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Prevalence of chronic venous insufficiency in men and women in Poland: Multicentre cross-sectional study in 40,095 patients
Abstract
Objective: To study the prevalence, clinical expression and risk factors of chronic venous insufficiency (CVI) in 40,095 Polish adults.
Method: This was a multicentre cross-sectional study with 803 participating primary care physicians.
Results: The study population was mainly female (84%). The mean age was 44.8 years. Of the total population, 10% presented with oedema, 34.3% had varicose veins, with approximately the same proportion in males and females and 1.5% presented with past or active ulceration. A similar prevalence of CVI to that observed in the developed countries was reported in Poland. Obesity, the number of pregnancies and a positive family history were found to be risk factors for CVI. Female gender was not shown to be a risk factor for varicose veins.
Conclusions: The relationship between the presence of symptoms and signs of CVI was high, whatever the gender. Thus, the previously described dominance of the disease in females is losing its significance.
... Venous disorders of the lower extremities are associated with a range of pathologic conditions, many of which present with edema, complicating the process of making a differential diagnosis [1]. Further, though treatment guidelines for chronic venous disease (CVD) are regularly updated, a range of signs and symptoms are associated with edema within the literature, such as "heaviness" and a "feeling of swelling". ...
... Due to the discrepancies in the use of terminology associated with edema of the lower extremities, determining its precise prevalence in patients with CVD has been challenging, with limited consistency apparent in the literature [1]. In a multicenter, cross-sectional study by Jawien and colleagues [1], the prevalence of CVI was assessed in 40,095 people visiting a doctor (general practitioner, gynecologist or internist) in Poland. ...
... Due to the discrepancies in the use of terminology associated with edema of the lower extremities, determining its precise prevalence in patients with CVD has been challenging, with limited consistency apparent in the literature [1]. In a multicenter, cross-sectional study by Jawien and colleagues [1], the prevalence of CVI was assessed in 40,095 people visiting a doctor (general practitioner, gynecologist or internist) in Poland. The majority of the participants were female (84%), the mean age was 44.8 years and 10% presented with edema. ...
Background: Edema is highly prevalent in patients with cardiovascular disease and is associated with various underlying pathologic conditions, making it challenging for physicians to diagnose and manage. Methods: We report on presentations from a virtual symposium at the Annual Meeting of the European Venous Forum (25 June 2021), which examined edema classification within clinical practice, provided guidance on making differential diagnoses and reviewed evidence for the use of the treatment combination of Ruscus extract, hesperidin methyl chalcone and vitamin C. Results: The understanding of the pathophysiologic mechanisms underlying fluid build-up in chronic venous disease (CVD) is limited. Despite amendments to the classic Starling Principle, discrepancies exist between the theories proposed and real-world evidence. Given the varied disease presentations seen in edema patients, thorough clinical examinations are recommended in order to make a differential diagnosis. The recent CEAP classification update states that edema should be considered a sign of CVD. The combination of Ruscus extract, hesperidin methyl chalcone and vitamin C improves venous tone and lymph contractility and reduces macromolecule permeability and inflammation. Conclusions: Data from randomized controlled trials support guideline recommendations for the use of Ruscus extract, hesperidin methyl chalcone and vitamin C to relieve major CVD-related symptoms and edema.
... They constitute the most severe complication of chronic venous insufficiency (CVI). Approximately 2% of the adult population and 5% of senior citizens (over 65 years of age) develop active or healed ulceration [1][2][3][4][5][6]. The main etiological factors of VLUs are chronic venous hypertension and venous stasis, which is why compression therapy remains the mainstay of treatment for the majority of patients. ...
... Approximately 20% of ulcers are reported to remain active for about 2 years and 8-10% remain active for 5 years. Ulcers active for over 10 years have also been reported [3,4,6,8,9]. Chronic ulcers are characterized by permanent inflammation and high activity of proteolytic enzymes [12,13]. ...
... Collagen dressings usually do not produce side effects but their effects are limited to the wound bed. However, patients with VLUs also suffer from accompanying tissue trophic lesions (such as hemosiderosis, lipodermatosclerosis, atrophie blanche) and skin complications [5,6,[29][30][31][32]. Many of them complain of persistent itch, excessive dryness and skin scaling. ...
Introduction:
Venous ulcers are difficult to heal chronic wounds. Most challenging are the non-healing and recurrent ulcers, because of which we are seeking for therapies that stimulate and support their healing.
Aim:
To assess the efficacy of fish collagen and its impact on the process of healing of venous leg ulcers.
Material and methods:
This 12-week randomized single-centre study included a total of 97 adults with venous leg ulcer, randomized into two groups: the study group (n = 48) and the control group (n = 49). All patients received specialist medical care including skin and limb care, wound development according to the TIME scheme (tissue debridement, infection and inflammation control, moisture balance, edge) and short-stretch bandage compression (compression class II). In addition, the study group received tropocollagen gel applied to the skin around the wound. Every 2 weeks we evaluated the wound surface and temperature distribution on the shin (average temperature, median, minimum and maximum) - symmetrically on the sick and healthy limb.
Results:
We observed a greater number of complete ulcer healing in the study group (week 12: 29.2% vs. 22.4%; week 24: 52.1% vs. 36.7%). Faster healing time in the study group was observed in both big and small ulcers. The thermographic analysis showed statistically significant reduction in periwound inflammation among patients from the study group (p < 0.05). Statistically significant reduction in mean as well as maximum values of limb temperature occurred only in the study group (Tx: R = 0.37, p < 0.001; Tmax: R = 0.40, p < 0.001).
Conclusions:
Thermographic analysis showed better wound healing effects in the group using tropocollagen. Significant impact of collagen on the healing process was observed only after 8 weeks of application.
... Venous insufficiency is a common clinical problem, although its prevalence varies among different statistics. When assessed as a fully symptomatic disease, it may affect approximately 60-65% individuals in the adult population [1][2][3]. However, if the early stage is also included, it may affect even 83% of the adult population [4,5]. ...
... Others, among them the inborn abnormalities of the venous system, with May-Thurner syndrome, combined venous malformations (e.g., Klippel-Trenaunay syndrome), or weakness and fragility of the venous wall due to the polymorphism of collagen-encoding genes, remain less recognized [6,[9][10][11]. Besides the aforementioned, presumably the most important factor for the development of venous disease is pregnancy, or more precisely, multiparity [3,[11][12][13]. ...
... Although the role of pregnancy as a risk factor in the development of chronic venous disease has been postulated by many authors [3,11,14], the mechanism that can explain this relationship remains unclear. Since most studies focused on the impairment of the lower limb venous system only, little was known about the pregnancy-induced malfunction of abdominal and pelvic veins [12,16]. ...
BACKGROUND: Although pregnancy has been identified as one of the risk factors for venous disease, the mechanism of this interaction remains unclear. Possibly, pregnancy results in overstrain and vein dilatation, which exceed their durability and persist after pregnancy. The aim of this study was the assessment of the relationship between the number of pregnancies in women with venous disease and the selected parameters of their venous systems.
PATIENTS & METHODS: The retrospective assessment concerned 518 patients subjected to the diagnostics of the venous system in the lower limbs and the abdomen/pelvis using ultrasound scan and magnetic resonance or computed tomography.
RESULTS: We found that the occurrence of pelvic venous symptoms increases proportionally to the number of pregnancies and is correlated with ovarian and parauterine vein dilatation/incompetence (e.g., 13.5%of nulliparous women reported pelvic pain, and reflux in left ovarian veins was detected in 21.4% of the patients from that group, whereas in women after two pregnancies, pain and reflux concerned 22.8% and 90.6% of patients, respectively). In the nulliparous group, the development of venous disease resulted from the presence of anatomic abnormalities in abdominal/pelvic veins.
CONCLUSIONS: Our report proved that the number of pregnancies is correlated with the incidence of pelvic vein insufficiency. Although not specifically addressed in this study, some correlation was found with saphenous disease as well. However, further studies are necessary to provide more evidence about the role of pelvic vein insufficiency in chronic venous disease of the lower limbs.
... Chronic venous disorders (CVD) are the most common diseases of peripheral vessels [1].They include phlebopathy (C0s clinical classaccording to the CEAP classification), telangiectasia, reticular (spider) veins (both of C1 clinical class) and disorders that are characterized by lower extremity varicose veins (VV) with potential edema formation and various trophic skin changes (C2-C6 clinical classes), namely primary VV (Ep etiological class), postthrombotic syndrome (Es etiological class) and angiodysplasia (Ec etiological class).The prevalence of thesediseases amongthe European and American adult population is 16-29% [2,3,4,5,6,7,8,9]. Etiology, diagnosisandtreatment ofCVDin the adult population are currently well covered in literature; however, their coursein children, adolescents and young people is still poorly understood [10]. ...
... The comparison of the results obtained with the results of other studies was rather difficult, since most research studies we have found observed the incidence rate of lower extremity VV in a general aged population. And only a few European studies known to us presented the distribution of the prevalence of lower extremity VV by age groups, which was close to our sample (from 16 to 32 years), including people from 18 to 30 years of age (in Italian research study -from 21 to 30 years of age) [2,3,4,5,6,7,8,9]. In these studies, among individuals of the aforementioned age, lower extremity VV were found in 10-16% of people. ...
... In literature, the frequency of complaints such as leg heaviness and pain, fatigue and swelling, calf cramps were most often studied if they got worse at night [3,6,7,8,9]. We have found no study where the frequency of venous symptoms was studied only in young people with lower extremity VV without studying it in all age categories simultaneously. ...
The Objective of the Research was to increase the frequency of detecting chronic venous disorders in young people by surveing the students using a specially designed questionnaire with an analysis of its results for timely treatment.
Materials and Methods. To detect lower extremity chronic venous disorders, 1,007 students of the Ivano-Frankivsk National Medical University were interviewed using questionnaire that was based on the VEIN-TERM, the Venous Clinical Severity Score, the Chronic Venous Insufficiency Quality of Life Questionnaire. In the surveyed people, there were estimated the following data: age; gender; objective symptoms of chronic venous disorders such as telangiectasia, reticular (spider) veins, varicose veins and leg swelling; 11 most common symptoms of chronic venous disorders; risk factors such as the presence of lower extremity varicose veins in parents, previous childbirth and frequent or rare use of high heels in females.
Results. In 617 (61.3%; 95 CI, 58.2 - 64.3%) respondents, phlebopathy was detected; 63 (6.3%, 95 CI 4.8 - 7.9%) students reported lower extremity telangiectasias; 11 (1.1%; 95 CI 0.5 - 1.9%) students reported reticular veins. Varicose veins were detected in 33 (3.3%; 95 CI 2.3 - 4.6%) cases. Among them, there were 14 (1.4%, 95 CI 0.8 - 2.3%) cases of leg swelling. Only two symptoms, namely calf cramps (p=0.01) and leg pain (p=0.04) turned out to occur significantly more frequent in the respondents with varicose veins. Varicose veins were more often found in the students whose fathers suffered from varicose veins as compared to those whose mothers had varicose veins – 12.1% (95% CI 5.4 - 22.5%) versus 4.2% (95% CI 2.1 - 7.5%), respectively (p=0.008). Among females without lower extremity varicose veins, 34.1% (95% CI 29.7 - 38.3%) of the respondents indicated wearing high heels (above 5 cm) which was approximately 3 times more often as compared to female respondents with varicose veins - 11.2% (95% CI 0.0 - 21.7%) of women (p=0.001).
