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Polidocanol-foam treatment of varicose veins: Quality-of-life impact compared to conventional surgery
Lissa Severo Sakugawaa, Felipe Soares Oliveira Portelaa,
, Andressa Cristina Sposato Louzadaa, Maria Fernanda Cassino Portugala, Marcelo Passos Teivelisa,b, Cynthia de Almeida Mendesa, Lucas Lembrança Pinheiroa,b, Marcelo Fiorelli Alexandrino da Silvaa, Alexandre Fioranellic, Nelson Woloskera,b
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A study of 14063 cases" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "en" ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0001" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1399 "Ancho" => 1667 "Tamanyo" => 102115 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0006" "detalle" => "Fig " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spara001" class="elsevierStyleSimplePara elsevierViewall">Quarterly surgical complication rate. Note: There is a progressive drop in the rate of complications represented by the gray bars. However, the first quarter is the only one that differs statistically. 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"autoresLista" => "Fang Yu, JiWei Liu, Xiao Wei" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Fang" "apellidos" => "Yu" ] 1 => array:2 [ "nombre" => "JiWei" "apellidos" => "Liu" ] 2 => array:2 [ "nombre" => "Xiao" "apellidos" => "Wei" ] ] ] ] "resumen" => array:1 [ 0 => array:3 [ "titulo" => "Highlights" "clase" => "author-highlights" "resumen" => "<span id="abss0001" class="elsevierStyleSection elsevierViewall"><p id="spara009" class="elsevierStyleSimplePara elsevierViewall"><ul class="elsevierStyleList" id="celist0001"><li class="elsevierStyleListItem" id="celistitem0001"><span class="elsevierStyleLabel">•</span><p id="para0002" class="elsevierStylePara elsevierViewall">Si-circABCA1 inhibits VMSC malignant proliferation, inflammation, and phenotypic switch.</p></li><li class="elsevierStyleListItem" id="celistitem0002"><span class="elsevierStyleLabel">•</span><p id="para0003" class="elsevierStylePara elsevierViewall">miR-885–5p blocks the promoting effects of circABCA1 on 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"tieneTextoCompleto" => true "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Lissa Severo Sakugawa, Felipe Soares Oliveira Portela, Andressa Cristina Sposato Louzada, Maria Fernanda Cassino Portugal, Marcelo Passos Teivelis, Cynthia de Almeida Mendes, Lucas Lembrança Pinheiro, Marcelo Fiorelli Alexandrino da Silva, Alexandre Fioranelli, Nelson Wolosker" "autores" => array:10 [ 0 => array:3 [ "nombre" => "Lissa Severo" "apellidos" => "Sakugawa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0001" ] ] ] 1 => array:4 [ "nombre" => "Felipe Soares Oliveira" "apellidos" => "Portela" "email" => array:1 [ 0 => "fsoaresportela@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0001" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0001" ] ] ] 2 => array:3 [ "nombre" => "Andressa Cristina 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"etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0001" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0002" ] ] ] 7 => array:3 [ "nombre" => "Marcelo Fiorelli Alexandrino da" "apellidos" => "Silva" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0001" ] ] ] 8 => array:3 [ "nombre" => "Alexandre" "apellidos" => "Fioranelli" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0003" ] ] ] 9 => array:3 [ "nombre" => "Nelson" "apellidos" => "Wolosker" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0001" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0002" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Hospital Israelita Albert Einstein, São Paulo, SP, Brazil" "etiqueta" => "a" "identificador" => "aff0001" ] 1 => array:3 [ "entidad" => "Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, SP, Brazil" "etiqueta" => "b" "identificador" => "aff0002" ] 2 => array:3 [ "entidad" => "Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil" "etiqueta" => "c" "identificador" => "aff0003" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0001" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sectitle0040">Introduction</span><p id="para0009" class="elsevierStylePara elsevierViewall">Lower limb Varicose Veins (VVs) are permanently dilated and tortuous veins that affect up to 50 % of men and 70 % of women. They can cause mild symptoms such as fatigue, a feeling of heaviness or burning, swelling, and itching in the legs or more severe complications such as phlebitis, ulcers, and bleeding.<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a></p><p id="para0010" class="elsevierStylePara elsevierViewall">Due to the high incidence of VVs, the number of surgeries for the treatment of VVs is substantial, reaching 80,000 per year in England and 70,000 per year in Brazil.<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a> The conventional surgical approach is the most widely used treatment in clinical practice and yields excellent results, which is why it is the preferred method in the Brazilian public health system. Alternatives such as the injection of sclerosing substances and the use of LASER or radiofrequency ablative techniques are also available.<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a></p><p id="para0011" class="elsevierStylePara elsevierViewall">Assessing the improvement in VV symptoms is complex, as VV symptoms are not pathognomonic, have poor correlations with anatomical and imaging parameters, and are strongly associated with psychological aspects.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a> A robust correlation between quality of life and the clinical outcome of surgical VV treatment has already been demonstrated.<a class="elsevierStyleCrossRef" href="#bib0006"><span class="elsevierStyleSup">6</span></a></p><p id="para0012" class="elsevierStylePara elsevierViewall">In recent decades, healthcare providers have increasingly recognized the importance of using patient-centered tools for various health conditions, including varicose veins, to offer better treatments in terms of quality, efficacy, and cost-effectiveness<a class="elsevierStyleCrossRef" href="#bib0007"><span class="elsevierStyleSup">7</span></a> Patient-reported outcome Measures (PROMs) are instruments that collect information on symptoms, functional status, and quality of life, making it possible to define the success of therapeutic interventions based on patient experience.<a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a></p><p id="para0013" class="elsevierStylePara elsevierViewall">However, in the scientific literature, the definition of success in treating VVs is still fundamentally based on technical criteria.<a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">10</span></a> Few studies have analyzed PROMs to determine the effectiveness of treatment, and several of them use generic questionnaires that are not specific to venous disease.<a class="elsevierStyleCrossRef" href="#bib0011"><span class="elsevierStyleSup">11</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0012"><span class="elsevierStyleSup">12</span></a> Additionally, few studies of polidocanol have addressed quality of life,<a class="elsevierStyleCrossRef" href="#bib0013"><span class="elsevierStyleSup">13</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0014"><span class="elsevierStyleSup">14</span></a> and most studies include few patients, if any, with more advanced degrees of Chronic Venous Disease (CVD).<a class="elsevierStyleCrossRef" href="#bib0014"><span class="elsevierStyleSup">14</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">15</span></a> No impact studies use PROMs in low- or middle-income countries. In this large sample (205 patients) of patients involving PROMs, the authors aimed to evaluate the impact of treating CVD with Polidocanol Foam Sclerotherapy (PFS) compared to Conventional Surgery (CS).</p></span><span id="sec0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sectitle0045">Methods</span><span id="sec0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sectitle0050">Study design</span><p id="para0014" class="elsevierStylePara elsevierViewall">This prospective, observational, and qualitative study involved 205 patients who underwent VV treatment. Among them, 57 patients underwent polidocanol sclerotherapy (foam group), and 148 patients underwent conventional surgical treatment (surgical group); these patients were the control group. The study took place at two institutions within the public health system in the city of São Paulo, Brazil, from October 2021 to October 2022. Patients were consecutively enrolled.