Peripheral Venous Disease: Varicose Veins and Chronic Venous Insufficiency

Objective: To highlight gaps in knowledge concerning the epidemiology of chronic venous insufficiency and to indicate what future studies are required. Methods: Existing classifications are compared. Limitations of epidemiological studies are defined. Data from published series and from the Edinburgh Vein Study are presented. Synthesis: The Basle 1978 classification of chronic venous insufficiency (CVI) is a purely clinical classification in which the earliest grade is corona phlebectatica. The Porter 1988 classification of CVI attempted to correlate clinical grades with sites of venous incompe-tence. However, a consistent relationship does not exist. The CEAP classification separates the clinical grades (which do not include corona phlebectasia) from the anatomical segments. The CEAP clinical classification covers a range of venous manifestations but is not consistent. There is a need for further consideration of classifications. Published selected series of patients show that the frequency of incompetence in both deep and superficial systems increases in proportion to the severity of the clinical manifestations of venous disease. To understand the significance of these data we need to know the patterns of venous incompetence in the general population. Data from 1566 subjects between the ages of 18 and 64 years in the Edinburgh Vein Study, a randomly selected cross-section of members of the Edinburgh population, showed that the prevalence of CVI was age-related and was present in 9.2% of men and 6.6% of women. Men had a significantly higher frequency of reflux in the deep system than women. In order to direct therapeutic interventions where they are most appropriate we need to know which patients with the early stages of varicose veins progress to CVI and which patients with early CVI progress to the serious skin complications. Conclusions: Key information concerning the natural history of venous disease and its evolution in relation to haemodynamic abnormalities awaits the findings of longitudinal-cohort epidemiological studies which include the duplex scanning of large populations.

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Epidemiology of Chronic Venous Insufficiency

Phlebology The Journal of Venous Disease ◽

10.1177/026835559601100102 ◽

1996 ◽

Vol 11 (1) ◽

pp. 2-5 ◽

Cited By ~ 26

Author(s):

F. G. R. Fowkes

Keyword(s):

General Population ◽

Chronic Venous Insufficiency ◽

Venous Insufficiency ◽

Varicose Veins ◽

Venous Disease ◽

Skin Changes ◽

Medline Search ◽

Study Selection ◽

Varicose Ulcer ◽

Definition Of

Objective: To determine the prevalence of chronic venous insufficiency in the general population and its association with varicose veins. Data sources: MEDLINE search 1980–94 plus scanning of reference lists in articles obtained. Study selection: Studies on venous disease in subjects not attending health services. Data synthesis: A formal systematic review of metaanalysis was not carried out because of the heterogeneity of the few available studies. Skin changes were found to occur in over 3% of adults, more so in women than men. The prevalence was higher in subjects with varicose veins and depended on the definition of skin changes and the severity of varicose veins. Approximately 0.3% of adults had an open varicose ulcer, and around 1% had an open or healed ulcer. Prevalence was higher in women and increased with age. Conclusions: The prevalence of chronic venous insufficiency was found to be common in the general population, but more studies of distribution and aetiology are required.

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Endocrine mechanisms in the pathogenesis of primary varicosis

Phlebologie ◽

10.12687/phleb2123_1_2013 ◽

2013 ◽

Vol 42 (01) ◽

pp. 13-18 ◽

Cited By ~ 3

Author(s):

S. Schnabl ◽

A. Strölin ◽

Ch. Busch

Keyword(s):

Chronic Venous Insufficiency ◽

Regulatory Networks ◽

Venous Insufficiency ◽

Varicose Veins ◽

Chronic Venous Disease ◽

Venous Disease ◽

Extensive Literature ◽

Vein Wall ◽

Extensive Literature Search ◽

Relaxin 2

SummaryIntroduction: Varicose veins affect up to 40 % of men and up to 51 % of women. The patho-physiology of primary varicosis (chronic venous insufficiency, CVI) is poorly understood. Here, the available data on possible endocrine mechanisms in healthy and varicose veins are reviewed.Methods: An extensive literature search was conducted in PubMed using the following key words: Chronic venous insufficiency, CVI, chronic venous disease, CVD, varicosis, saphenous vein, pathogenesis, hormone.Results: Several theories ranging from incompetence of the valves to functional, biological or morphologic changes in different layers of the vein wall have been proposed. However, an increasing body of evidence suggests that endocrine mechanisms might be involved in the pathogenesis of primary varicosis. In this respect a growing number of hormones (e.g. estrogen, progesterone, relaxin-2, and oxytocin) and their receptors have been linked to primary varicosis in experimental, pharmacological and histological studies.Conclusion: In summary, endocrine-based mechanisms seem to play a role in the pathogenesis of primary varicosis. This opens up the perspective for pharmacological treatments targeting the various described endocrine regulatory networks.