Conclusions. 1. Leg pain and calf cramps can be considered as the most important subjective symptoms for early diagnosis of lower extremity varicose veins in young people. 2. The presence of lower extremity varicose veins in a father results in higher risk of detecting this pathology in the respondent than the presence of lower extremity varicose veins in a mother: 12.1% (95% CI 5.4-22.5%) versus 4.2% (95% CI 2.1 - 7.5%) (p = 0.008). 3. Early diagnostics of lower extremity varicose veins in young people with the aim of further adequate treatment to prevent their progression and the development of complications can be implemented by questioning students in different educational institutions.
... Przewlekłe owrzodzenia żylne uznawane są za najbardziej zaawansowane stadium przewlekłej niewydolności żylnej [1]. Przewlekła niewydolność żylna jest stanem wywoływanym niewydolnością zastawek żylnych, który prowadzi do zastoju krwi w układzie żylnym. ...
... introduction Chronic venous ulcers are an end stage of chronic venous insufficiency [1]. Chronic venous insufficiency is caused by impaired venous valves that lead to venous stasis. ...
... Because of its high incidence, the disorder is considered a social disease. It is estimated that the incidence among adult Poles ranges from 38.33% in men to 50.99% in women [2,3]. The social cost of chronic venous insufficiency, which includes medical leave, diagnostic tests, hospitalization and surgery, is comparable to the cost of treatment of diseases generally regarded as more serious, for example cardiovascular diseases [4]. ...
... The Polish study conducted by Jawień et al. in 2003 [3] showed that the symptomatic form of the disease was significantly more common in the overweight population compared to asymptomatic patients, and that the majority of the subjects were women. At the same time, these women declared less physical activity compared to asymptomatic patients [3]. Similar results were obtained by Evans et al. in the Edinburgh Vein Study [18]. ...
Chronic venous insufficiency is the most common vascular disease. One of the major risk factors for its development is long-term sitting or standing in the same position and the nature of the work performed. This study aimed to evaluate the incidence of chronic venous insufficiency in a group of persons employed in workplaces with a predominance of standing or sitting positions, and to determine work-related and non-work risk factors. The research used two tools: questionnaires and medical examinations. The survey comprised 500 people, including 238 men (47.6%) and 262 women (52.4%), aged 25–60 years, 39.75 ± 10.80 years old on average. In addition, a group of 100 randomly selected people was subjected to medical examinations to confirm or exclude chronic venous insufficiency symptoms in the study group. The study showed a statistically significant correlation between postures adopted at work and the symptoms of chronic venous insufficiency of the lower limbs.
... Not only is venous compression a common contributor of chronic venous disease, it is also associated with more severe disease, in part due to the raised venous ambulatory pressure [21] . Class C4-6 disease occurred in 35% of patients with venous obstruction [20] , compared to 3%-6% of the general population (i.e., patients with chronic venous disease unselected for a specific pathophysiology) [22,23] . In addition, disease with untreated venous compression is more resistant to conventional treatment such as vein ligation and stripping [5] . ...
... CT venogram of the pelvis is used in the diagnosis of ICS. Patients are given intravenous contrast at a rate of 4 to 5 mL/s followed by 20-50 mL of saline and venous phase imaging is obtained generally after 60-80 s delay [8,22] . Timing of the imaging sequence may require optimization to obtain maximal contrast opacification of the target veins. ...
Iliocaval venous compression syndrome (ICS) is the extrinsic compression of the common iliac vein by the overlying iliac artery against the vertebra. Chronic compression can lead to venous stenosis and stasis, which manifests as chronic venous disease and treatment resistance. Therefore, early recognition of ICS and prompt treatment are essential. Clinical presentations of ICS can be ambiguous and diagnosis requires a high index of suspicion with the relevant imaging studies. The initial imaging test is typically a Duplex ultrasound for vessel assessment and pelvic ultrasound to exclude a compressive mass, which is followed by computed tomography (CT) or magnetic resonance (MR) venography. CT and MRI can identify the anatomical causes for venous compression. In patients with high clinical suspicion for ICS, negative findings on CT and MR venography would still warrant further investigations. Definitive diagnosis can be established using catheter-based venography complemented with intravascular ultrasonography but the nature of their invasiveness limits its utility as a routine imaging modality. In this review paper, we will discuss the evidence, utility and limitations of the existing imaging modalities and endovascular intervention used in the management of ICS.
... Średnia zachorowalność waha się w granicach od 1 do 4 przypadków na 1000 osób. Schorzenie występuje częściej u kobiet niż u mężczyzn w stosunku 3 : 1. Najwięcej pacjentów jest w wieku 60-80 lat [4,5]. Szacuje się, że w Polsce CVI występuje u ponad 600 tys. ...
Chronic venous insufficiency is encountered by specialistsof different fields of medicine. For the treatment to be effec-tive, comprehensive therapy and cooperation of an interdis-ciplinary team – including physicians, nurses and physiother-apists – is required. Rehabilitation, as a method supportingpharmacological and surgical treatment, deals with prophy-laxis in a venous insufficiency risk group use of compressiontherapy and draining methods, complementing the treatmentwith physiotherapeutic procedures, activating the patient,using kinesitherapeutic exercises and educational activities.A combination of rehabilitation methods accelerates the pro-cess of patients’ recovery, positively influences their attitudeto the disease and significantly improves their quality of life.Physiotherapy should be an integral part of the therapeuticprocess in cases of venous ulcers of lower legs; however, itsrole is often underestimated.Aim of the study: Discussion of chosen questions of reha-bilitation of patients with chronic venous ulcers.Material and methods: Review of the Polish and foreignspecialist literature from 2000 to 2014.
Key words: chronic venous insufficiency, ulcer, rehabilitation, compression therapy.
... Epidemiological studies like Basel study, Edinburg vein study and Jaw et al study showed relationship between obesity and varicose vein. [14][15][16] Since obese patients have more severe forms of CVD than non-obese patients, Van Rig et al postulated that obesity increases the severity of the CVD once venous reflux occurs. 17 ...
Background: Chronic venous disease (CVD) is a multifactorial condition affecting among populations worldwide. The symptoms appear early in the progression of the disease and as the time progresses the severity of the disease increases. Thus a proper clinical management tool is essential to prevent potential harms of the disease, which also entails a significant loss of the quality of life in these individuals. The aim of the present study is to make use of the tool phleboscore for the patients with lower limb problems to quantify the risk of developing CVD complications. Methods: A prospective observational study with 2788 patients with lower limb complaints of venous disease was conducted in the out-patient department at A. J. Institute of medical sciences, Mangalore. Patients were asked about the symptoms of the venous diseases like sensation in the limb, any changes in the limb. The patients with two or more symptoms were assessed with phleboscore questions. Based on the phleboscore a descriptive analysis of the collected data was done. Results: With regards to the phleboscore patients were divided into three classes; low risk, moderate risk and high risk. Almost 73.6% patients were at medium risk of developing CVD. 7.6% patients at high risk. 63.5% of patients with sedentary lifestyle were at medium risk. Conclusions: Phleboscore is an essential tool to assess the potential risk of patients developing CVD. This tool helps in early identification of patients who are about to go into high risk group and help them by early interventions to prevent the development of more serious disease.
... wykazały, że przewlekła choroba żylna dotyczy prawie połowy populacji dorosłych mieszkańców kraju [3]. W badaniu przeprowadzonym na populacji ponad 40 tysięcy osób wykazano obecność PChŻ u 50,99% kobiet i 38,335% mężczyzn. ...
Streszczenie: Wstęp Owrzodzenia żylne goleni należą do chorób powszechnych, przewlekłych i powodujących inwalidztwo. Cel Celem niniejszej pracy była ocena wpływu miejscowego stosowania żelu z oktenidyną na proces gojenia przewlekłych owrzodzeń pochodzenia żylnego, w porównaniu z maścią Argosulfan®. Materiał i metody Pacjentów podzielono na 2 grupy – u chorych z grupy I zastosowano antyseptyczny żel z oktenidyną, Octenilin® (Schülke), w grupie II natomiast maść Argosulfan® (Jelfa). Po założeniu odpowiedniego opatrunku u wszystkich pacjentów zastosowano kompresjoterapię. Wszyscy badani przed rozpoczęciem leczenia, a następnie co 7 dni mieli wykonywany planimetryczny pomiar powierzchni owrzodzenia, aż do czasu wygojenia owrzodzenia. Wyniki Owrzodzenia goleni u osób z grupy I zagoiły się w ciągu 8 tygodni leczenia. Natomiast u pacjentów w grupie II owrzodzenia wygoiły się w ciągu 14 tygodni. Wnioski Miejscowe stosowanie żelu z oktenidyną znacznie szybciej wpływa na zmniejszenie powierzchni owrzodzeń żylnych goleni, a tym samym skraca czas leczenia, w porównaniu do maści Argosulfan®.
... 4 A study in Poland in 2003 calculated the incidence of phlebolymphedema as 10%, in 40 095 patients with CVI. 5 Moreover, Dean et al showed that out of 440 patients with lymphedema, 41.8% of cases were caused by phlebolymphedema, followed by cancer in 33.9% and lipedema in 11.8%. 6 The lymphatics play a major role in any kind of edema, 2,7,8 with >300 million people suffering from edema worldwide. ...
Phlebolymphedema is a vascular condition in which there is damage of the venous and lymphatic systems in the lower limbs. It is secondary to chronic venous insufficiency, which results in venous hypertension causing fluid leakage into the interstitial space. Under normal conditions, this fluid would be drawn away by the lymphatic system. However, when the capacity of the lymphatic system is exceeded over time, the lymphatic vessels get damaged and the interstitial protein-rich fluid cannot be drained. Current information on the most effective way to diagnose and treat this pathology is incomplete and inconclusive. Nowadays, the diagnosis is based on clinical examination, duplex ultrasound to assess the venous component of the disease, and lymphoscintigraphy to evaluate the lymphatic damage. The treatment commonly consists of complete decongestive therapy and manual lymph drainage. Despite these being the most used management methods, new modalities of diagnosis and treatment are emerging and will be discussed in this article. The purpose of this review is to increase physician knowledge about the epidemiologic aspects, physiopathology, and management of phlebolymphedema. We intend to raise awareness of this disease, which has been underdiagnosed and poorly treated, and to show the need for new studies that compare treatment and diagnostic methods to establish a consensus about how to approach this disease.
... 3 Another large study conducted in Thailand 4 also reported a female predominance. In the Edinburgh Vein Study 5 and the Polish Sample Study, 6 prevalence of severe CVD was higher in women, as in our study. Women are more likely to participate in epidemiologic studies because of cosmetic concerns regarding varicose veins. ...
Introduction
Chronic venous disease (CVD) is characterized by venous hypertension and stasis, which occur because of valvular incompetence and/or venous outflow obstruction. This study aimed to investigate the relationship between CVD clinical presentation and duplex ultrasonography findings in a Thai patient population.