</p><p id="para0015" class="elsevierStylePara elsevierViewall">This research was approved by the ethics committees of the respective institutions according to the following protocols: CAAE 51668821.6.0000.0071 and 51668821.6.3001.0083. A consent form was administered to all patients who agreed to participate in the study. Patients who underwent PFS received treatment on an outpatient basis. The tributary veins were punctured under direct vision, and 1 % polidocanol foam was applied. In cases where the saphenous veins were insufficient, ultrasound-guided distal puncture was performed, followed by the injection of 3 % polidocanol foam.<a class="elsevierStyleCrossRef" href="#bib0016"><span class="elsevierStyleSup">16</span></a> Patients who underwent CS were treated in an operating room under spinal anesthesia. The VV was resected through staggered incisions. In patients with great saphenous vein insufficiency, treatment was performed through an incision at the root of the thigh, with ligation of tributary veins and resection of the insufficient segment with a pin-stripper.</p><p id="para0016" class="elsevierStylePara elsevierViewall">Two occasions were assessed for each patient: before the procedure of choice and again 30 days after the treatment. During both assessments, the Clinical manifestations, Etiologic factors, Anatomic distribution of disease, and Pathophysiologic findings (CEAP) were evaluated, and the Venous Clinical Severity Score (VCSS)<a class="elsevierStyleCrossRef" href="#bib0017"><span class="elsevierStyleSup">17</span></a> and VEINES/QOL-Sym<a class="elsevierStyleCrossRef" href="#bib0018"><span class="elsevierStyleSup">18</span></a> (Portuguese version)<a class="elsevierStyleCrossRef" href="#bib0019"><span class="elsevierStyleSup">19</span></a> questionnaires were applied. In terms of the CEAP classification, the primary focus was on the assessment of clinical manifestations (C), by which the status of venous disease is stratified into seven categories:<ul class="elsevierStyleList" id="celist0002"><li class="elsevierStyleListItem" id="celistitem0004"><span class="elsevierStyleLabel">•</span><p id="para0017" class="elsevierStylePara elsevierViewall">C0: No signs of venous disease;</p></li><li class="elsevierStyleListItem" id="celistitem0005"><span class="elsevierStyleLabel">•</span><p id="para0018" class="elsevierStylePara elsevierViewall">C1: Telangiectasias or reticular veins;</p></li><li class="elsevierStyleListItem" id="celistitem0006"><span class="elsevierStyleLabel">•</span><p id="para0019" class="elsevierStylePara elsevierViewall">C2: Visible varicose veins;</p></li><li class="elsevierStyleListItem" id="celistitem0007"><span class="elsevierStyleLabel">•</span><p id="para0020" class="elsevierStylePara elsevierViewall">C3: Edema;</p></li><li class="elsevierStyleListItem" id="celistitem0008"><span class="elsevierStyleLabel">•</span><p id="para0021" class="elsevierStylePara elsevierViewall">C4: Skin changes ‒ hyperpigmentation, eczema, lipodermatosclerosis;</p></li><li class="elsevierStyleListItem" id="celistitem0009"><span class="elsevierStyleLabel">•</span><p id="para0022" class="elsevierStylePara elsevierViewall">C5: Healed ulcer.</p></li><li class="elsevierStyleListItem" id="celistitem0010"><span class="elsevierStyleLabel">•</span><p id="para0023" class="elsevierStylePara elsevierViewall">C6: active ulcer</p></li></ul></p><p id="para0024" class="elsevierStylePara elsevierViewall">The VCSS (Appendix 1) comprises 10 attributes (pain, varicose veins, edema, pigmentation, inflammation, induration, number of ulcers, duration of ulcers, size of ulcers, and compressive therapy), each rated on a scale of 0 to 3, representing absent, mild, moderate or severe symptoms, respectively.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">20</span></a> In this scenario, the higher the score, the more severe the venous disease. All these attributes were analyzed in this study.</p><p id="para0025" class="elsevierStylePara elsevierViewall">The VEINES/QOL-Sym (Appendix 1) is a specific quality-of-life assessment tool for venous disease that consists of 26 items. These items include questions about symptoms (10 items), limitations in daily activities (9 questions), psychosocial impact (5 items), changes in complaints over 1 year (1 item), and the time of day when symptoms are most frequent.<a class="elsevierStyleCrossRef" href="#bib0021"><span class="elsevierStyleSup">21</span></a> In these cases, the higher the score, the better the patient's quality of life. To facilitate a more comprehensive analysis of changes in quality of life before and after treatment, the VEINES scores were transformed into a 0‒100 scale using a method previously described in the literature.<a class="elsevierStyleCrossRef" href="#bib0022"><span class="elsevierStyleSup">22</span></a> All items from the original questionnaire were evaluated both before and 30 days after each type of procedure. The demographic data of patients who underwent either CS or PFS and their preoperative CEAP classification were examined. The VCSS and VEINES/QOL-Sym scores were computed before and after the treatment, and comparative analyses were conducted between these periods and the two treatment groups.</p><p id="para0026" class="elsevierStylePara elsevierViewall">Furthermore, the authors investigated the factors within each score that had the most significant impact on the differences between the treatments. To achieve this, the authors calculated the average change in each score associated with each type of procedure, and linear regression analysis was employed to identify the items from each questionnaire that exhibited statistically significant effects.</p></span><span id="sec0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sectitle0055">Sample calculation and statistical analysis</span><p id="para0027" class="elsevierStylePara elsevierViewall">Based on the main objective, which was to find a difference of at least 1.5 points in the VCSS between the CS and PFS groups since, in a reference study, the average variability in the VCSS was 2.355 points,<a class="elsevierStyleCrossRef" href="#bib0023"><span class="elsevierStyleSup">23</span></a> with 80 % power and 95 % Confidence, the sample size required for the study included at least 39 patients in each group, considering a two-tailed test.</p><p id="para0028" class="elsevierStylePara elsevierViewall">All the statistical analyses were performed using SPSS software version 22 (IBM ‒ Armonk, New York, USA). The patients' clinical and epidemiological characteristics were analyzed, as were all the variables in each of the quality-of-life scores (VCCS, VEINES-QoL, and VEINES-Sym).</p><p id="para0029" class="elsevierStylePara elsevierViewall">Student's <span class="elsevierStyleItalic">t</span>-test was used to assess continuous variables, while the Chi-Square test was used to analyze categorical variables.</p><p id="para0030" class="elsevierStylePara elsevierViewall">To analyze the variations in the quality-of-life scores at each time point (pre- and posttreatment), a generalized estimating equation with a normal distribution and identity link function was used, assuming an AR(1) correlation matrix between the time points and Bonferroni multiple comparisons. Multiple linear regression was used in the multivariate analysis.</p><p id="para0031" class="elsevierStylePara elsevierViewall">A p-value less than or equal to 0.05 was considered indicative of statistical significance for all tests.</p></span></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sectitle0060">Results</span><p id="para0032" class="elsevierStylePara elsevierViewall">In total, 57 patients (involving 90 limbs) were treated with PFS, while 148 (involving 236 limbs) underwent CS.</p><p id="para0033" class="elsevierStylePara elsevierViewall">The demographic data for both groups are presented in <a class="elsevierStyleCrossRef" href="#tbl0001">Table 1</a>. Patients who underwent PFS were significantly more likely to have hypertension (58.8 % vs. 29.1 %, p < 0.001), diabetes (29.4 % vs. 8.1 %, p < 0.001), or obesity (48 % vs. 24.2 %, p < 0.001). Both groups were predominantly composed of females, with no significant difference between them (p = 0.121). Patients in the foam group were significantly older (p = 0.002) and had a greater body mass index (p < 0.001).</p><elsevierMultimedia ident="tbl0001"></elsevierMultimedia><p id="para0034" class="elsevierStylePara elsevierViewall">The CEAP classification of the treated limbs is detailed in <a class="elsevierStyleCrossRef" href="#tbl0002">Table 2</a>. While the foam group did have a greater percentage of patients with more advanced stages of CVD (24.4 % of individuals with CEAPs C5 and C6, compared to 9.3 % of patients in the control group), there was no statistically significant difference between the groups (p = 0.455).</p><elsevierMultimedia ident="tbl0002"></elsevierMultimedia><p id="para0035" class="elsevierStylePara elsevierViewall">A comparison of the VCSS and VEINES scores before and after treatment for both groups is shown in <a class="elsevierStyleCrossRef" href="#tbl0003">Tables 3</a> to <a class="elsevierStyleCrossRef" href="#tbl0005">5</a>.