","journal-title":"J Vasc Surg"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: development and validation","volume":"40","author":"Charlson","year":"1987","journal-title":"J Chronic Dis"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1111\/j.1600-0447.1983.tb09716.x","article-title":"The hospital anxiety and depression scale","volume":"67","author":"Zigmond","year":"1983","journal-title":"Acta Psychiatr Scand"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1002\/nur.22431","article-title":"Psychometric properties of the Chinese version of Aberdeen varicose veins questionnaire (AVVQ) in patients with varicose veins of lower extremity: a cross-sectional study","volume":"48","author":"Wang","year":"2025","journal-title":"Res Nurs Health"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"710","DOI":"10.1016\/s0741-5214(99)70110-2","article-title":"Evaluating and improving health-related quality of life in patients with varicose veins","volume":"30","author":"Smith","year":"1999","journal-title":"J Vasc Surg"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"470","DOI":"10.1016\/j.ejvs.2008.11.036","article-title":"Measurement of health-related quality of life with the Dutch translated Aberdeen varicose vein questionnaire before and after treatment","volume":"37","author":"Klem","year":"2009","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"2S","DOI":"10.1016\/j.jvs.2011.05.117","article-title":"Validation of venous clinical severity score (VCSS) with other venous severity assessment tools from the American venous forum, National Venous Screening Program","volume":"54","author":"Passman","year":"2011","journal-title":"J Vasc Surg"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"360","DOI":"10.1016\/j.ejvs.2015.05.013","article-title":"Association of Venous Disorders with leg symptoms: results from the Bonn vein study 1","volume":"50","author":"Wrona","year":"2015","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"664","DOI":"10.1016\/j.jvs.2010.04.023","article-title":"Impact of obesity on venous hemodynamics of the lower limbs","volume":"52","author":"Willenberg","year":"2010","journal-title":"J Vasc Surg"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1016\/j.ejvs.2012.12.011","article-title":"Body mass index and primary chronic venous disease \u2013 a cross-sectional study","volume":"45","author":"Vlajinac","year":"2013","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"488","DOI":"10.1056\/NEJMra055289","article-title":"Chronic venous disease","volume":"355","author":"Bergan","year":"2006","journal-title":"N Engl J Med"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1016\/j.jvs.2003.09.036","article-title":"Structured exercise improves calf muscle pump function in chronic venous insufficiency: a randomized trial","volume":"39","author":"Padberg","year":"2004","journal-title":"J Vasc Surg"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1503\/cmaj.100248","article-title":"Six-month exercise training program to treat post-thrombotic syndrome: a randomized controlled two-Centre trial","volume":"183","author":"Kahn","year":"2011","journal-title":"CMAJ"},{"key":"ref32","first-page":"105","article-title":"Epidemiology of chronic venous disorders in geographically diverse populations: results from the vein consult program","volume":"31","author":"Rabe","year":"2012","journal-title":"Int Angiol"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1848120\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T14:50:23Z","timestamp":1781794223000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1848120\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,15]]},"references-count":32,"alternative-id":["10.3389\/fmed.2026.1848120"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1848120","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,15]]},"article-number":"1848120"}}