Method
This cross-sectional study examined patients diagnosed with CVD at the Chulabhorn Hospital Vascular Clinic (Bangkok, Thailand) between December 1, 2018 and October 1, 2021. Patient data was obtained from the medical records and review of lower limb venous ultrasonography studies. Patients were assessed using the Clinical, Etiological, Anatomical, and Pathological (CEAP) classification of venous disorders: mild-to-moderate CVD was defined as C1 to C3 and severe CVD was defined as C4 to C6.
Results
Overall, 260 CVD patients were analyzed (60 men and 200 women). More than 75% of the patients were women and more than 80% had bilateral lower limb involvement. Factors associated with severe CVD were older age, female sex, high body mass index, hypertension, diabetes mellitus, and history of deep venous thrombosis. The most common CEAP classification was C2 (38.8%), followed by C1 (33.85%), C4 (12.2%), C3 (9.23%), C6 (3.46%), and C5 (2.31%). Two-thirds of the patients had great saphenous vein reflux and nearly half had perforator vein reflux. Perforator reflux and small saphenous vein reflux were significantly associated with severe CVD (P < 0.001 and P = 0.028, respectively). Higher number of venous systems involved was significantly associated with severe CVD (P = 0.005). Reflux time of the great saphenous vein correlated with severe CVD and VCSS (P = 0.026 and P = 0.037, respectively). Mean diameters of the superficial vein, perforator vein, and deep vein and reflux times of the perforator and deep veins were not significantly associated with severe CVD.
Conclusion
The major risk factors for severe CVD are older age, female sex, high body mass index, hypertension, diabetes mellitus, and history of deep venous thrombosis. The most common CEAP classification was C2 (39%). Great saphenous vein reflux was the most common type of reflux in our study population. Increasing number of venous systems involved increased the risk of severe CVD. The presence of perforator vein reflux and small saphenous vein reflux also increased the risk of severe CVD. Reflux time of the great saphenous vein correlated with severe CVD and venous clinical severity score.
... Porém, existem controvérsias sobre a relação entre peso corporal e doença varicosa 10,11 , e outros trabalhos citam a obesidade apenas como um fator que aumenta o risco de complicação da doença [12][13][14] . A doença venosa de membros inferiores e a obesidade são cada vez mais comuns. ...
Introdução: A doença varicosa em membros inferiores é uma patologia de alta prevalência na população, e diversos fatores são relacionados com seu aparecimento e evolução. Objetivo: avaliar a associação da alteração na composição corporal a fatores associados à doença crônica vascular (DCV) com varizes de membros inferiores. Métodos: trata-se de estudo transversal, prospectivo, com pacientes submetidos à cirurgia de varizes de membros inferiores em hospital referência, no período de maio a novembro de 2018. Utilizou-se instrumento de pesquisa semiestruturado com questões que abordavam fatores associados a DVC. Para análise dos dados foram utilizados os testes qui-quadrado de Pearson e Teste Exato de Fisher, além do Teste de Concordância de Kendall. Resultados: Foram selecionados 146 indivíduos, dos quais 89% do sexo feminino, e com idade média de 48,89 anos. A grande maioria (76%) apresentava história familiar de doença venosa, não possuía história de úlceras venosas, tromboembolismo venoso individual e familiar ou cirurgias anteriores. Além disso, mais de 50% não realizava atividade física, e 65% encontravam-se em sobrepeso ou obesidade. Quando analisados estatisticamente, os fatores não diferiram entre não-eutróficos e eutróficos. O Teste de Concordância de Kendall mostrou boa correlação entre a ordem de aparecimento dos fatores entre todos os grupos estudados. Conclusões: Os fatores associados mais prevalentes na população estudada foram a presença de história familiar de varizes em membros inferiores, sexo feminino e presença de sobrepeso/obesidade. A presença de alteração do peso corporal não determinou diferenças na ocorrência e aparecimento dos fatores avaliados.
... Special importance may be ascribed to the presence of chronic venous insufficiency, which is one of the most common circulatory system diseases in Western countries occurring in <1-40% in females and <1-17% in males, depending on the geographic location [74]. In Poland, the prevalence of this disease in females may be as high as 84% [75]. In the case described in the present study, the blackfly saliva components with a broad spectrum of activity probably intensified the symptoms of varicose disease. ...
The components of blackfly (Diptera: Simuliidae) saliva secreted during feeding on humans and animals induce various pathological reactions manifested by skin lesions and systemic symptoms. In this study, we describe 43 cases of severe skin lesions induced by blackfly bites and analyze their potential causes. Based on the results of a survey of 418 patients, we identified periods with risk of blackfly attacks and their environmental determinants in the eastern part of the European Union. Especially strong inflammatory reactions after blackfly bites were reported in patients with concomitant cardiovascular diseases (mainly with venous insufficiency), metabolic diseases, and bacterial infections. Enhanced symptoms of simuliosis were also observed in other patients attacked by these insects only once or repeatedly. The greatest number of blackfly attacks in the study area is recorded from May to July, with a peak in June (38.73%) in the afternoon (37.10%) and evening (33.03%), when patients are in fields, forests, or their households. The case analysis indicates interactions of various factors in the development of severe inflammatory reactions in patients bitten by blackflies. Therefore, it is recommended that subjects exposed to the presence of blackflies during their work or rest should limit the length of their stay in a vulnerable environment during the highest seasonal and daily activity of these insects. It is also necessary to take measures to reduce the number of blackflies and popularize methods for prophylaxis of their attacks.
... Depending on the study, varicose veins, which are one of the early symptoms of this disease, affect 2-56% of all men and 1-60% of all women [11]. In a large epidemiological study conducted in 2003 in Poland, signs of CVD were reported in 47% of all women and 37% of all men [12]. In a subsequent study conducted in Poland involving 13.393 participants, initial symptoms of CVD were observed in 56.1% of all subjects [13]. ...
Chronic venous disease (CVD) is a common disease caused by hemodynamic disorders of the venous circulation in the lower extremities. The clinical image of this disease is complex and includes such signs as telangiectases, varicose veins, leg edema and skin changes, usually accompanied with ache, pain, tightness, heaviness, swelling and muscle cramps of legs. Venous ulcers develop in the advanced stages of the disease and lead to significant impairment of patient abilities and reduction of the quality of life. CVD is diagnosed based on physical and image examinations, and main treatment options include compression therapy, invasive treatments like endovenous ablation and foam sclerotherapy, as well as pharmacotherapy. Currently, there is no biochemical and molecular biomarkers utilized in diagnosis or treatment of CVD. With regard to this situation, one of the most investigated fields for identification of disease biomarkers is microRNA (miRNA). These constitute a pool of small, non-coding RNAs that play crucial roles in maintaining cellular homeostasis through posttranscriptional regulation of genes expression. Dysregulations of miRNA expression profiles have been found in patients with various diseases, and this situation provides information about potential miRNA signatures involved in pathophysiology. In this review, the studies focused on investigations of miRNA expression patterns in patients with CVD were collected. The performed literature analysis provides contemporary knowledge in the field of miRNA-dependent mechanisms involved in the etiopathogenesis of CVD and shows gaps that need to be filled in further studies.
... In some studies, the difference in gravity field in studied region was up to +/À 50 mGal. 30,[32][33][34] Thus, potential bias due to the method of estimation of mean gravity anomaly is possible. To reduce the negative influence of this factor, the weight of studies with a low number of participants and of studies with a high number of participants was the same. ...
Aim:
This study examines the influence of Earth's gravity field on the prevalence of varicose veins in geophysical area.
Material and methods:
We performed a systematic review (OVID and Google Scholar) of studies focusing on prevalence of varicose veins to determine the influence of Earth's gravity field-GRACE GGM05S gravity model-on the disease prevalence. PROSPERO: CRD42021279513.
Results:
81 studies met inclusion and quality criteria. Areas with stronger gravity have significantly higher prevalence of varicose veins with adjustment for age, gender and body mass index (BMI) (p-values < 0.02). Adjusted for age, prevalence of varicose veins in areas with gravity field +20 mGal and more is 1.37 time higher than in areas with gravity field less than +20 mGal, p-value 0.005 (95% CI: -12.5 to -2.4): mean disease prevalence for gravity field +20 mGal and more-27.5% (mean age, 40.1 years; mean gravity field, +27.1 mGal; 63.9% females, 37 studies, 123,164 participants) vs mean disease prevalence for gravity field less than +20 mGal - 20.1% (mean age, 42.2 years; mean gravity field, +5.7 mGal; 56.8% females, 44 studies, 205,925 participants). Older age is the main risk factor for varicose veins (p-values < 0.005). Female gender and high BMI are insignificantly associated with high prevalence of varicose veins (p-values > 0.4 for gender, p-values > 0.2 for BMI).
Conclusion:
Stronger gravity field is significantly associated with higher prevalence of varicose veins-risk factor. The potential mechanism of this phenomenon is that high gravity field alters systemic venous return, pooling blood and fluid in the peripheral, gravity-dependent regions of the body in upright humans constantly living in the defined geophysical area.
... 14 Epidemiological studies estimated that, of the general population presenting with symptomatic varicose veins, about 14% had varicose veins alone (i.e., CEAP class C2) and about 17% presented with more advanced clinical stages of venous insufficiency (i.e., CEAP class C3 to C6). 8 A study of primary care patients with symptomatic varicose veins found the distribution of these CEAP classes to be around 21% and 10%, respectively. 15 In an international study of symptomatic varicose vein cases in primary care and specialist practices, about 35% of patients had CEAP 2 varicose veins alone and the remaining 65% had more advanced venous disease (CEAP 3+ i.e., edema, skin changes, healed venous ulcer, or active venous ulcer). 16 The symptoms of varicose veins and venous disease negatively affect a person's quality of life. ...
Background:
Varicose veins are part of the spectrum of chronic venous disease and are a sign of underlying chronic venous insufficiency. Treatments to address varicose veins include surgical vein removal under general anesthesia, or endovenous laser (EVLA) or radiofrequency ablation (RFA) under tumescent anesthesia. Two newer nonthermal endovenous procedures can close veins without any tumescent anesthesia, using either mechanochemical ablation (MOCA, a combination of mechanical and chemical techniques) or cyanoacrylate adhesive closure (CAC). We conducted a health technology assessment of these nonthermal endovenous procedures for people with symptomatic varicose veins, which included an evaluation of effectiveness, safety, cost-effectiveness, the budget impact of publicly funding MOCA and CAC, and patient preferences and values.
Methods:
We performed a systematic literature search of the clinical evidence. We assessed the risk of bias of each included study using the Cochrane Risk of Bias or RoBANS tool, and the quality of the body of evidence according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group criteria. Meta-analysis was conducted using Review Manager 5.2, where appropriate.We performed a systematic economic literature search and conducted a cost-utility analysis with a 5-year time horizon from the perspective of Ontario Ministry of Health. In our primary economic evaluation, we assessed the cost-effectiveness of nonthermal endovenous procedures (CAC and MOCA) compared with surgical vein stripping and thermal endovenous therapies (EVLA and RFA). We also analyzed the budget impact of publicly funding nonthermal and thermal endovenous therapies for adults with symptomatic varicose veins in Ontario over the next 5 years. Costs are expressed in 2020 Canadian dollars.To contextualize the potential value of nonthermal endovenous treatments, we spoke with 13 people with varicose veins who had sought various treatment options. We conducted phone interviews and qualitatively analyzed their responses regarding their care journey and the impact of different treatment options; the only nonthermal treatment that participants had experience with was CAC.