</p><elsevierMultimedia ident="tbl0003"></elsevierMultimedia><p id="para0036" class="elsevierStylePara elsevierViewall">Before treatment (<a class="elsevierStyleCrossRef" href="#tbl0003">Table 3</a>), patients who were treated with PFS had notably greater mean VCSS than those who underwent CS (20.33 vs. 18.04, p = 0.019). However, there was no difference between the two groups in the pre-procedure assessment concerning the VEINES scores for quality of life (control 64.62 vs. foam 64.48, p > 0.999) or for symptoms (control 61.93 vs. foam 59.29, p > 0.999).</p><p id="para0037" class="elsevierStylePara elsevierViewall">Both treatments (<a class="elsevierStyleCrossRef" href="#tbl0004">Table 4</a>) resulted in a significant improvement in scores 30 days after the procedures (p ≤ 0.05 in all patients).</p><elsevierMultimedia ident="tbl0004"></elsevierMultimedia><p id="para0038" class="elsevierStylePara elsevierViewall">Nevertheless, the surgical group exhibited a greater improvement rate than the foam group did (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 5</a>). Specifically, the post-treatment VCSS of patients who underwent CS was, on average, 4.02 points lower (indicating better results) than that of patients who underwent PFS (14.48 vs. 18.50, p < 0.001). Concerning the VEINES scores, patients in the surgical group scored an average of 8 points higher in terms of quality-of-life (80.09 vs. 71.99, p < 0.001) and an average of 11.66 points higher in terms of symptoms (82.11 vs. 70.50, p < 0.001) than did those in the foam group.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="para0039" class="elsevierStylePara elsevierViewall">Subsequently, the authors analyzed all criteria within each questionnaire to determine which factors most significantly contributed to the superior performance of surgery compared to foam treatment. Pain emerged as the primary factor that substantially contributed to the significantly improved postoperative VCSS in the control group compared to the foam group. Although the groups initially exhibited similarities concerning this symptom (p > 0.999, 95 %CI -0.56; +0.83), patients who underwent CS experienced a significant improvement in this regard 30 days after the procedure (mean improvement in VCSS of 1.28 points, p < 0.001, 95 % CI +0.80; +1.77), whereas patients who underwent PFS did not exhibit a statistically significant improvement (mean improvement in VCSS of 0.5 points, p = 0.642, 95 % CI -0.32; +1.34).</p><p id="para0040" class="elsevierStylePara elsevierViewall">According to the VEINES-Sym questionnaire, the scores in the domains related to edema and the sensation of heat or burning did not significantly improve in the foam group compared to the control group, leading to less favorable postoperative scores. Concerning edema, there was a mean difference of 0.95 points (p < 0.001, 95 % CI -1.33; -0.57) in the postoperative score favoring the surgical group. Regarding the sensation of burning, there was an average improvement of 1.31 points in the surgical group (p<0.001, 95 % CI -1.99; -0.63), whereas the foam group exhibited only a minor and nonsignificant improvement of 0.24 points (p > 0.999, 95 % CI -1.19; +0.71).</p><p id="para0041" class="elsevierStylePara elsevierViewall">In the context of the VEINES-QoL questionnaire, concerns about the risk of falling and the impact of leg appearance on clothing choice were the factors that led to a less favorable postprocedure evaluation in the foam group than in the control group. Treatment with CS resulted in an average improvement of 1.78 points in patients’ concerns about the risk of falling (p < 0.001, 95 % CI -2.49; -1.06), while there was a slight and nonsignificant worsening of 0.16 points (p > 0.999, 95 % CI -0.71; +1.03) after PFS. Regarding the influence of leg appearance on clothing choice, surgery led to a significant average improvement of 2.05 points (p < 0.001, 95 % CI -2.73; -1.38), whereas foam treatment brought about a slight nonsignificant improvement of 0.45 points (p > 0.999, 95 % CI -1.40; +0.49).</p><p id="para0042" class="elsevierStylePara elsevierViewall">According to multivariate analysis (see Appendix 2), regarding the VCSS, a higher preoperative (baseline) score was associated with a less favorable post-treatment outcome in the foam group than in the control group (p < 0.001). Regarding the VEINES scores, grade 2 obesity significantly influenced the foam group's less favorable results 30 days after the procedure, both in terms of symptoms and quality of life (p < 0.001 in both scenarios).</p></span><span id="sec0006" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sectitle0065">Discussion</span><p id="para0043" class="elsevierStylePara elsevierViewall">While interventions for treating CVD are commonly performed in clinical practice, the outcomes of these interventions have been inconsistent.<a class="elsevierStyleCrossRef" href="#bib0024"><span class="elsevierStyleSup">24</span></a> Most studies primarily evaluate the success of VV treatment based on technical criteria, such as the presence of venous reflux and remaining veins, with limited consideration of clinical criteria related to patients’ symptoms and quality of life.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">25</span></a></p><p id="para0044" class="elsevierStylePara elsevierViewall">Quality-of-life questionnaires and PROMs serve as valuable tools for evaluating the impact of VVs and their treatment on patients' well-being.<a class="elsevierStyleCrossRef" href="#bib0026"><span class="elsevierStyleSup">26</span></a> It is important to note that no perfect scoring system is available to comprehensively assess the clinical complexity and patient perceptions of venous disease. In this study, for a more thorough analysis, the authors chose to combine a scoring system focused on clinical evaluation (VCSS) with one focusing on the patient's perceptions of their Symptoms (VEINES-Sym) as well as the impact of these symptoms on their Quality-of-Life (VEINES-QoL). The VCSS enables the measurement of subtle changes in the severity of CVD. Nevertheless, it encompasses many symptoms not specific to VVs and may not be particularly useful, especially for patients with lower CEAP classifications (C1 to C3). On the other hand, the VEINES questionnaire is currently one of the most reasonable options for assessing the impact of CVD on quality of life across the entire spectrum of CVD.<a class="elsevierStyleCrossRef" href="#bib0027"><span class="elsevierStyleSup">27</span></a> However, the ability of the original VEINES scoring system to evaluate changes in quality of life between two different time points may be limited. For this reason, the authors chose to use an alternative approach, as previously described in the literature, to adapt this scoring system objectively.<a class="elsevierStyleCrossRef" href="#bib0021"><span class="elsevierStyleSup">21</span></a></p><p id="para0045" class="elsevierStylePara elsevierViewall">In this study, 44 legs (13.5 %) presented active ulcers during treatment. Most published papers, however, do not include CEAP C6 patients,<a class="elsevierStyleCrossRef" href="#bib0011"><span class="elsevierStyleSup">11</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0014"><span class="elsevierStyleSup">14</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">15</span></a> which constituted a notable aspect of this study. In Brazil, where approximately 75 % of the population (approximately 160 million individuals) depend exclusively on the care provided by the public health system, patient access to health services often involves long delays, especially for nonurgent conditions such as VVs. This may explain the greater proportion of individuals with more advanced stages of venous disease in the present study.<a class="elsevierStyleCrossRef" href="#bib0028"><span class="elsevierStyleSup">28</span></a></p><p id="para0046" class="elsevierStylePara elsevierViewall">Although varicose vein surgery poses a low risk for patients, sclerotherapy represents an even less invasive alternative, as it does not require hospitalization or invasive procedures.<a class="elsevierStyleCrossRef" href="#bib0029"><span class="elsevierStyleSup">29</span></a> In this series, the authors found that patients selected for treatment for PFS were older than those who underwent CS, which aligns with findings from other available studies.<a class="elsevierStyleCrossRef" href="#bib0011"><span class="elsevierStyleSup">11</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">15</span></a></p><p id="para0047" class="elsevierStylePara elsevierViewall">In general, studies also indicate an immediate improvement in quality of life following interventions, whether through sclerotherapy or conventional surgery.