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CHRONIC VENOUS INSUFFICIENCY

Polonia University Scientific Journal ◽

10.23856/3217 ◽

2019 ◽

Vol 32 (1) ◽

pp. 131-136

Author(s):

Antoni Stadnicki ◽

Martin Rusnák ◽

Anna Stadnicka

Keyword(s):

Chronic Venous Insufficiency ◽

Venous Insufficiency ◽

Varicose Veins ◽

Chronic Venous Disease ◽

Postthrombotic Syndrome ◽

Venous Disease ◽

Compression Stockings ◽

Venous Leg Ulcer ◽

Color Flow ◽

Clinical Disorder

Chronic venous insufficiency (CVI) is a common, but underdiagnozed clinical disorder associated with a variety of signs and symptoms. The presence of leg edema in association with varicose veins, and venous leg ulcer in later disease stages defines the disease. The pathogenesis of chronic venous disease is based on venous reflux, obstruction, or a combination thereof. Prior postthrombotic syndrome is one of risk factor for CVI which may explain observed prevalence of thrombophilia in CVI. Color flow duplex ultrasound is the gold standard for nearly all diagnostic issues related to chronic venous disease. Compression stockings are the mainstay for conservative management. Earlier use of venous ablation therapy should be considered in symptomatic patients with superficial tortuous vein

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Venous Volumetry In The Assessment Of The Post-Thrombotic Limb

10.1055/s-0038-1652475 ◽

1981 ◽

Author(s):

C V Ruckley ◽

H M Crawshaw ◽

J Seaton

Keyword(s):

Chronic Venous Insufficiency ◽

Venous Insufficiency ◽

Varicose Veins ◽

Response To Treatment ◽

Venous Disease ◽

Clinical Relapse ◽

Non Invasive ◽

Coefficients Of Variation ◽

Primary Varicose Veins

The reproducibility of venous volumetry has been evaluated in 20 normal legs (N), 20 legs with primary varicose veins (W) and 30 with stable post-thrombotic chronic venous insufficiency (CVI).The test has shown significant differences between the groups in mean relative expelled volume (EV rel, ccs): N 1.65 ± SD 0.66; W 1.01 ± 0.40; CVI 0.64 ± 0.39 and in half refilling time (T3 secs): N 23.9 ± 11.5; W 11.8 ± 7.4; CVI 3.6 ± 1.8. The percent coefficients of variation in tests repeated at intervals of up to a month were as follows.The reproducibility of the test confirms its value as a non-invasive means of measuring the severity of postthrombotic venous disease and thus as a means of assessing response to treatment. Serial volumetric tests on 25 patients before and for up to 12 months after Linton operations for chronic venous insufficiency show significant early improvements in expelled volume. But in many of these patients the refilling time tends to remain short indicating residual valvular incompetence and the possibility of clinical relapse in the long term.

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Epidemiology and classification of venous disease

ESC CardioMed ◽

10.1093/med/9780198784906.003.0669 ◽

2018 ◽

pp. 2805-2806

Author(s):

Eberhard Rabe ◽

Felizitas Pannier

Keyword(s):

Risk Factors ◽

Chronic Venous Insufficiency ◽

Venous Insufficiency ◽

Varicose Veins ◽

Adult Population ◽

Clinical Signs ◽

Advanced Age ◽

Chronic Venous Disease ◽

Venous Disease ◽

General Adult Population

Chronic venous diseases are frequent pathologies in the general population. The most common chronic venous pathologies are varicose veins and chronic venous insufficiency including post-thrombotic syndrome. In the general adult population, varicose veins are present in up to 25% of people with an increasing prevalence with age. Risk factors include advanced age, genetic predisposition, female sex, and multiparity. The term chronic venous insufficiency summarizes the clinical signs of chronic venous disease with oedema, skin changes, or venous ulcers. More than 15% of the population is affected by chronic venous insufficiency. Risk factors include advanced age, obesity, and prolonged sitting.

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The Epidemiology of Chronic Venous Diseases

Phlebology The Journal of Venous Disease ◽

10.1177/026835550001500102 ◽

2000 ◽

Vol 15 (1) ◽

pp. 2-18 ◽

Cited By ~ 14

Author(s):

A. Adhikari ◽

M. H. Criqui ◽

V. Wooll ◽

J. O. Denenberg ◽

A. Fronek ◽

...

Keyword(s):

Risk Factors ◽

Chronic Venous Insufficiency ◽

World Literature ◽

Venous Insufficiency ◽

Varicose Veins ◽

Female Gender ◽

Venous Disease ◽

Leg Ulcers ◽

Venous Leg Ulcers ◽

Venous Diseases

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.

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Obesity and lower limb venous disease – The epidemic of phlebesity

Phlebology The Journal of Venous Disease ◽

10.1177/0268355516649333 ◽

2016 ◽

Vol 32 (4) ◽

pp. 227-233 ◽

Cited By ~ 21

Author(s):

Huw OB Davies ◽

Matthew Popplewell ◽

Rishi Singhal ◽

Neil Smith ◽

Andrew W Bradbury

Keyword(s):

