***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: PURPOSE We set out to assess the new Aberdeen Varicose Veins Question naire ( Aberdeen Question naire ) for the properties necessary for a valid measure of health outcome , to determine quality of life of patients with varicose veins , and to determine the effect of surgery on quality of life . METHODS A prospect i ve consecutive cohort of 137 patients undergoing varicose vein surgery completed the self-administered SF-36 and Aberdeen Question naire and 25 questions relating to the symptoms and concerns of patients with varicose veins . Follow-up was done by repeated question naires 6 weeks after surgery . The Aberdeen Question naire was assessed for reliability , validity , responsiveness , and practicality . Quality of life of patients with varicose veins was compared with an age- and sex-matched sample of the general population . RESULTS Reliability estimates for the 8 scales short-form health survey ( SF-36 ) and the Aberdeen Question naire were all above 0.7 ( Cronbach 's alpha ) . The Aberdeen Question naire had a highly significant correlation ( r = 0 . 74 , P < .0001 ) with the patients ' symptoms and concerns question naire , which is evidence of its validity . Patients with varicose veins score lower than United Kingdom norms ( P < .001 ) in the physical domains of the SF-36 , indicating worse health . After surgery , the SF-36 scores improved in all 8 domains of health , reaching significance in " Mental Health " ( P < .05 ) and approaching significance in " General Health " ( P = .066 ) . The Health Transition Item of the SF-36 and the Aberdeen Question naire both showed a highly significant improvement in health ( P < .001 ) . CONCLUSION The Aberdeen Question naire is a valid measure of quality of life for patients with varicose veins . Persons with varicose veins have a reduced quality of life compared with the general population , and this discrepancy is significantly improved at 6 weeks by operating on them OBJECTIVE To determine whether a period of one or three weeks of compression following varicose vein surgery influenced the outcome . DESIGN R and omised controlled trial . METHOD 300 patients aged between 18 - 80 years underwent unilateral varicose vein surgery in a Day Procedure Unit .  Compression b and aging was applied post-operatively for three days . Patients then wore graduated elastic compression stockings r and omised to a period of either one or three weeks . Patients were assessed by question naire on pain scores at rest and during mobilisation for up to six weeks , total analgesic consumption , duration of time off work , any complications , and patient perception of cosmetic results at various periods up to 12 weeks following surgery . RESULTS The mean pain score reported by patients over 6 weeks was similar in the two groups ( 1 week group : mean 2.18 , three week group : mean 1.87 ) . The 95 % confidence interval ( CI ) for the mean difference in pain was ( -0.05 - 0.66 ) . Analysis of the pain curves at 1 week , 4 weeks and 6 weeks , showed equivalence at 4 and 6 weeks , but not for 1 week , with the group wearing stockings for only one week complaining of more pain for this period . A significant increase in the total number of analgesia tablets consumed was also found in the group wearing stockings for only one week . No significant differences were found in the other secondary endpoints - return to work ( categorised as < 2 weeks , 2 - 6 weeks or 6 - 12 weeks ) , patient satisfaction or post-operative complications . CONCLUSION We found no benefit in wearing compression stockings for more than one week following uncomplicated high saphenous ligation with stripping of the great saphenous vein with respect to post-operative pain , number of complications , time to return to work , or patient satisfaction for up to 12 weeks following surgery Quality of life may be considerably reduced in patients who are suffering from chronic lower limb venous insufficiency , although existing generic quality of life instruments ( NHP , SF-36 or SIP ) can not completely identify their specific complaints . The Chronic Venous Insufficiency Question naire ( CIVIQ ) has been developed by iterative process . First , a pilot group of 20 patients was used to identify a number of important features of quality of life affected by venous insufficiency , other than physical symptoms of discomfort . A second study involving 2,001 subjects was used to reduce the number of items . Subjects were asked to score both the severity of their problems and the importance they attributed to each problem on a 5-point Likert scale . The