<a class="elsevierStyleCrossRef" href="#bib0011"><span class="elsevierStyleSup">11</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0013"><span class="elsevierStyleSup">13</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0014"><span class="elsevierStyleSup">14</span></a> However, extensive trials with long-term follow-up have shown a late deterioration in clinical severity and quality-of-life scores, typically occurring approximately two years after treatment,<a class="elsevierStyleCrossRef" href="#bib0012"><span class="elsevierStyleSup">12</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">15</span></a> as CVD recurs. In this study, the authors observed an improvement in the quality-of-life scores of patients who underwent PFS and those who underwent CS. Nevertheless, the postoperative improvement was more substantial among patients who underwent surgery. These outcomes may be attributed to the inherent effects of the procedures themselves and the specific characteristics of the patients chosen for each treatment.</p><p id="para0048" class="elsevierStylePara elsevierViewall">In the present study, pain was the factor exerting the most significant impact on the less favorable post-treatment outcomes observed in the foam group. These findings contrast with those of other studies, which suggest increased post-treatment pain following conventional surgery.<a class="elsevierStyleCrossRef" href="#bib0012"><span class="elsevierStyleSup">12</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">30</span></a> The heightened perception of pain after sclerotherapy in the sample may be related to the effects of polidocanol, which can induce phlebitis due to local inflammatory reactions.<a class="elsevierStyleCrossRef" href="#bib0031"><span class="elsevierStyleSup">31</span></a></p><p id="para0049" class="elsevierStylePara elsevierViewall">In addition, the occurrence of phlebitis and hyperpigmentation potentially associated with foam application<a class="elsevierStyleCrossRef" href="#bib0013"><span class="elsevierStyleSup">13</span></a> may correlate with the less favorable results observed in the post-procedure VEINES score quality-of-life domain, influencing patients' concern about the appearance of their legs.</p><p id="para0050" class="elsevierStylePara elsevierViewall">Finally, patients’ individual characteristics inevitably influence their perception of postoperative improvement. Patients in the foam group tended to be older and to present more comorbidities. Previous studies have independently associated these two aspects with lower quality-of-life scores specific to varicose veins, irrespective of the severity of venous disease.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">25</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRefs" href="#bib0032"><span class="elsevierStyleSup">32–34</span></a> Furthermore, in many circumstances, the age of patients and the severity of comorbidities (such as obesity) may be contraindications to traditional surgical procedures but not to sclerotherapy. Therefore, especially in the public health system, many patients (who already have a lower quality of life due to their clinical characteristics) end up receiving sclerotherapy as their only interventional treatment option.</p><p id="para0051" class="elsevierStylePara elsevierViewall">It is important to highlight that, despite these distinctions, both treatments proved effective in addressing VVs. Surgery yields positive outcomes in terms of technical aspects at both early and late follow-up<a class="elsevierStyleCrossRef" href="#bib0012"><span class="elsevierStyleSup">12</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">30</span></a> and in clinical aspects<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">35</span></a> On the other hand, sclerotherapy, while potentially requiring reoperations and presenting local side effects, remains highly practical and cost-effective. Sclerotherapy also entails lower costs, does not require hospitalization or periprocedural anesthesia, and allows a quicker return to normal activities.<a class="elsevierStyleCrossRef" href="#bib0036"><span class="elsevierStyleSup">36</span></a></p><p id="para0052" class="elsevierStylePara elsevierViewall">In a healthcare context such as the Brazilian public health system, where many patients contend with multiple comorbidities or are elderly ‒ factors that may render surgical intervention challenging or prohibitive ‒ sclerotherapy emerges as a viable and effective alternative.</p><p id="para0053" class="elsevierStylePara elsevierViewall">Several factors limit this study. While patients were enrolled consecutively, there was no randomization process for the treatment groups. Since the study evaluated patients treated within the public health system, it was restricted to assessing available treatment options. Unfortunately, other currently available methods, such as ablative techniques, could not be explored.</p><p id="para0054" class="elsevierStylePara elsevierViewall">Despite its limitations, this is, to the best of our knowledge, one of the few, if any, studies to address the quality-of-life outcomes of polidocanol sclerotherapy versus surgical treatment using PROMs within one of the largest public health systems in the world.</p></span><span id="sec0007" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sectitle0070">Conclusion</span><p id="para0055" class="elsevierStylePara elsevierViewall">Both PFS and CS have demonstrated an immediate (within 30 days) positive impact on the quality of life of patients with VV.</p><p id="para0056" class="elsevierStylePara elsevierViewall">Nevertheless, the improvement in quality-of-life scores attributed to surgical treatment surpasses that achieved through sclerotherapy, primarily because patients treated with foam tend to experience more pronounced pain and heightened aesthetic concerns.</p></span><span id="sec0008" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sectitle0075">Authors’ contributions</span><p id="para0058" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Lissa Severo Sakugawa:</span> Data curation, writing - original draft, writing – review & editing. <span class="elsevierStyleBold">Felipe Soares Oliveira Portela:</span> Data curation, formal analysis, writing – original draft, writing – review & editing. <span class="elsevierStyleBold">Andressa Cristina Sposato Louzada:</span> Data curation, methodology, validation. <span class="elsevierStyleBold">Maria Fernanda Cassino Portugal:</span> Writing – review & editing, investigation. <span class="elsevierStyleBold">Marcelo Passos Teivelis:</span> Writing – review & editing, project administration. <span class="elsevierStyleBold">Cynthia de Almeida Mendes:</span> Investigation, formal analysis. <span class="elsevierStyleBold">Lucas Lembrança Pinheiro:</span> Conceptualization, methodology, project administration. <span class="elsevierStyleBold">Marcelo Fiorelli Alexandrino da Silva:</span> Methodology, resources, visualization. <span class="elsevierStyleBold">Alexandre Fioranelli:</span> Conceptualization, project administration, supervision. <span class="elsevierStyleBold">Nelson Wolosker:</span> Conceptualization, supervision, writing – review & editing.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres2290898" "titulo" => "Highlights" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abss0001" ] ] ] 1 => array:3 [ "identificador" => "xres2290899" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abss0002" "titulo" => "Background and objective" ] 1 => array:2 [ "identificador" => "abss0003" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abss0004" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abss0005" "titulo" => "Conclusion" ] ] ] 2 => array:2 [ "identificador" => "xpalclavsec1903297" "titulo" => "Keywords" ] 3 => array:2 [ "identificador" => "sec0001" "titulo" => "Introduction" ] 4 => array:3 [ "identificador" => "sec0002" "titulo" => "Methods" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0003" "titulo" => "Study design" ] 1 => array:2 [ "identificador" => "sec0004" "titulo" => "Sample calculation and statistical analysis" ] ] ] 5 => array:2 [ "identificador" => "sec0005" "titulo" => "Results" ] 6 => array:2 [ "identificador" => "sec0006" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0007" "titulo" => "Conclusion" ] 8 => array:2 [ "identificador" => "sec0008" "titulo" => "Authors’ contributions" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-09-22" "fechaAceptado" => "2024-03-11" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1903297" "palabras" => array:5 [ 0 => "Varicose veins" 1 => "Saphenous vein" 2 => "Polidocanol" 3 => "Sclerotherapy" 4 => "Quality of life" ] ] ] ] "tieneResumen" => true "highlights" => array:2 [ "titulo" => "Highlights" "resumen" => "<span id="abss0001" class="elsevierStyleSection elsevierViewall"><p id="abspara0005" class="elsevierStyleSimplePara elsevierViewall"><ul class="elsevierStyleList" id="celist0001"><li class="elsevierStyleListItem" id="celistitem0001"><span class="elsevierStyleLabel">•</span><p id="para0002" class="elsevierStylePara elsevierViewall">Both polidocanol foam sclerotherapy and conventional surgery had positive impacts on patient quality of life.