Results:
We included 19 primary studies reported in 25 publications comparing either MOCA or CAC with at least one other invasive treatment for symptomatic varicose veins. No studies compared MOCA with CAC. Based on evidence of low to moderate quality, MOCA resulted in slightly poorer technical outcomes (vein closure and recanalization) than thermal endovenous ablation procedures. However, clinical outcomes, quality of life improvement, and patient satisfaction were similar compared with RFA (GRADE: Very low to Moderate) and EVLA (GRADE: High). Cyanoacrylate adhesive closure resulted in little to no difference in technical outcomes, clinical outcomes, and quality of life improvement compared with RFA and EVLA (GRADE: Moderate). Patient satisfaction may also be similar (GRADE: Low). Recovery time was slightly reduced with nonthermal endovenous procedures compared with thermal ablation (GRADE: Moderate). The effect of CAC compared with surgical vein stripping is very uncertain (GRADE: Very low). Major complications of any procedure were rare, with minor complications occurring as expected and resolving.We included two European studies in the economic evidence review that were partially applicable to the Ontario context. Both studies found that thermal ablation procedures (RFA, EVLA, or steam vein sclerosis) were the most cost-effective treatments, compared with surgical vein stripping and nonthermal therapies. Our cost-utility analysis showed that surgical vein stripping is the least effective and most costly treatment among five treatments for varicose veins. Differences in quality-adjusted life-years (QALYs) between endovenous treatments (CAC, MOCA, RFA, and EVLA) were small. When the willingness-to-pay (WTP) value was 100,000 per QALY gained, the probabilities of being cost-effective were 40.2%, 30.0%, 17.7%, 12.1%, and 0%, for EVLA, CAC, RFA, MOCA, and surgical vein stripping, respectively. Publicly funding endovenous procedures (both nonthermal and thermal) would increase the total volume of treatments, resulting in a total 5-year budget impact of around 100,000 per QALY), EVLA is most likely to be cost-effective. Assuming an 80% increase in the number of eligible people over the next 5 years, we estimate that publicly funding nonthermal and thermal endovenous treatments for varicose veins in Ontario would range from 4.35 million in year 5, and that the total 5-year budget impact would be around $17 million.For people with varicose veins, the CAC procedure was seen as a positive treatment method that reduced their symptoms and improved their quality of life.
... Aetiology of the disease is multifactorial and results from complex interactions of genetic and environmental factors. Risk factors include age, gender, obesity, family history and ethnicity [10][11][12]. Older people are affected more often, with a higher prevalence among females [13]. ...
Introduction:
Chronic venous disorder (CVD) is thoroughly spread across the globe. It affects about 40% of the Polish population. European guidelines underline that there are no data on the percentage of people who have first symptoms of chronic venous insufficiency.
Aim:
To determine the frequency and pattern of first symptoms and examine public knowledge on CVD in a selected group of patients.
Material and methods:
Our study group consists of 175 patients who took part in preventive assessment of nevi. To determine public knowledge on CVD, we constructed a questionnaire, which consisted of two sections: one part to be completed by the patient and the other by the doctor.
Results:
The median age was 41 years. From 175 patients, about 40% claimed that they do not recognize CVD. Only about half of them knew how to diagnose and treat it. Most of them associate telangiectasia and varicose veins as primary signs and symptoms of CVD.
Conclusions:
Despite the fact that the disease itself is common, the level of public awareness is astonishingly low. Majority of patients tested could not associate first signs and symptoms, even though most of them had primary symptoms of the disease. In order to avoid high-cost treatment of ulcers and varicose veins, we should spread the knowledge on CVD.
... Najczęstszą przyczynę tworzenia się ran przewlekłych stanowi dysfunkcja naczyń żylnych kończyn dolnych, przez co przekłada się ona bezpośrednio na przewagę lokalizacji zmian troficznych w obrębie goleni. Największe jak do tej pory badanie epidemiologiczne populacji polskiej, dotyczące niewydolności żylnej, zostało przeprowadzone w grupie 40 095 pacjentów [6]. Wskazano w nim, że prawie połowa badanych (49%; 38% mężczyzn vs. 51% kobiet) zmagała się z przewlekłą postacią choroby. ...
Owrzodzenia stóp są częstym powikłaniem w większości źle kontrolowanej cukrzycy i słabego krążenia, powstają w wyniku rozpadu tkanki skórnej i odsłonięcia warstw pod nią. Ze względu na częstość występowania, trudności w leczeniu oraz przewlekły charakter, zmiany troficzne pozostają istotnym problemem społecznym, epidemiologicznym i klinicznym. Bez szybkiej i właściwej terapii owrzodzenie stopy może wymagać leczenia szpitalnego i skutkować dalszymi poważnymi powikłaniami, takimi jak: głęboka infekcja, zgorzel i amputacja. Celem pracy była ocena i przedstawienie sytuacji polskiej populacji pod kątem epidemiologii owrzodzeń stóp, leczenia operacyjnego i finansowania w latach 2011–2015. Materiał i metody W pracy zaprezentowano przekrojową analizę populacji polskiej, dotyczącą leczenia chirurgicznego owrzodzeń stóp. W celu oceny rozpowszechnienia i pośrednich kosztów opieki zdrowotnej związanych z tym schorzeniem przeanalizowano dane zgromadzone przez Narodowy Fundusz Zdrowia w latach 2011–2015. Wyniki W 2015 roku w Polsce leczono 176 860 pacjentów z powodu owrzodzeń stóp. Całkowity koszt opieki medycznej w tej grupie oszacowano na blisko 85 milionów zł. Ponad 95% (168 162) osób leczono w ambulatoryjnej opiece specjalistycznej, a tylko 4,5% (8040) było hospitalizowanych. Jednocześnie łączne wydatki związane z pobytem w szpitalu prawie potroiły koszty opieki ambulatoryjnej (62 534 550,48 vs. 21 864 721,1 zł). Oddziały chirurgii ogólnej nadal stanowią większość (93,17%) wszystkich oddziałów specjalistycznych w trakcie hospitalizacji. Cukrzyca insulinozależna i miażdżyca są najczęstszą przyczyną przyjęcia do szpitala (kolejno 21,17% i 17,75%). Można zaobserwować znaczny wzrost liczby hospitalizacji. W 2015 roku, w porównaniu do 2011 roku, odnotowano wzrost o około 35% (8828 vs. 6570 pacjentów), przy jednoczesnym wzroście kosztów całkowitych z 48 milionów do 62,5 miliona zł. Wydaje się, że zmiany troficzne częściej występują u mężczyzn niż u kobiet (64,15% vs. 35,85%) oraz u pacjentów w wieku powyżej 60 lat (62,05% leczonych). Wnioski Liczba chorych z owrzodzeniami stóp w polskim społeczeństwie stale rośnie. Zdecydowana większość hospitalizowanych pacjentów wymaga interwencji chirurgicznej, co znacznie obciąża budżet systemu opieki zdrowotnej i stwarza liczne zagrożenia. Można zaobserwować wyraźną nierównowagę pomiędzy środkami przeznaczonymi na hospitalizację a ambulatoryjną opiekę specjalistyczną. Biorąc pod uwagę skalę emisji, należy przewartościować dotychczasowe strategie leczenia i finansowania.
... The role of dietary supplementation in venous ulcer healing is less well documented. Active leg ulcers affect up to 0.6% of the general population [21,22], and 70-80% of cases are of venous aetiology [21,23]. Venous leg ulcers (VLU) develop because of chronic venous insufficiency. ...
Introduction:
Malnutrition is known to impair the wound healing process, contributing to wound chronicity. Venous leg ulcers (VLU) represent the most common chronic leg wounds and become epidemiologically relevant in an ageing society.
Aim:
This study investigated the effects of a complex treatment, including a specialized oral nutritional supplementation, on the dynamics of the VLU healing.
Material and methods:
This 12-week prospective study included 35 individuals with VLU. The patients received professional wound care including specialized dressings. To ensure an optimal nutritional status for wound healing, the patients were asked to drink three times per day 200 ml of an energy-dense protein-rich formula containing arginine, zinc, and vitamins. The healing dynamics were assessed by planimetry.
Results:
Complete wound healing was achieved in 6 patients, and the median ulcer area decreased from 26.5 cm2 to 14.8 cm2 (p = 0.0001). Both the highest healing rates and most marked increase in prealbumin levels were observed in the first 6-8 weeks. The progress in wound healing was associated with a decreased pain intensity and an improved quality of life. Supplementation was well accepted by the patients.
Conclusions:
This study shows that a complex intervention involving nutritional support contributes to a significant progress in VLU healing and promotes the well-being of affected individuals.
... The result of study published by Evans (1999) in which on the contrary, a higher occurrence was found in men (Evans et al., 1999). A Polish study showed that advanced form of venous pathology was more prevalent in male as compared to female (Jawien et al., 2003). This finding is comparable to our study. ...
... The data originated from 2136 records, corresponding to consecutive patients, that were subjected to routine diagnostics and treatment procedures, according to our standard protocol. To improve the homogeneity of data, we aimed to exclude the role of sex-related differences [6]; therefore, the assessment was limited to the data of women only. The concept of the study was formally approved by the Local Ethics Committee at the Medical University of Warsaw (decision no. ...
Introduction:
The current treatment of venous disease is focused on reflux elimination in main venous trunks, especially in the saphenous vein. However, a high recurrence rate, independent of the method of treatment, suggests that the reason of low effectiveness may be due to a strategy focused on symptoms, without considering their origin.
Method:
The aim of study was the comparison of retrospective data from 535 women with venous disease, either after treatment (n = 183) or not treated before (n = 352). The analysis concerned clinical symptoms and the results of the extended diagnostics, including the examination of the lower limb, pelvic and abdominal veins either using duplex-doppler ultrasound as well as venography with computed tomography or magnetic resonance.
Results:
The comparison of selected venous system parameters revealed more advanced disease progression in previously treated patients, compared to non-treated individuals (e.g., ipsi- or bilateral incompetence of sapheno-phemoral junction-29.5% vs. 20.4%, at P < 0.05 and 13.6% vs. 7.7% at P < 0.05, respectively). This difference could be explained by post-treatment alterations in the venous system, an older age and the higher number of pregnancies in the recurrence group. However, both groups did not differ in regards to the symptoms of pelvic venous insufficiency or the frequency of relevant variants/abnormalities in venous system.
Conclusions:
Based on the aforementioned findings, we postulate the revision of treatment strategy, which should consider abdominal and pelvic veins as the source of reflux in many female subjects.
... The incidence of CVI increases with increasing age, occurring in 1-5% of the adult population. 2 Increasingly, a centrally located iliofemoral lesion causing venous outflow obstruction (VOO) is being recognized as a major cause of CVI. The most commonly described primary non-thrombotic iliac vein lesion (NIVL) is May-Thurner syndrome (MTS), traditionally described as compression of the left common iliac vein by the right common iliac artery against a vertebral body. ...