importance items found in patients with venous insufficiency were subjected to factorial analyses ( PCA , PAF ) . The final version is a 20-item self-administered question naire which explores four dimensions : psychological , physical and social functioning and pain . Internal consistency of the question naire was vali date d for each dimension ( Cronbach 's alpha > 0.820 for three out of four factors ) . Reproducibility was confirmed in a 60 patient test-retest study . Pearson 's correlation coefficients for both the four dimension subscales and for the global score at 2-week intervals were greater than 0.940 . Finally , the question naire was tested in a r and omized clinical trial of 934 patients in order to assess responsiveness and the convergent validity of the instrument , together with the patient 's own quality of life . This study demonstrated that convergence was valid : Pearson 's correlation coefficients between clinical score differences and quality of life score differences were small ( from 0.199–0.564 ) but were statistically different from 0 ( p<0.001 ) . St and ardized response mean ( SRM ) and effect size ( ES ) were calculated to assess sensitivity to change . SRM and ES both demonstrated considerble responsiveness to change ( > 0.80 ) . Reliability , face , content , construct validity and responsiveness were also determined for this specific quality of life question naire relating to venous insufficiency . Results suggest that this question naire may be used with confidence to assess quality of life in clinical trials on chronic venous insufficiency OBJECTIVE --To develop a valid and reliable outcome measure for patients with varicose veins . DESIGN --Postal question naire survey of patients with varicose veins . SETTING --Surgical outpatient departments and training general practice s in Grampian region . SUBJECTS--373 patients , 287 of whom had just been referred to hospital for their varicose veins and 86 who had just consulted a general practitioner for this condition and , for comparison , a r and om sample of 900 members of the general population . MAIN MEASURES --Content validity , internal consistency , and criterion validity . RESULTS --281(76 % ) patients ( mean age 45.8 ; 76 % female ) and 542(60 % ) of the general population ( mean age 47.9 ; 54 % female ) responded . The question naire had good internal consistency as measured by item-total correlations . Factor analysis identified four important health factors : pain and dysfunction , cosmetic appearance , extent of varicosity and complications . The validity of the question naire was demonstrated by a high correlation with the SF-36 health profile , which is a general measure of patients ' health . The perceived health of patients with varicose veins  , as measured by the SF-36 , was significantly lower than that of the sample of the general population adjusted for age and a lower proportion of women . CONCLUSION --A clinical ly derived question naire can provide a valid and reliable tool to assess the perceived health of patients with varicose veins . IMPLICATION S -- The question naire may be used to justify surgical treatment of varicose veins BACKGROUND Neoreflux at the sapheno-femoral junction ( SFJ ) is an important cause of recurrent great saphenous varicose veins . This study compares four surgical methods of ligating the SFJ with the aim to reduce the rate of neoreflux . METHOD In a prospect i ve study , 379 patients ( 500 SFJ ligations ) were r and omised to one of four surgical procedures at the SFJ ( 125 groins each ) . In group A ( control group ) the SFJ was ligated in st and ard fashion with Vicryl ( absorbable ligature ) ; in group B , after Vicryl ligation continuous Prolene ( non-absorbable ) was sutured over the stump endothelium to prevent any contact with surrounding tissue ; in group C. SFJ ligation was done with Ethibond ( non-absorbable ) ; in group D Ethibond ligation was followed by Prolene oversewing . The final study group included 114 patients ( 152 groins ) who were all known to be free from recurrent groin reflux 3 months postoperatively and had colour duplex venous imaging 2 years after operation . RESULTS Duplex imaging identified neoreflux at the SFJ in 10 out of 114 groins after 2 years ( 7 % ) . There were differences in the rates between the four groups : Group A 3/31 ( 10 % ) , Group B 0/32 , Group C 5/44 ( 11 % ) and Group D 2/45 ( 4 % ) . Neoreflux was significantly reduced in the two groups with endothelial closure ( B and D ) : 2/70 ( 3 % ) versus 8/75 ( 11 % , p<0.025 ) . CONCLUSION Recurrent reflux in the groin was reduced by over sewing the ligated SFJ in patients