</p></li><li class="elsevierStyleListItem" id="celistitem0002"><span class="elsevierStyleLabel">•</span><p id="para0003" class="elsevierStylePara elsevierViewall">Conventional surgery promotes greater improvement in patient quality-of-life than sclerotherapy.</p></li><li class="elsevierStyleListItem" id="celistitem0003"><span class="elsevierStyleLabel">•</span><p id="para0004" class="elsevierStylePara elsevierViewall">Post-procedure pain and aesthetic concerns about the legs worsen the efficacy of sclerotherapy.</p></li></ul></p></span>" ] "resumen" => array:1 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abss0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sectitle0015">Background and objective</span><p id="abspara0010" class="elsevierStyleSimplePara elsevierViewall">Lower limb varicose veins are a prevalent disease associated with several available treatment options, including conventional surgery and polidocanol foam sclerotherapy. However, few studies have analyzed therapeutic modality outcomes based on Patient-Reported Outcome Measures (PROMs). This large sample-size study was designed to evaluate the outcomes of polidocanol foam sclerotherapy compared to conventional surgery based on an analysis of PROMs.</p></span> <span id="abss0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sectitle0020">Methods</span><p id="abspara0015" class="elsevierStyleSimplePara elsevierViewall">This was a prospective, observational, and qualitative study of 205 patients who underwent varicose vein treatment with either polidocanol foam sclerotherapy (57 patients, 90 legs) or conventional surgery (148 patients, 236 legs). Patients were preoperatively assessed and re-evaluated 30 days after the procedure using the Venous Disease Severity Score (VCSS) and specific venous disease quality-of-life questionnaires (VEINES-QoL/Sym).</p></span> <span id="abss0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sectitle0025">Results</span><p id="abspara0020" class="elsevierStyleSimplePara elsevierViewall">Both treatments significantly improved VCSS and VEINES results 30 days after the procedure (p < 0.05). However, surgery promoted greater improvements in VCSS (on average 4.02-points improvement, p < 0.001), VEINES-QoL (average 8-points improvement, p < 0.001), and VEINES-Sym (average 11.66 points improvement, p < 0.001) than did sclerotherapy. Postoperative pain and aesthetic concerns about the legs were the domains of the questionnaires in which the results varied the most between the treatment modalities, with worse results for sclerotherapy.</p></span> <span id="abss0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sectitle0030">Conclusion</span><p id="abspara0025" class="elsevierStyleSimplePara elsevierViewall">Both polidocanol foam sclerotherapy and conventional surgery positively impact patients’ quality of life after 30 days, but the improvement is more significant for patients who undergo conventional surgery.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abss0002" "titulo" => "Background and objective" ] 1 => array:2 [ "identificador" => "abss0003" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abss0004" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abss0005" "titulo" => "Conclusion" ] ] ] ] "NotaPie" => array:1 [ 0 => array:1 [ "nota" => "<p class="elsevierStyleNotepara" id="ntpara0005">A previous version of this study has been published via a preprint server: DOI: <span class="elsevierStyleInterRef" id="intref0005" href="https://doi.org/10.1101/2023.08.25.23294616I">https://doi.org/10.1101/2023.08.25.23294616I</span></p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="para0057a" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="ecom0001"></elsevierMultimedia></p>" "etiqueta" => "Appendix" "titulo" => "Supplementary materials" "identificador" => "sec0010" ] ] ] ] "multimedia" => array:6 [ 0 => array:8 [ "identificador" => "tbl0001" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0001" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="tspara0010" class="elsevierStyleSimplePara elsevierViewall">Statistical tests: Chi-Square (a); Fisher's test (b); likelihood ratio (c); Student's <span class="elsevierStyleItalic">t</span>-test (d).</p><p id="tspara0015" class="elsevierStyleSimplePara elsevierViewall">CS, Conventional Surgery; PFS, Polidocanol Foam Sclerotherapy; BMI, Body Mass Index.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><a name="en0001"></a><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top" scope="col"></th><a name="en0002"></a><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="4" align="left" valign="top" scope="col">Group</th><a name="en0003"></a><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_rowgroup colgroup " rowspan="2" align="center" valign="top" scope="col" colspan="2" style="border-bottom: 2px solid black">Total</th><a name="en0004"></a><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="2" align="left" valign="top" scope="col">p-value</th></tr><tr title="table-row"><a name="en0005"></a><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top" scope="col"></th><a name="en0006"></a><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top" scope="col">CS</th><a name="en0007"></a><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">PFS</th></tr><tr title="table-row"><a name="en0010"></a><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black"></th><a name="en0011"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">n \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0012"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleHsp" style=""></span>% \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0013"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">n \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0014"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleHsp" style=""></span>% \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0015"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">n \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0016"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleHsp" style=""></span>% \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0018"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead colgroup " colspan="2" align="left" valign="top"><span class="elsevierStyleBold">Average age (years)</span></td><a name="en0019"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top">56.7</td><a name="en0020"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top">62.8</td><a name="en0021"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top"></td><a name="en0022"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">0.002<span class="elsevierStyleSup">d</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0023"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="2" align="left" valign="top"><span class="elsevierStyleBold">Gender</span></td><a name="en0024"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0025"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">112 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0026"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">75.7 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0027"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">37 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0028"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">64.9 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0029"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">149 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0030"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">72.7 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0031"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="2" align="left" valign="top">0.121ª</td></tr><tr title="table-row"><a name="en0033"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0034"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">36 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0035"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">24.3 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0036"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0037"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">35.1 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0038"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">56 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0039"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">27.