Deep Vein Thrombosis ◽

Lower Limb ◽

Chronic Venous Insufficiency ◽

Venous Insufficiency ◽

Varicose Veins ◽

Venous Disease ◽

Obese Patients ◽

Obese People ◽

Vein Thrombosis ◽

Deep Vein

Introduction Lower limb venous disease affects up to one half, and obesity up to one quarter, of the adult population. Many people are therefore affected by, and present to health services for the treatment of both conditions. This article reviews the available evidence of pathophysiological and clinical relationship between obesity and varicose veins, chronic venous insufficiency and ulceration and deep vein thrombosis. Methods A literature search of PubMed and Cochrane libraries was performed in accordance with PRISMA statement from 1946 to 2015, with further article identification from following cited references for articles examining the relationship between obesity and venous disease. Search terms included obesity, overweight, thrombosis, varicose veins, CEAP, chronic venous insufficiency, treatment, endovenous, endothermal, sclerotherapy, bariatric surgery and deep vein thrombosis. Results The proportion of the population suffering from lower limb venous disease and obesity is increasing. Obesity is an important risk factor for all types of lower limb venous disease, and obese patients with lower limb venous disease are more likely to be symptomatic as a result of their lower limb venous disease. The clinical diagnosis, investigation, imaging and treatment of lower limb venous disease in obese people present a number of challenges. The evidence base underpinning medical, surgical and endovenous management of lower limb venous disease in obese people is limited and such treatment may be associated with worse outcomes and increased risks when compared to patients with a normal body mass index. Conclusion Lower limb venous disease and obesity are both increasingly common. As such, phlebologists will be treating ever greater numbers of obese patients with lower limb venous disease, and clinicians in many other specialties are going to be treating a wide range of obesity-related health problems in people with or at risk of lower limb venous disease. Unfortunately, obese people have been specifically excluded from many, if not most, of the pivotal studies. As such, many basic questions remain unanswered and there is an urgent need for research in this challenging and increasingly prevalent patient group.

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Progression in venous pathology

Phlebology The Journal of Venous Disease ◽

10.1177/0268355514568847 ◽

2015 ◽

Vol 30 (1_suppl) ◽

pp. 95-97 ◽

Cited By ~ 18

Author(s):

F Pannier ◽

E Rabe

Keyword(s):

Varicose Vein ◽

Chronic Venous Insufficiency ◽

Venous Insufficiency ◽

Varicose Veins ◽

Chronic Venous Disease ◽

Venous Disease ◽

Leg Ulcers ◽

Skin Changes ◽

Venous Leg Ulcers

Aim To review epidemiologic data on progression of venous pathology in varicose veins and from varicose veins towards chronic venous insufficiency. Methods We searched Medline and PubMed for epidemiologic studies concerning progression of venous pathology. Results The data suggest that reflux progression may develop from segmental to multisegmental superficial reflux. In younger age, reflux in tributaries and non-saphenous veins is more frequent. In older age, more saphenous reflux develops and more proximal sites seem to be affected. A high proportion of uncomplicated varicose vein (C2) develops skin changes and chronic venous insufficiency (C3–C6). Significant risk factors for the progression of varicose vein towards venous leg ulcers are skin changes, corona phlebectatica, higher body mass index and popliteal vein reflux. During a 13.4-year follow-up period, 57.8% (4.3%/year) of all chronic venous disease patients showed progression of the disease. Summary Studies on the progression of venous pathology show a high progression rate of chronic venous disease. More follow-up studies are still needed to get better information about the risk of varicose vein patients for progression to venous leg ulcers and to answer the question which patients may benefit from early varicose vein interventions.

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Diagnosis and treatment of varicose veins and chronic venous insufficiency

Journal of Korean Medical Association ◽

10.5124/jkma.2020.63.12.756 ◽

2020 ◽

Vol 63 (12) ◽

pp. 756-763

Author(s):

Shin-Seok Yang

Keyword(s):

Surgical Treatment ◽

Varicose Vein ◽

Chronic Venous Insufficiency ◽

Venous Insufficiency ◽

Varicose Veins ◽

Symptom Relief ◽

Venous Pressure ◽

Chronic Venous Disease ◽

High Ligation ◽

Venous Disease

This study aimed to review the pathophysiology of varicose veins and chronic venous insufficiency and the recent surgical treatment trend. Varicose veins are tortuous, twisted, or lengthened veins in the lower extremities. It is part of the spectrum of chronic venous disease. Primary pathogenesis is increased chronic venous hypertension caused by valvular insufficiency, venous outflow obstruction, and calf muscle pump failure. Some patients complain of no symptoms, except report cosmetic concerns. If the varicose vein progresses to chronic venous insufficiency, it may cause edema of the lower limb. The skin lesion can present as hyperpigmentation of the median part of the ankle, congestive dermatitis, and even a skin ulcer. The varicose vein can be diagnosed easily by visual inspection after identifying the skin lesions. For non-surgical treatment, elastic stocking, Unna boots, and pneumatic compression devices are recommended to reduce venous pressure. High ligation with stripping has been the standard treatment for varicose veins to achieve symptom relief and improve cosmetic effects. Endovenous laser ablation, radiofrequency ablation, mechanochemical ablation, and the VenaSeal closure system have been introduced as surgical treatment methods. Recently, endovenous thermal/non-thermal ablations are recommended for treatment because both are less invasive techniques. The appropriate therapy should be selected after considering the patients’ symptoms and signs, anatomical structure, and economic burden of the treatment.

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