having varicose vein surgery . This adds weight to the theory of neovascularisation as a cause of recurrent veins and offers a means to reduce clinical recurrence rates AIM The innovations for disease management need to be thoroughly evaluated so that their benefits and potential downsides can be compared with the already existing approaches . Endovascular laser ( EVL ) treatment for varicose veins offers today several advantages over surgical st and ard stripping . The Italian Endovenous-laser Working Group ( IEWG ) is a homogeneous group of surgeons and phlebologists who have been using EVL since 1999 and has undertaken to examine EVL in a multicenter study starting from a well defined rationale , with the benefit of a single protocol to use . METHODS In a cooperative , multicenter , clinical study , 1076 limbs in 1050 patients , mean age of 54.5 years , 241 males and 809 females affected by chronic venous insufficiency ( CVI ) were considered eligible for surgery and stratified by CEAP classification in a four-year period ( January 1999 December 2003 ) . Inclusion criteria were insufficiency of the great and /or small saphenous vein at various levels , beyond those accessory saphenous trunks with incompetence in the saphenofemoral junction . In all cases truncular reflux apparead up on duplex scan examination , with or without associated varicosities . All the patients underwent a surgery on the basis of the clinical assessment . All the centres involved performed treatment in conformity with the Food and Drug Administration ( FDA ) vali date d procedure , using an endo-laser venous system kit with a 810 - 980 nm diode . Duplex scan was performed in all patients after 36 months with very few lost to follow-up cases . RESULTS In the immediate postoperative period the results have been impressive , with a very effective closure of incompetent great saphenous vein and the other treated varicose veins ( the early occlusion rate has been 99 % ) . Major complications have not been detected : in particular , no deep venous thrombosis ( DVT ) evaluated duplex ultrasound . The patients ' acceptability and satisfaction regarding the procedure , have been measured by means of a question naire on the quality of life , and the result was 96.7 % . After 36 months , the total occusion rate of saphenous trunks has been 97 % . CONCLUSIONS The first important Italian experience with EVL based on preoperative , perioperative and postoperative duplex control and which is also based on the patients ' satisfaction at mid/long-term has indicated some advantages over the st and ard treatment with the stripping method . In terms of reduced postoperative pain , shorter sick leave , a faster resumption of the normal activities , and , in particular , the total absence of DVT , we can conclude that EVL is a good solution for all patients with anatomic and hemodinamic patterns for saphenous vein surgery Endovenous laser ablation ( EVLA ) is a minimally invasive technique for treating varicose veins due to truncal vein incompetence . This r and omized trial compared EVLA with  conventional surgery  in patients with primary saphenofemoral and great saphenous vein ( GSV ) reflux OBJECTIVE Conventional surgery for varicose veins due to small saphenous reflux is associated with high recurrence rates ( up to 50 % ) , many result ing from inadequate surgery . This prospect i ve audit examines the safety and efficacy of EVLA in the treatment of this . METHOD 65 patients ( 68 limbs ) with varicosities due to primary or recurrent sapheno-popliteal junction ( SPJ ) and small saphenous vein ( SSV ) reflux underwent out-patient EVLA ( 810 nm diode laser ) . The SSV was ablated from mid-calf to the SPJ . Symptomatic improvement ( Aberdeen Varicose Vein Severity Score [ AVVSS ] ) , time to return to normal activity , post-EVLA analgesic requirements , and complications were recorded . RESULTS Duplex ultrasound follow-up ( median 6-months ) confirmed abolition of SPJ/SSV reflux in all limbs following a median total laser energy delivery of 1131J ( IQR 928 - 1364 ) at an energy density of 66.3 Joules/cm ( IQR 54.2 - 71. 
    Output:
    
Serious adverse events after ELT or surgery were rare .
While occurrence rates of some minor adverse events appeared higher after ELT in collated data , comparative studies commonly favored ELT over surgery .
Few differences were apparent between treatments with respect to clinical effectiveness outcomes , although long-term follow-up was lacking .
Non clinical effectiveness outcomes generally favored ELT over surgery in the first 2 months after treatment .
ELT appears to be at least as safe as surgery .