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0041"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead colgroup " colspan="2" align="left" valign="top"><span class="elsevierStyleBold">Hypertension</span></td><a name="en0042"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">43 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0043"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">29.1 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0044"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0045"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">58.8 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0046"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">73 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0047"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">36.7 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0048"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top"><span class="elsevierStyleBold"><0.001ª</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0049"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead colgroup " colspan="2" align="left" valign="top"><span class="elsevierStyleBold">Diabetes</span></td><a name="en0050"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0051"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">8.1 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0052"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0053"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">29.4 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0054"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">27 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0055"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">13.6 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0056"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top"><span class="elsevierStyleBold"><0.001ª</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0057"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead colgroup " colspan="2" align="left" valign="top"><span class="elsevierStyleBold">Smoking</span></td><a name="en0058"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0059"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">8.8 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0060"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0061"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">6.3 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0062"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0063"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">8.2 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0064"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">0.765<span class="elsevierStyleSup">b</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0065"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead colgroup " colspan="2" align="left" valign="top"><span class="elsevierStyleBold">Physical activity</span></td><a name="en0066"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">38 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0067"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">25.9 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0068"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0069"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">31.1 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0070"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">52 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0071"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">27.1 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0072"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">0.487<span class="elsevierStyleSup">a</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0073"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead colgroup " colspan="2" align="left" valign="top"><span class="elsevierStyleBold">BMI</span> Average (kg/m<span class="elsevierStyleSup">2</span>)</td><a name="en0074"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top">27.0</td><a name="en0075"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top">31.3</td><a name="en0076"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="top"></td><a name="en0077"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="6" align="left" valign="top"><span class="elsevierStyleBold"><0.001<span class="elsevierStyleSup">c</span></span></td></tr><tr title="table-row"><a name="en0078"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead colgroup " colspan="2" align="left" valign="top">Underweight/Eutrophic</td><a name="en0079"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">51 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0080"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">35.2 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0081"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0082"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">26 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0083"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">64 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0084"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">32.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0086"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead colgroup " colspan="2" align="left" valign="top">Overweight</td><a name="en0087"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">59 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0088"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">40.7 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0089"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0090"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">26 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0091"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">72 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0092"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">36.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0094"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead colgroup " colspan="2" align="left" valign="top">Obesity class 1</td><a name="en0095"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">31 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0096"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">21.4 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0097"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0098"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">22 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0099"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">42 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0100"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">21.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0102"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead colgroup " colspan="2" align="left" valign="top">Obesity class 2</td><a name="en0103"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0104"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">2.1 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0105"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0106"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0107"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0108"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">6.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0110"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead colgroup " colspan="2" align="left" valign="top">Obesity class 3</td><a name="en0111"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0112"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.7 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0113"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0114"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0115"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0116"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">2.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3711548.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="tspara0005" class="elsevierStyleSimplePara elsevierViewall">Demographics and clinical characteristics of the sample.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0002" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0002" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="tspara0025" class="elsevierStyleSimplePara elsevierViewall">Statistical test: Chi-square test for trends (a).</p><p id="tspara0030" class="elsevierStyleSimplePara elsevierViewall">CS, Conventional Surgery; PFS, Polidocanol Foam Sclerotherapy.