Objective
Current literature regarding iliofemoral intervention and stenting is mostly based on Western populations. We present our experience of iliofemoral stenting for chronic venous disease within a South‐East Asian population.
Methods
This is a single‐centre retrospective review of a prospectively collected registry. Seventy‐one patients with 105 limbs underwent iliac vein IVUS and stenting between 2016 and 2019. All patients underwent pre‐procedure ultrasound venous scan and MRI venogram. Pre‐ and post‐operative CEAP classification, Villalta score and Venous Clinical Severity Score (VCSS), technical results, stent patency rates and complication rates are documented.
Results
Seventy‐six per cent of the cases are non‐thrombotic iliac vein lesion, and 68% of patients have C4 to C6 disease. Ten percentage of patients had acute thrombosis on presentation. There was 100% technical success. A 6‐ and 7‐point reduction in the mean VCSS and Villalta score, respectively, were noted post‐stenting (baseline of 10 points and P < 0.001 in both categories). Post‐stenting ulcer healing rate was 91% at 6 and 12 months. One‐year ulcer recurrence and cellulites recurrence were at 8% and 7%, respectively. One unplanned 30‐day readmission (not related to procedure) and no 30‐day mortality were noted. Bleeding complication from anticoagulation was 3%. There was 10% in‐stent non‐flow limiting stenosis on surveillance. One‐year primary patency was 91%, and secondary patency was 100%.
Conclusion
Within our series, iliofemoral stenting has 100% technical success, with statistically significant reduction in VCSS and Villalta score, good wound healing rates, low ulcer and cellulites recurrence and good primary and secondary patency rates at 1 year.
... Эпидемиологические исследования показывают, что доля пациентов с C0S среди пациентов с ХВН может достигать достаточно значительного количества. В исследовании San Diego Vein Study [22], 15% пациентов с С0 имели жалобы на симптомы ХВН, 13-23% в исследовании в Польше [23] и 20% в Vein Consult Program [24]. Несмотря на то, что распространенность заболевания в целом достаточно изучена, его анатомические и патофизиологические причины остаются неясными. ...
The high prevalence of varicose veins has been established in numerous population studies. Currently, guidelines have been developed for the treatment of patients with varicose veins for various stages of chronic venous insufficiency. Nevertheless, despite the use of modern drugs, leg compression, surgical and other interventions, it is not possible to completely reverse the symptoms of venous insufficiency. The article is devoted to the analysis of micronized flavonoid purified fraction. The development of modern drugs for chronic venous diseases is an important direction in medicine. The creation of a drug pool manufactured InRussiais a priority in the development of the country’s pharmaceutical industry. The review presents data on the study of Detravenol (Russia), which is a combination of diosmin and hesperidin (micronized purified flavonoid fraction).
... These limitations are likely the cause of the high variability of lower limb oedema frequencies evaluated in epidemiological studies on superficial venous disorders. [7][8][9][10] Moreover, since lower limb oedema increases during the course of a day and/or following long standing or sitting, it has been suggested, in order to homogenize the study populations, that the examination of patients occurs within a few hours after night rest. 11,12 Attempts to find an objective and reliable while noninvasive and sensitive tool to diagnose oedema have more recently been oriented toward the use of duplex ultrasound testing (DUS). ...
Objectives
The aim of this study was to assess inter‑ and intra‑observer agreement of detection and grading of oedema measured by vascular physicians using ultrasonography.
Method
In this observational study, three investigators read 113 videos of ultrasonography of the medial lower leg of 77 patients using a 15–18 MHz linear probe and reported whether oedema was present or not and, if present, to what extent. The videos were selected by the coordinator and sent every two months for a period of six months to the three investigators. Intra‑ and interobserver agreements were calculated using the Fleiss Kappa coefficient, reported with their 95% confidence interval and interpreted using the Landis and Koch values.
Results
Inter-observer agreement as to whether oedema was present or not was 0.88 (0.77–0.98), 0.96 (0.89–1.0) and 0.91 (0.80–1.0) for the first, second and third readings, respectively. The concordance was considered to be “excellent.” Inter-observer agreement as to the severity of oedema was 0.52 (0.38–0.65), 0.53 (0.39–0.66) and 0.61 (0.47–0.75) for the first, second and third readings, respectively. The concordance was “moderate”. Intra-observer reliability for the diagnosis of oedema was only 0.89 (0.70–1.0), 0.93 (0.75–1.0) and 0.92 (0.74–1.0) for the first, second and third reader, respectively, which was “excellent”.
Conclusions
The inter-observer agreement interpreting ultrasound videos using standard probes was excellent. Only moderate agreement in grading the severity of the edema using our arbitrary criteria was shown.
... [1][2][3] In the European population, ulcers affect 0.18 to 2% of society, but the average occurrence increases with age, up to 5% at the age of 65 years. 3,4 In the pathogenesis of VLUs, a key event is a self-accelerating inflammatory reaction triggered by hemodynamic abnormalities, including venous hypertension, venous stasis, and microcirculatory disturbances. 5 The reasons for ulcer occurrence are complex, and their multifactorial etiology makes successful treatment a difficult, long, and unpredictable process. ...
Venous leg ulcers are complex, and their multifactorial etiology make successful treatment a difficult and long process. Nonhealing ulcers are the greatest challenge because they are resistant to standard therapies. In this study, we analyzed whether monitoring the temperature of the ulcered limb wound area could benefit the diagnosis of the wound's tendency to heal (estimating the presence of a healing or nonhealing wound) in patients with two‐sided venous leg ulcers. This prospective, 12‐week observational study included 57 adult individuals with chronic venous leg ulcers. The dynamics of wound healing was assessed by planimetry and infrared thermography every two weeks. We analyzed temperatures measured at three marked areas—the wound, the periwound skin and the reference area. An initial wound area larger than 1 cm2 was associated with a temperature increase of 0.027°C in the periwound skin. A 1‐cm2 decrease in the wound area was associated with a 0.04°C decrease in the temperature difference between the periwound skin and wound. A strong positive relationship was identified for both the bacteriology variables (the presence of bacteria: temperature increase in the periwound skin of 0.4°C, p < 0.001; the number of bacterial species in a wound, temperature increase of 0.95°C, p < 0.001). The temperature in the reference area was significantly correlated with the failure of the superficial and perforating veins (temperature increase of 0.69°C, p = 0.04). This study reports that the assessment of the temperature a limb may be beneficial in predicting whether an ulcer is a healing or a nonhealing ulcer. The decrease in the temperature differences between the areas referred to as healing wounds was the only beneficial prognostic marker. Other temperature differences in the periwound skin were caused by disorders, such as multibacterial wound infections and superficial venous inflammation. This article is protected by copyright. All rights reserved.
... Самой распространенной и широко используемой в клинической практике для лечения ХЗВ является группа флеботропных препаратов, которые в литературе получили название флеботоники и флебопротекторы, что только отчасти отражает их механизм действия. Применение этих средств обосновано многочисленными клиническими исследованиями, и их использование рекомендовано во всех национальных клинических руководствах, в том числе и в российском национальном согласительном документе по лечению и профилактике ХЗВ: назначение флеботропных препаратов предлагается в качестве первоочередных действий [8][9][10][11][12][13][14][15][16][17]. ...
The article discusses up-to-date concepts of the prevalence, pathogenesis and clinical manifestations of chronic venous diseases and chronic venous insufficiency of the lower extremities. It discusses the current views on the mechanism of action of various phlebotrophic drugs used in the symptomatic treatment of chronic venous diseases of the lower extremities and chronic venous insufficiency, updates data on the advantages of micronized purified flavonoid fraction for the treatment of all clinical classes of chronic venous diseases.
... CVI is characterized by venous pathology and objective signs like edema, skin changes or venous leg ulcers (Rabe et al. 2003;Evans et al. 1999;Bergan et al. 2006;Eberhardt and Raffetto 2014). Risk factors for varicose veins and CVI include genetic factors, age, female sex, obesity, pregnancy, prolonged standing, and greater body height (Evans et al. 1999;Rabe et al. 2003;Jawien et al. 2003;Lacroix et al. 2003;Fowkes et al. 2001). Subjective symptoms traditionally ascribed to CVD include pain, discomfort, heaviness and a feeling of swelling, cramps, itching, tingling and restless legs (Bergan et al. 2006;Eberhardt and Raffetto 2014). ...
... En relación con los mestizos de la región (37,4 %, anatómicas y 46,1 %, clínicas; datos no publicados [13]), las telangiectasias tuvieron menos prevalencia entre los embera-chamí de Karmata Rua del presente estudio (21,7 % anatómicas y 23,6 % clínicas) La prevalencia de venas varicosas también fue menor que entre caucásicos, según los datos disponibles de poblaciones urbanas de Escocia [22], Polonia [23], Francia [4] y según los resultados de un estudio precedente de colombianos hospitalizados [14]. En segmentos superficiales (34,8 %) y venas profundas (1,8 %) entre embera-chamí asimismo hay menor prevalencia respecto a los mestizos de la misma región (44,2 y 4,1 % respectivamente) [13]. ...
Objetivo:
Analizar la prevalencia de los desórdenes venosos crónicos (dvc) en los embera-chamí de Cristianía (Karmata Rua), en el suroeste de Antioquia, y conocer sus posibles factores asociados (fa).
Metodología:
Estudio de corte de una muestra aleatoria de 488 sujetos. El diagnóstico se realizó mediante ecoduplex venoso. Se recolectó información sobre fa sociodemográficos, comportamentales y antropométricos. Los fa más relevantes se seleccionaron por regresión logística binaria múltiple.
Resultados:
La prevalencia de várices fue del 27,5 % y la de insuficiencia venosa crónica (ivc) del 0,8 %. Hubo compromiso de segmentos anatómicos superficiales en el 34,8 % de los individuos. La edad fue el fa más importante, con Odds Ratio (or) entre 3,33 y 6,30 según el tipo de dvc (excepto C1). El sexo femenino, la paridad, la grasa en el muslo y pierna y la talla alta se asociaron a telangiectasias. La edad, la grasa abdominal y la forma de la pierna fueron fa de várices. A las venas superficiales, en ambos sexos, se asociaron la edad y la grasa abdominal y, en mujeres, también los antecedentes familiares de várices. A las profundas y perforantes se asociaron la edad y la depleción de grasa periférica.
Conclusiones:
El patrón de baja prevalencia de los dvc en embera-chamí puede ser consecuencia de los estilos de vida relacionados con la actividad física diaria y las diferencias genéticas compartidas con amerindios. En los programas de atención en salud diferencial deberían considerarse los desórdenes profundos y perforantes respecto a mestizos.
... L'oedème des membres inférieurs est une des complications de l'insuffisance veineuse chronique (IVC) dont la fréquence varie de 2,2 % à 13,4 % dans les études épidémiologiques utilisant la classification CEAP [1][2][3][4]. L'oedème chronique est une situation préoccupante car altérant, sur le long terme, la trophicité cutanée principalement distale et l'aptitude fonctionnelle particulièrement de l'articulation de la cheville [5]. Il est la conséquence, dans l'IVC, d'un excès de filtration capillaire du fait de l'hyperpression veineuse associée ou non à une réduction ou une saturation de la capacité Tirés à part : D. Rastel de drainage lymphatique [6]. ...
