Dear Editor,

With great interest we have read the letter to the editor of Dr. Yetkin.1 In his letter, he questioned whether our study population is a good representation of the average varicose vein population. To his opinion most patients attending a Dermatology Department are presenting with complaints of itch or aesthetic concerns. This opinion is rather based on a general assumption and there is no evidence substantiating this statement. In our hospital, all patients with symptoms and signs of chronic venous disease (CVD) are referred to the Department of Dermatology. The same is true for many other hospitals in the Netherlands. In our study, over 89% of the patients had mild to severe CVD (C2 to C6), including 17 patients (27%) with active venous ulceration (C6). Over 65% of the CVD patients complained either of heavy legs, aching legs or night cramps.2 At duplex ultrasound examination all patients had truncal reflux. Considering the oversampling of C6 disease in our cohort, the severity of CVD in our study population may even have been worse than what can be expected in a typical CVD population.

In view of the above, we reconfirm that our cohort of CVD patients was indeed representative, contrarily to what has been suggested in Dr. Yetkin’s letter.