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><a name="en0118"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0119"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">PFS \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0120"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">CS \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0121"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0122"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">C1</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0123"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">7 (7.7 %) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0124"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0125"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="7" align="left" valign="top">0.455<span class="elsevierStyleSup">a</span></td></tr><tr title="table-row"><a name="en0126"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">C2</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0127"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">18 (20.0 %) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0128"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">38 (16.1 %) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0130"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">C3</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0131"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">23 (25.5 %) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0132"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">60 (25.4 %) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0134"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">C4</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0135"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">20 (22.2 %) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0136"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">116 (49.1 %) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0138"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">C5</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0139"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">9 (10.0 %) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0140"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0142"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">C6</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0143"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">13 (14.4 %) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0144"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">22 (9.3 %) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0146"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Total</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0147"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">90 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0148"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">236 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3711546.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="tspara0020" class="elsevierStyleSimplePara elsevierViewall">Preoperative CEAP classification of the treated limbs.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0003" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0003" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="tspara0040" class="elsevierStyleSimplePara elsevierViewall">CS, Conventional Surgery; PFS, Polidocanol Foam Sclerotherapy; 95 % CI, Confidence Interval.</p><p id="tspara0045" class="elsevierStyleSimplePara elsevierViewall">For the statistical analysis, a generalized estimating equation with a normal distribution and identity link function was used, assuming an AR(1) correlation matrix between the time points and Bonferroni multiple comparisons.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><a name="en0150"></a><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_rowgroup " align="left" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0151"></a><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="6" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Pretreatment values</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0153"></a><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_rowgroup " align="left" valign="top" scope="col">CS \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0154"></a><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_rowgroup " align="left" valign="top" scope="col">PFS \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0155"></a><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_rowgroup " align="left" valign="top" scope="col">Mean difference (CS–PFS) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0156"></a><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_rowgroup " align="left" valign="top" scope="col">p \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0157"></a><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">95 % CI</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0163"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Inferior \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0164"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Superior \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0165"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">VCSS</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0166"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">18.04 ± 4.52 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0167"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">20.33 ± 6.53 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0168"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">-2.29 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0169"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.019 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0170"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">-4.35 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0171"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">-0.24 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0172"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">VEINES-QoL</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0173"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">64.62 ± 11.12 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0174"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">64.48 ± 11.02 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0175"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.24 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0176"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">>0.999 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0177"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">-4.22 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0178"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">4.69 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0179"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">VEINES-Sym</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0180"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">61.93 ± 15.78 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0181"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">59.29 ± 15.57 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0182"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">2.81 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0183"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">>0.999 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0184"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">-3.21 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0185"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">8.83 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3711547.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="tspara0035" class="elsevierStyleSimplePara elsevierViewall">Scores (mean ± standard deviation) and comparisons between groups (CS and PFS) at the pretreatment time point.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0004" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0004" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="tspara0055" class="elsevierStyleSimplePara elsevierViewall">CS, Conventional Surgery; PFS, Polidocanol Foam Sclerotherapy; 95 % CI, Confidence Interval.</p><p id="tspara0060" class="elsevierStyleSimplePara elsevierViewall">For the statistical analysis, a generalized estimating equation with a normal distribution and identity link function was used, assuming an AR(1) correlation matrix between the time points and Bonferroni multiple comparisons.