Oedema as a complication of venous disorders can lead, over a long period of evolution, to trophic changes and a loss of distal leg mobility if untreated . Compression therapy is the key treatment of lower limb oedema. Despite poor clinical data, it is recommended to use bandages at the initial phase, over a short period of time, in case of severe oedema.
Compression stockings are used during the maintenance phase. Nonetheless, this strategy must be adapted patient to patient in order for the patient to adopt compression for life.
Superimposed stockings, air pressotherapy and auto adjustable compression devices are ways to increase patient adherence. Compression must be associated with postural drainage, physiotherpy and needs to be strictly clinically followed since mainly bandages can be poorly tolerated, providing side-effects.
Improving the results of treatment for patients with varicose veins in the lower extremities, complicated by trophic ulcers, is an urgent task for modern medicine. A long-term, recurrent course of the disease leads to a reduction in working capacity and deterioration in quality of life, as well as permanent disability for patients, whose treatment causes special economic problems. At present, there are virtually no effective methods for conservative therapy, leading to prolonged unsuccessful treatment of such patients. This article presents the clinical case of a 63-year-old patient undergoing complex treatment for chronic lower limb venous insufficiency of class C6 according to the CEAP classification. Conclusion . An effective complex method for treating trophic ulcers in patients with chronic venous disease involves the correction of venous hemodynamic disorders (in this case, through radiofrequency ablation), as well as primary surgical treatment for the ulcerative defect, and simultaneous autodermaplasty with a perforated skin flap.
Background: The aim of this publication is to demonstrate similarities and differences in the association of risk factors with the prevalence of different manifestations of Chronic Venous Disease (CVD), like varicose veins (VV), venous oedema (C3) and severe Chronic Venous Insufficiency (CVI) in the population-based cross-sectional Bonn Vein Study 1 (BVS). Methods: In the BVS 1 between 13.11.2000 and 15.3.2002, 3.072 participants, 1350 men and 1722 women, from a simple random sample of the general population of the city of Bonn and two rural townships aged 18–79 years were included. The overall response proportion was 59%. All participants answered a standardized questionnaire including information about socio-economic data, lifestyle, physical activity, medical history, and quality of life. Venous investigations were performed clinically and by a standardized duplex examination by trained investigators. The CEAP classification in the version of 1996 was used to classify the findings. Logistic regression models were performed for the association of possible risk factors with VV, venous edema (C3) and severe CVI (C4–C6). The predictive risk (PR) describes the association of the diseases and the possible influencing factors. Results: VV, venous oedema (C3) and severe CVI (C4–C6) have common risk factors like higher age, number of pregnancies, family history of VV and overweight or obesity. Female gender is significantly associated with VV and C3 but not with severe CVI (C4–C6). High blood pressure and urban living are only associated with C3 and C4–C6 disease whereas prolonged sitting is associated with C3 and lower social class with C4–C6 exclusively. Discussion: In many epidemiological studies risk factors were associated with chronic venous disorders in general. Our data show that VV, venous edema and severe CVI may have different risk profiles. Venous edema is more often associated with arterial hypertension and sedentary lifestyle whereas lower social class seems to be a risk factor for severe CVI including venous ulcers. Summary: The differences in the association of risk factors to VV, venous edema and severe CVI should be considered if prevention and treatment of chronic venous diseases are planned. As examples, compression stockings could be proposed in sitting profession to prevent oedema, VV patients with risk factors like obesity might benefit from early treatment for VV and obesity. More longitudinal evaluation of risk factors is necessary to evaluate the true risk profile of CVD.
Introduction
Chronic venous disease is a global public health problem, with high morbidity and economic distress. There is scarcity of data on this disease in sub-Saharan Africa.
Methods
We conducted the first population-based study over a period of 20 months from 1st February 2020 to 30th September 2021 in the 10 regions of Cameroon. A stratify sampling method was chose to select study site. Socio-demographic data, personal and family history, anthropometric parameters, clinical signs, illustrative images, CEAP (Clinical-Etiological-Anatomical-Pathophysiological) classification revised in 2004, VCSS (venous Clinical Severity Score) and risk factor assessment score were used to construct the survey form. Chi-squared test and Fischer exact test were used to compare the prevalence of chronic venous disease across different potential risk factors (sex, age category, previous history of deep vein thrombosis, hypertension, diabetes, smoking status, obesity). Simple and multiple logistic regression models were used to obtain crude and adjusted odds ratio for risk factors associated with chronic venous insufficiency. Statistical analyses were done with R version 4.2 for Linux and the threshold for statistical significance was 0.05.
Results
A total of 6578 participants were included in the study, with a mean age of 41.09 ± 16.02 years with female predominance (54.3%). The prevalence of chronic venous disease was 21.8% (95% CI: 20.8–22.9) and the prevalence of chronic venous insufficiency (C3–C6) was 7.02% ( n = 462). Night cramps (43.2%), oedema (21.7%), lower limbs pain (20.4%) mostly worsens by walking and heavy legs (16.2%) were more common symptoms. The mean total venous clinical severity score was 0.69 ± 1.76 and this score had a significant positive correlation with C classification ( p < .001). In the multivariate analysis, the following factors were independently associated with CVD: Male gender (aOR: 1.27; 95%CI: 1.04–1.56; p = .021), retired people (aOR: 46.9; 95% CI: 12.6–174.5; p < .001), hypertension (aOR: 289.5; 95%CI: 169.69–493.1; p < .001), diabetes (aOR: 2.19; 95% CI: 1.21–3.96; p = .009), obesity (aOR: 10.22; 95%CI: 7.67–13.62; p < .001). Smoking appears as a protective factor (aOR: 0.18; 95%CI: 0.10–0.30; p < .001).
Conclusion
Chronic venous disease is frequent in Cameroon and main traditional cardiovascular risk factors are associated to this condition. Systematic screening of the CVD in these specific groups could reduce the burden of the disease and its economic impact.
Healing of skin wounds of the lower extremities can be complicated by concomitant vascular disease. Dysfunction of the arterial, venous, and/or lymphatic systems can compromise the healing of skin ulcers of the legs, creating a burden for patients from painful, draining wounds and placing patients at risk for infection, amputation, and even death. Insights into vascular pathophysiology and an understanding of the processes of wound healing permit an evidence-based approach to patients with vascular leg ulcers. Clinical trials have demonstrated opportunities to improve the care of patients with vascular leg ulcers, thereby reducing morbidity and mortality and easing patients' burdens.
This expert masterclass, supported by an independent grant from OM/Vifor Pharma, brought together physicians specialising in vascular surgery, gynaecology, and dermatology from Pakistan, Egypt, Turkey, Lebanon, and Germany to discuss the current management of chronic venous disease (CVD) and haemorrhoidal disease. The meeting included plenary lectures and interactive case study discussions, allowing delegates and presenters to take part in high-level discussions of pressing issues in the field.
Este seminario especializado financiado mediante una contribución independiente realizada por OM/Vifor Pharma reunió a facultativos especializados en cirugía vascular, ginecología y dermatología de Pakistán, Egipto, Turquía, Líbano y Alemania para debatir acerca del manejo actual de la enfermedad venosa crónica (EVC) y la enfermedad hemorroidal. El seminario estuvo compuesto de presentaciones plenarias y debates interactivos sobre estudios de casos, permitiéndose a delegados y oradores participar en discusiones de mayor nivel sobre cuestiones candentes en este campo.
Chronische venöse Erkrankungen wie Krampfadern und die CVI gehören zu den häufigsten Krankheitsbildern in den westlichen Industrieländern. Venöse Symptome wie Schweregefühl der Beine, Schwellungsneigung und Schmerzen während des Stehens sind häufige Beschwerden in der Allgemeinbevölkerung. Die Häufigkeit von ernsteren chronischen venösen Zeichen wie Ekzem, Pigmentation oder Dermatoliposklerose und venöse Ulzerationen liegt bei ca. 5 % bei Männern und Frauen. Krampfadern zeigen ca. 20 % der Allgemeinbevölkerung. Bestätigte Risikofaktoren für Krampfadern sind höheres Lebensalter, eine positive Familienanamnese, weibliche Geschlecht und Schwangerschaften. Bei der CVI spielt das höhere Gewicht eine wichtige zusätzliche Rolle.
Scop. VARICES este un studiu descriptiv transversal efectuat în scopul de a colecta date epidemiologice privind factorii de risc agravanţi şi semnele/simptomele de afectare venoasă la pacienţi aflaţi în stadiile clinice C3-C4 de insuficienţă venoasă cronică (IVC) şi de a radiografia managementul acestor pacienţi în practica specialiştilor de medicină internă din România. Metodă. Screening-ul stadiilor clinice C3-C4 de IVC a fost efectuat prin înrolarea în studiu a pacienţilor consecutivi activi (cu vârsta între 18-65 de ani), care prezentau semne/simptome de IVC stadiile clinice C3-C4 conform clasificării CEAP. Obiectivul principal a fost de a evalua pacienţii din punct de vedere al frecvenţei factorilor de risc agravanţi asociaţi (ortostatism/şezut prelungit, obezitate, istoric familial, fumat, lipsa compresiei elastice, antecedente de tromboză venoasă profundă sau superficială, reflux venos, constipaţie, multiparitate, contracepţie). Obiectivul secundar a fost de a analiza frecvenţa semnelor şi simptomelor de insuficienţă venoasă. Rezultate. Studiul a colectat date de la 151 de pacienţi, în perioada octombrie-noiembrie 2015, prin implicarea a 15 medici specialişti de medicină internă din 10 oraşe mari din România. Stadiile clinice C3-C4 de IVC au fost mai frecvente la femei (68,9%) decât la bărbaţi (31,1%), iar vârsta medie a populaţiei de studiu a fost de 54,85 + 7,95 ani. Factorii de risc agravanţi ai bolii s-au raportat cu următoarea frecvenţă: istoricul familial 74,2%; lipsa aplicării compresiei elastice 68,2%; ortostatismul prelungit 58%; poziţia şezândă prelungită 42%; obezitatea 36,4%; constipaţia 30,5%; fumatul 23,2%. Semnele bolii s-au raportat cu următoarea frecvenţă: venele varicoase 88,7%; edemul 84,7%; telangiectaziile 64,7%; hiperpigmentarea/eczema 42%; lipodermatoscleroza/atrofia albă 4%. Simptomele bolii au apărut cu frecvenţa: senzaţia de picioare grele 88,7%, senzaţia de picioare umflate 80,1%; senzaţia de picioare obosite 76,2%; durere 70,9%; crampe musculare 41,1%; senzaţia de arsuri la picioare 37,1%; furnicături/înţepături 29,1%; senzaţia de picioare neliniştite 23,2%; prurit 20,5%. Concluzie. Studiul VARICES subliniază importanţa screening-ului stadiilor clinice C3-C4 de IVC la pacienţii activi în practica specialiştilor de medicină internă. Se impune continuarea acestui studiu epidemiologic şi extinderea semnificaţiei investigaţiei, cu posibilitatea aplicării tratamentului recomandat pentru această afecţiune de către ghidurile terapeutice actuale, în vederea creşterii aderenţei şi a eficacităţii terapeutice.
Objectives The diagnosis of deep venous thrombosis (DVT) is hampered in patients with primary varicose veins due to similarity of symptoms of DVT and PVV and elevated levels of D-dimers. The purpose of this study was to analyze factors that influence the D-dimer concentration in patients with PVV in order to redefine its diagnostic value. Methods Forty- one patients with non-complicated PVV were enrolled in the study, in whom D-dimer level was determined by immunoturbidimetric assay. The influence of selected clinical factors on the concentration of D-dimers was determined with univariate and bivariate analysis. Besides descriptive statistics the D-dimers levels were compared to the age -adjusted cutoff values. Results The median concentration of D-dimer was 630.0 ng/ml (440.0-1140.0 ng/ml) and was above the age-adjusted level in 21 (52%) of patients. There was a positive correlation between the patient’s age and and D-dimer concentration (p = 0.035, Spearman correlation coefficient rs=0,33. The bivariate analysis showed a significant interaction between age and weight p=0,02. Conclusions In patients with PVV the diagnostic value of D-dimers is limited especially in older and overweight subjects.
Objective
The development of a venous leg ulcer (VLU) represents the most severe clinical manifestation of a chronic venous disease. Despite major progress, there is a limited understanding of VLU pathogenesis and wound healing biology. Treatment of VLUs remains a serious challenge for physicians of different specialties. This communication focuses on describing the rationale and scientific basis for topical wound care in the management of VLUs.
Methods
A literature review was performed to summarize methods with proven efficacy in VLU management. A systematic literature search was also performed to identify new evidence from the randomized controlled trials published within 2014-2021. The scientific challenges, clinical practice concerns, economic obstacles, and possible directions for further research have been discussed.
Results
Hundreds of topical products have been advertised for the treatment of VLUs. Published data on topical treatment of venous ulcers is insufficient, scattered, weak, and has significant methodological flaws. Forty-three randomized controlled trials on topical treatment of VLUs have been published within 2014-2021. Clinical practice guidelines need to be updated. Major gaps in knowledge have been identified, and suggestions for future research directions have been provided.
Conclusions
The American Venous Forum Research Committee would like to bring attention to topical wound care for VLUs as a critical gap in knowledge, and encourage scientists, practitioners, and industry to collaborate to fill this gap.
Chronic venous disease, CEAP, Reticular veins, Telangiectasias, primary varicose veins, pelvic varicose veins, post-thrombotic syndrome, Venous malformations, phlebopathy, Compression treatment, Compression stockings, medical treatment, venoactive drugs, endovenous laser ablation, radiofrequency ablation, Non-thermal ablation, phlebectomy, venous stenting, Superficial thrombophlebitis, venous ulcers, sclerotherapy, diagnostics, treatment, guidelines
Objective:
To provide an updated estimate of the global prevalence of CVD and to comprehensively evaluate risk factors associated with this condition.
Background:
Chronic Venous Disease (CVD) is an important cause of morbidity internationally, but the global burden of this condition is poorly characterised. The burden of CVD must be better characterised to optimise service provision and permit workforce planning to care for patients with different stages of CVD.
Methods:
A systematic search in Ovid MEDLINE and Embase (1946 - 2019) identified 1271 articles. Full-text, English language articles reporting on the epidemiology of CVD in a general adult population were included. Data extraction was performed by two independent reviewers, in accordance with a pre-registered protocol (PROSPERO: CRD42019153656). STATA and Review Manager were used for quantitative analysis. A crude, unadjusted pooled prevalence was calculated for each Clinical (C) stage in the Clinical, Etiologic, Anatomic, Pathophysiologic (CEAP) classification and across different geographical regions. Qualitative analysis was performed to evaluate associated risk factors in CVD.
Results:
32 articles across 6 continents were identified. 19 studies were included in the overall pooled prevalence for each Clinical (C) stage; pooled estimates were: C0 s: 9%, C1: 26%, C2: 19%, C3: 8%, C4: 4%, C5: 1%, C6: 0·42%. The prevalence of C2 disease was highest in Western Europe and lowest in the Middle East and Africa. Commonly reported risk factors for CVD included: female gender (OR 2·26, 95% CI 2·16-2·36, p < 0.001), increasing age, obesity, prolonged standing, positive family history, parity and Caucasian ethnicity. There was significant heterogeneity across the included studies.
Conclusions:
CVD affects a significant proportion of the population globally however there is significant heterogeneity in existing epidemiological studies.
Objective:
The subcutaneous venous network (SVN) is difficult to see with the naked eye. Near infrared illumination (NIr-I) claims to improve this. The aims of this observational study were to investigate whether there are differences between the different methods; to quantify the length and diameter of SVNs; and to confirm if they differ between C0A and C1 CEAP limbs.
Methods:
In total, 4 796 images, half of them from the visible spectrum (VS) and the other half from the nearninfrared spectrum (NIrS), belonging to 109 females (C0A: n = 50; C1 CEAP: n = 59) were used to establish the morphological characteristics of the SVN by visual analysis. With Photoshop CS4, SVN diameters and lengths were obtained by digital analysis of 3 052 images, once the images of whole extremities were excluded.
Results:
On NIr-I, the diameters, trajectories, and colouration of SVNs of C1 limbs appeared more irregular than SVNs of C0A limbs. Compared with the VS images, NIr-I allowed visualisation of a greater length of the SVN in both groups (p < .010). This capacity varied from 2.6 ± 0.9 times (C1) to 16.2 ± 11.9 (C0A). While the SVN length seen in the VS images from C1 limbs was greater than observed in C0A limbs (p < .001), differences between NIr-I images only existed in the lateral part of the lower leg (p = .016). With NIr-I, the median diameter of the C1 CEAP SVN veins was 5.8 mm (interquartile range [IQR] 4.3-7.5 mm), while the median diameter in C0A SVN limbs was 2.6 mm (IQR 2.0-3.6 mm) (p < .001).
Conclusion:
The NIr-I reveals the characteristics of the SVN better than the naked eye. Further studies are required to determine the significance of the changes in the SVN in C0A and C1 limbs, and the factors causing them.
To determine the prevalence of varicose veins and chronic venous insufficiency (CVI) in the general population.
Cross sectional survey.
City of Edinburgh.
Men and women aged 18-64 years selected randomly from age-sex registers of 12 general practices.
In 1566 subjects examined, the age adjusted prevalence of trunk varices was 40% in men and 32% in women (p < or = 0.01). This sex difference was mostly a result of higher prevalence of mild trunk varices in men. More than 80% of all subjects had mild hyphenweb and reticular varices. The age adjusted prevalence of CVI was 9% in men and 7% in women (p < or = 0.05). The prevalence of all categories of varices and of CVI increased with age (p < or = 0.001). No relation was found with social class.
Approximately one third of men and women aged 18-64 years had trunk varices. In contrast with the findings in most previous studies, mainly conducted in the 1960s and 1970s, chronic venous insufficiency and mild varicose veins were more common in men than women. No evidence of bias in the study was found to account for this sex difference. Changes in lifestyle or other factors might be contributing to an alteration in the epidemiology of venous disease.
To critically review the classification, epidemiology, outcomes, diagnosis and treatment of chronic venous disorders of the leg (CVDL), to issue evidence-based recommendations, and to identify areas requiring further research.
Articles identified by an extensive literature search were scored by members of an international task force. Only those articles with a moderate or strong rating for internal validity were retained.
A scoring system weighing CVDL severity according to the probability of ulcer occurrence is proposed. Epidemiological data on the frequency of CVDL and its risk factors are reviewed. The following items are evaluated: costs associated with treatment; clinical outcomes related to CVDL and its treatment; available generic and disease-specific measures of quality of life; diagnostic procedures used to detect venous reflux; and efficacy of available treatments.
CVDL is an important public health problem, based on its prevalence, cost and impact on quality of life. High-priority areas for research on CVDL are identified.
In 1994, a group of vascular surgeons and physicians met in Hawaii to establish a new classification of the symptomatology of chronic venous insufficiency (CVI). This classification covers all aspects of CVI, Clinical, Etiology, Anatomy, and Pathophysiology, hence its name: the CEAP classification. It also provides three scores enabling the quantitative evaluation of monitoring. By virtue of this classification system, 'venous' patients are defined more accurately and homogeneous groups of patients can be identified. It has thus become possible to undertake studies in cohorts with well-defined profiles. Although the CEAP is remarkably complete, it is nevertheless complex. This complexity, and particularly the processing of the scores, makes it difficult, if not impossible, to use in everyday practice. A new computer program enables classification and calculation of automatic scores, making the CEAP accessible to all. Evaluation of C is now possible. A total of 1017 patients were included in this study. Age, gender, and CEAP profile are reported.
Objective: To review the prevalence of and risk factors for varicose veins, chronic venous insufficiency (CVI) and venous leg ulcers. Data sources: MEDLINE was searched for the terms prevalence and varicose veins, chronic venous insufficiency, or venous leg ulcers. Study selection: The extant world literature (1966-1999) with a minimum of an available English abstract was collected. Ninety-nine studies were reviewed. Data extraction: Data were extracted on prevalence of diseases of the veins in the lower limb, age and gender of the subject populations, and other risk factors for those diseases examined by the original researchers. Data synthesis: The two most prominent risk factors for venous disease are increasing age and female gender. Additional risk factors for venous disease with at least some documentation in the literature include dietary patterns, obesity, physical activity, standing occupations, constrictive clothing, connective tissue laxity, and hormonal differences, including pregnancy. Family history is also a prominent risk factor, suggesting a genetic component. Conclusions: Varicose veins are found more commonly in women, and with increased age. The increase with age is linear, suggesting a constant incidence and cumulative prevalence. CVI is also more common in women and increases with age, but data are limited. Venous leg ulcers are much less common than varicose veins or CVI and show less of a female preponderance, but increase exponentially with age, suggesting a true increasing incidence with age.
The prevalence of varicose veins (VV) and of chronic venous insufficiency (CVI) was studied among 1755 adults over 15 years of age (443 men and 1312 women). These people attended the University Health Center in Botucatu, a country town in the State of Sao Paulo, Brazil, for routine examination or for any disease complaints. The prevalence of all grades of VV not including telangiectasis and reticular varices grade I was 47.6% (37.9% in men and 50.9% in non-pregnant women). The prevalence of VV recorded as moderate or severe was 21.2%. The more severe form of CVI with active or healed ulcer was present in 3.6% of the subjects (2.3% of men and 4% of women). For only 5.5% of the patients was VV or CVI the reason for medical consultation.
The prevalence of VV increased with age and number of pregnancies and was greater among white than non-white people. Working posture or posture adopted for defaecation did not influence the prevalence of VV.
Our data show the prevalence of VV and CVI to be higher or as high as the prevalence found in developed western countries. We therefore propose that studies of these conditions should be included in epidemiological surveys of other developing areas or countries, so that if data similar to ours are verified prophylaxis and early treatment could be included in health planning for these areas with the aim of reducing future morbidity and the related social onus.