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><a name="en0186"></a><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_rowgroup " align="left" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0187"></a><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_rowgroup " align="left" valign="top" scope="col">CS mean difference (pre–post) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0188"></a><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_rowgroup " align="left" valign="top" scope="col">p \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0189"></a><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">95 % IC</th><a name="en0190"></a><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_rowgroup " align="left" valign="top" scope="col">PFS mean difference (pre–post) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0191"></a><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_rowgroup " align="left" valign="top" scope="col">p \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0192"></a><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">95 % IC</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0196"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Inferior \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0197"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Superior \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0200"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Inferior \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0201"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Superior \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0202"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">VCSS</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0203"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">+3.86 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0204"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0205"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">2.76 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0206"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">4.97 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0207"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">+2.13 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0208"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.005 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0209"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.44 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0210"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">3.82 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0211"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">VEINES-QoL</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0212"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">-15.58 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0213"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0214"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">-18.98 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0215"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">-12.19 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0216"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">-7.81 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0217"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0218"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">-12.84 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0219"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">-2.78 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0220"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">VEINES-Sym</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0221"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">-20.45 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0222"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0223"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">-25.04 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0224"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">-15.85 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0225"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">-11.60 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0226"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0227"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">-18.40 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0228"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">-4.79 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3711549.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="tspara0050" class="elsevierStyleSimplePara elsevierViewall">Comparison of pre- and posttreatments.</p>" ] ] 4 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 5" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0005" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="tspara0070" class="elsevierStyleSimplePara elsevierViewall">For the statistical analysis, a generalized estimating equation with a normal distribution and identity link function was used, assuming an AR(1) correlation matrix between the time points and Bonferroni multiple comparisons</p><p id="tspara0075" class="elsevierStyleSimplePara elsevierViewall">CS, Conventional Surgery; PFS, Polidocanol Foam Sclerotherapy; 95 % CI, Confidence Interval.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><a name="en0229"></a><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_rowgroup " align="left" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0230"></a><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="6" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Posttreatment values</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0232"></a><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_rowgroup " align="left" valign="top" scope="col">CS \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0233"></a><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_rowgroup " align="left" valign="top" scope="col">PFS \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0234"></a><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_rowgroup " align="left" valign="top" scope="col">Mean difference (CS–PFS) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0235"></a><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_rowgroup " align="left" valign="top" scope="col">p \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0236"></a><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">95 % CI</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0242"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Inferior \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0243"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Superior \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0244"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">VCSS</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0245"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">14.48 ± 2.66 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0246"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">18.50 ± 7,09 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0247"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">-4.02 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0248"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0249"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">-6.35 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0250"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">-1.70 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0251"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">VEINES-QoL</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0252"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">80.09 ± 9.29 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0253"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">71.99 ± 11,28 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0254"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">8.01 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0255"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0256"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">2.81 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0257"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">13.21 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0258"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">VEINES-Sym</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0259"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">82.11 ± 10.56 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0260"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">70.50 ± 14,80 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0261"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">11.66 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0262"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0263"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">4.64 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0264"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">18.69 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3711550.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="tspara0065" class="elsevierStyleSimplePara elsevierViewall">Post-treatment scores (mean ± standard deviation) and comparisons between groups (CS and PFS).</p>" ] ] 5 => array:6 [ "identificador" => "ecom0001" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0006" "detalle" => "Image, application " "rol" => "short" ] ] "Ecomponente" => array:2 [ "fichero" => "mmc1.docx" "ficheroTamanyo" => 443838 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "cebibsec0005" "bibliografiaReferencia" => array:36 [ 0 => array:3 [ "identificador" => "bib0001" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Schottenfeld D. 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