The prevalence and incidence of venous thromboembolism and other venous disease was determined as part of a longitudinal study of health and disease in a Michigan community. When these data are extrapolated to 1970 U.S. census figures, a rough estimate of annual incidence of clinically recognized deep venous thrombosis is over 250,000 cases while that of superficial thrombophlebitis is over 123,000. An estimated 24 million US citizens have 'significant' varicose veins while 6 to 7 million have stasis changes in the skin of the legs and 400,000 to 500,000 have or have had a varicose ulcer. The relatively high frequency of these conditions in the adult population of Tecumseh, Michigan, indicates that they represent several of the more common medical problems encountered by the practicing physician.
Most epidemiologic studies on chronic venous insufficiency (CVI) are cross-sectional surveys that suggest potential risk factors by describing their population. However, these relationships could be due to the CVI population's older age. We performed a dual case-control study with multivariate analysis to address this issue.
Ninety-three patients with venous ulcers, 129 patients with varicose veins (VV), and 113 general population control patients from two hospitals were interviewed by use of a standardized questionnaire covering medical history, patient demographics, medications, and lifestyle questions. Univariate and multivariate analyses were used to compare the groups.
Univariate analyses showed CVI to be characterized by several factors, many of which were found to be age related after multivariate analysis. Age-adjusted relationships for CVI include male sex and obesity. Histories of serious leg injury or phlebitis were important associations resulting in a 2.4-fold and 25.7-fold increase in risk for CVI, respectively. After adjusting for age, subjects with VV tend to be younger and female, to more frequently have a history of phlebitis, and to report a family history of VV more frequently than control subjects.
Many of the previously suggested associations found with CVI are in reality due to this population's greater age. Patients with CVI are older, male, obese, have a history of phlebitis, and have a history of serious leg injury. These results suggest that a prior deep vein thrombosis, either clinical or subclinical, may be a predisposing factor for CVI.
Assessment and treatment of varicose veins comprises a significant part of the surgical workload. In the UK, National Health Service waiting lists suggest that there is still considerable unmet need. This review analyses all published data on the epidemiology of varicose veins, paying particular regard to the differing epidemiological terminology, populations sampled, assessment methods and varicose vein definitions, which account for much of the variation in literature reports. Half of the adult population have minor stigmata of venous disease (women 50-55 per cent; men 40-50 per cent) but fewer than half of these will have visible varicose veins (women 20-25 per cent; men 10-15 per cent). The data suggest that female sex, increased age, pregnancy, geographical site and race are risk factors for varicose veins; there is no hard evidence that family history or occupation are factors. Obesity does not appear to carry any excess risk. Accurate prevalence data allow provision of appropriate resources or at least aid rational debate if demand is greater than the resources available.
Advances in modern technology have made available a large number of both invasive and non-invasive investigations that can provide information not only on the presence, absence or anatomic extent but also quantitation of the abnormalities. It was soon realised that the combinations of presence, absence, extent and severity of reflux and/or obstruction in the deep, superficial or perforating veins are so large that the classification of chronic venous disease would be a major challenge. This challenge has been taken up by the Consensus Committee which met in Maui on 22-26 February 1995. The Consensus that developed is in three parts. Part I deals with a classification system that covers the Clinical picture, the Etiology, the Anatomic distribution and the Pathophysiology (the CEAP Classification). Part II suggests a scoring system intended to be evaluated on patients classified according to the CEAP classification, and Part III provides guidelines on the use of various investigations which according to the current medical literature will aid in the classification, The Consensus Committee has retained the copyright of the document so that it can be made available for reproduction to all interested parties. Reproduction is free provided there is no alteration and it is always reproduced in its entirety, The development of this consensus document is a continuous process. Suggestions for improvement are expected from all involved in the study and management of patients with chronic venous disease. The classification has already been presented and debated at several national and international meetings and plans for an updated version are already in progress.
To define the relations between age, sex, lower limb symptoms, and the presence of trunk varicose veins on clinical examination.
Cross sectional population study.
12 general practices with catchment areas geographically and socioeconomically distributed throughout Edinburgh.
An age stratified random sample of 1566 people (699 men and 867 women) aged 18-64 selected from the computerised age-sex registers of participating practices.
Self administered questionnaire on the presence of lower limb symptoms and physical examination to determine the presence and severity of varicose veins.
Women were significantly more likely than men to report lower limb symptoms such as heaviness or tension, swelling, aching, restless legs, cramps, and itching. The prevalence of symptoms tended to increase with age in both sexes. In men, only itching was significantly related to the presence and severity of trunk varices (linear test for trend, P=0.011). In women there was a significant relation between trunk varices and the symptoms of heaviness or tension (P</=0.001), aching (P</=0.001), and itching (P</=0.005). However, the level of agreement between the presence of symptoms and trunk varices was too low to be of clinical value, especially in men.
Even in the presence of trunk varices, most lower limb symptoms probably have a non-venous cause. Surgical extirpation of trunk varices is unlikely to ameliorate such symptoms in most patients.
The relationships between varicose veins (VVs) and leg symptoms have not been studied. The aim of this study was to define the relationships between age, sex, leg symptoms and VVs.
An age-stratified sample of 699 men and 867 women aged 18–64 years, selected randomly from 12 general practices distributed socioeconomically throughout the city, completed a questionnaire regarding leg symptoms (heaviness/tension, swelling, aching, restless legs, cramps, itching, tingling) and underwent a clinical examination.
In men, swelling and cramps (both P ≤ 0·001), and in women swelling (P= 0·02), restless legs (P= 0·001) and itching (P= 0·045), were significantly more common in older subjects. Data have therefore been age adjusted. Women were significantly (P < 0·01) more likely to respond positively when asked about all leg symptoms, except tingling. The commonest symptoms were aching in women (53·8 per cent) and cramps in men (34·0 per cent). There was no difference between right and left legs. In men, only itching was significantly related to trunk VVs (P= 0·011). In women, there was a relationship between trunk VVs and heaviness/tension, aching and itching (P ≤ 0·005). Hyphen-web varices were not related to symptoms in men but were related to heaviness/tension and swelling in women. There was no association between reticular varices and symptoms in either sex.
Even in the presence of VVs, most lower limb ‘venous’ symptoms are non-venous in aetiology. Surgery is unlikely to ameliorate symptoms in the majority of patients. © 1999 British Journal of Surgery Society Ltd
The RELIEF study (Reflux assEssment and quaLity of lIfe improvement with micronized Flavonoids in chronic venous insufficiency [CVI]) is a prospective, controlled, multi center, international study performed in patients with or without venous reflux. This study was conducted between March 1997 and December 1998 in 23 countries worldwide with the participation of more than 10,000 patients suffering from CVI. The European countries, the subject of this report, were represented by the Czech and Slovak Republics, Hungary, Poland, Russia, and Spain.
The principal aims of the study were:
1. To validate the first quality-of-life scale specific to chronic venous insufficiency (CIVIQ) in different languages and to assess the evolution of quality of life in patients suffering from CVI, with or without venous reflux, treated with micronized purified flavonoid fraction (MPFF*) (1,000 mg/day)
2. To collect international epidemiologic data on venous reflux assessed with pocket Doppler and photoplethysmography
3. To assess the evolution of symptoms and signs with a specific emphasis on edema through validated Leg-O-Meter measurement (heaviness, pain, cramps, sensation of swelling, edema) in patients suffering from CVI and treated with MPFF, 1,000 mg/day, during 6 months.
The first country-by-country statistical analysis and the European consolidated analysis are now available. The CIVIQ questionnaires adapted to each participating country have been validated with highly significant validity and reproducibility (p < 0.0001). All dimen sions have demonstrated a highly significant and evolving improvement during the study.
The results show several interesting findings concerning the epidemiologic data and, of these, two were particularly interesting:
• More than 50% of patients suffering from CVI (class 0 to 4 of the CEAP classification) were reflux-free, which means that they were suffering from functional CVI.
• Patient distribution between the different classes of the CEAP classification changed in a statistically significant manner after 6 months' treatment with MPFF; the number of patients in the more severe classes decreased to the benefit of the less severe classes.
Symptoms such as pain, leg heaviness, sensation of swelling, and cramps were signifi cantly improved (p=0.0001). This was associated with a significant decrease in edema, when present, measured by leg circumferences with the Leg-O-Meter (p=0.0001).
In conclusion, the European results of the RELIEF study showed the perfect validity and reproducibility of CIVIQ questionnaire adaptations, and the positive progression of quality-of-life scores on MPFF treatment. This progression was paralleled by clinical improvement of patients reflected not only by assessment of CVI symptoms and signs but also by evolution of the CEAP classification.
This consensus document provides an up-to-date account of the various methods available for the investigation of chronic venous insufficiency of the lower limbs (CVI), with an outline of their history, usefulness, and limitations. CVI is characterized by symptoms or signs produced by venous hypertension as a result of structural or functional abnormalities of veins. The most frequent causes of CVI are primary abnormalities of the venous wall and the valves and secondary changes due to previous venous thrombosis that can lead to reflux, obstruction, or both. Because the history and clinical examination will not always indicate the nature and extent of the underlying abnormality (anatomic extent, pathology, and cause), a number of diagnostic investigations have been developed that can elucidate whether there is calf muscle pump dysfunction and determine the anatomic extent and severity of obstruction or reflux. The difficulty in deciding which investigations to use and how to interpret the results has stimulated the development of this consensus document. The aim of this document was to provide an account of these tests, with an outline of their usefulness and limitations and indications of which patients should be subjected to the tests and when and of what clinical decisions can be made. This document was written primarily for the clinician who would like to learn the latest approaches to the investigation of patients with CVI and the new applications that have emerged from recent research, as well as for the novice who is embarking on venous research. Care has been taken to indicate which methods have entered the clinical arena and which are mainly used for research. The foundation for this consensus document was laid by the faculty at a meeting held under the auspices of the American Venous Forum, the Cardiovascular Disease Educational and Research Trust, the European Society of Vascular Surgery, the International Angiology Scientific Activity Congress Organization, the International Union of Angiology, and the Union Internationale de Phlebologie at the Abbaye des Vaux de Cernay, France, on March 5 to 9, 1997. Subsequent input by co-opted faculty members and revisions in 1998 and 1999 have ensured a document that provides an up-to-date account of the various methods available for the investigation of CVI.
Venous disease in the legs occurs very commonly in the general population in Western countries. Around one third of women have trunk varices. A lower prevalence has been observed in men but some recent surveys have suggested that the occurrence in men may be comparable to that in women. The prevalence increases with age but the incidence of new cases appears to be constant throughout adult life. Open venous ulcers occur in about 0.3% of the adult population and a history of open or healed ulceration occurs in around 1%. The etiology of chronic venous disease in the legs is unknown. A genetic predisposition may be present but evidence for this and for a mode of inheritance is lacking. There is some suggestion that prolonged standing may be a risk factor but studies are open to considerable bias. In women, obesity and previous pregnancy has been associated with the presence of varicose veins but the evidence is inconsistent. There have been few well-conducted studies examining diet and bowel habit as a risk factor. The risk of ulceration is related to the severity of varicosities and venous insufficiency, and is increased following deep vein thrombosis. Much further research is required to investigate the cause of this common condition in the general population.
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