Pathogenesis of varicose veins - lessons from biomechanics

VASA ◽  
2014 ◽  
Vol 43 (2) ◽  
pp. 88-99 ◽  
Author(s):  
Larissa Pfisterer ◽  
Gerd König ◽  
Markus Hecker ◽  
Thomas Korff
Keyword(s):  
Risk Factors ◽  
Venous Insufficiency ◽  
Varicose Veins ◽  
Wall Stress ◽  
Filling Pressure ◽  
Venous Hypertension ◽  
Venous Disease ◽  
Prolonged Standing ◽  
Venous Filling ◽  
Venous Wall

The development of varicose veins or chronic venous insufficiency is preceded by and associated with the pathophysiological remodelling of the venous wall. Recent work suggests that an increase in venous filling pressure is sufficient to promote varicose remodelling of veins by augmenting wall stress and activating venous endothelial and smooth muscle cells. In line with this, known risk factors such as prolonged standing or an obesity-induced increase in venous filling pressure may contribute to varicosis. This review focuses on biomechanically mediated mechanisms such as an increase in wall stress caused by venous hypertension or alterations in blood flow, which may be involved in the onset of varicose vein development. Finally, possible therapeutic options to counteract or delay the progress of this venous disease are discussed.

Epidemiology and classification of venous disease

ESC CardioMed ◽  
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.

The Epidemiology of Chronic Venous Diseases

2000 ◽  
Vol 15 (1) ◽  
pp. 2-18 ◽  
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.

Epidemiology of chronic venous disease

2008 ◽  
Vol 23 (3) ◽  
pp. 103-111 ◽  
Author(s):  
L Robertson ◽  
C Evans ◽  
F G R Fowkes
Keyword(s):  
Risk Factors ◽  
Varicose Veins ◽  
Adult Population ◽  
Chronic Venous Disease ◽  
Western World ◽  
Venous Disease ◽  
Venous Ulceration ◽  
Prolonged Standing ◽  
True Incidence ◽  
Disease Definition

Chronic venous disease of the legs occurs commonly in the general population in the Western world. Estimates of the prevalence of varicose veins vary widely from 2–56% in men and from 1–60% in women. These variations reflect differences in variability of study populations including age, race and gender, methods of measurement and disease definition. Definitions of chronic venous disease may rely on reports of varicose veins by study participants, based on self-diagnosis or recall of a diagnosis, or on a standardized physical examination. Venous ulceration is less common, affecting approximately 0.3% of the adult population. Age and pregnancy have been established as risk factors for developing varicose veins. Evidence on other risk factors for venous disease is inconclusive. Prolonged standing has been proposed, but results of studies should be interpreted with caution given the difficulty in measuring levels of posture. Obesity has been suggested as a risk factor in women, but appears to be an aggravating factor rather than a primary cause. Other postulated risk factors include dietary intake and smoking, but evidence is lacking. Longitudinal studies using standardized methods of evaluation are required before the true incidence of chronic venous disease and associated risk factors can be determined.

scholarly journals TO EVALUATE THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING VARICOSE VEINS AND ITS PREVENTION AMONG OT AND ICU STAFF NURSES

2021 ◽  
Vol 8 (3) ◽  
Author(s):  
Mr. Abhimanyu Sharma sharma ◽  
Dr. Rajendra Prasad Sharma sharma ◽  
Dr. Rajendra Prasad Sharma sharma
Keyword(s):  
Risk Factors ◽  
Varicose Veins ◽  
Staff Nurses ◽  
Venous Disease ◽  
Human Beings ◽  
Vein Wall ◽  
Teaching Programme ◽  
Prolonged Standing ◽  
Vein Thrombosis ◽  
Deep Vein

Many factors predispose human beings to a disease of the lower extremities, and this condition affects approximately eighty million Americans. Itsmanifestations may appear to be little more than a cosmetic nuisance, yet it may be an indication of a more serious underlying problem undetected by visual inspection. Venous disease is also capable of producing a plethora of uncomfortable symptoms, and left untreated, may progress to cutaneous pigmentation, dermatitis, ulceration, haemorrhage, or superficial thrombophlebitis. Although uncomplicated cases of the disease are more common, venous disease should not be taken lightly. Steps to retard disease expression and progression should be implemented whenever possible. As blood rushes through our legs the veins send it back to the heart. In case of prolonged standing, due to force of gravity the veins lose their ability to push the blood upwards, causing the blood to settle down in certain areas of the veins. Varicose veins are tortuous, distended and bulging vein s (varicosities) beneath the skin of the legs. They are most often swollen and gnarled veins that most frequently occur in the legs, ankles and feet. Even though the exact cause of varicose veins is unknown, there are some risk factors which contribute to development of this problem. Some of the risk factors are, low physical activity, smoking, family heredity of varicose veins, congenital valve or vein wall defects, valve damage from trauma, obstruction, deep vein thrombosis (DVT) or inflammation, chronic venous distention associated with occupations requiring prolonged standing, obesity or pregnancy, systemic conditions that interfere with venous return and loss of vein wall elasticity with ageing.

Prevalence and Risk Factors of Chronic Venous Insufficiency

Angiology ◽  
2001 ◽  
Vol 52 (1_suppl) ◽  
pp. S5-S15 ◽  
Author(s):  
F.G.R. Fowkes ◽  
C.J. Evans ◽  
A.J. Lee
Keyword(s):  
Risk Factor ◽  
General Population ◽  
Venous Insufficiency ◽  
Varicose Veins ◽  
Adult Population ◽  
Adult Life ◽  
Chronic Venous Disease ◽  
Bowel Habit ◽  
Venous Disease ◽  
Prolonged Standing

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.

scholarly journals Understanding Chronic Venous Disease: A Critical Overview of Its Pathophysiology and Medical Management

2021 ◽  
Vol 10 (15) ◽  
pp. 3239
Author(s):  
Miguel A. Ortega ◽  
Oscar Fraile-Martínez ◽  
Cielo García-Montero ◽  
Miguel A. Álvarez-Mon ◽  
Chen Chaowen ◽  
...  
Keyword(s):  
Inflammatory Responses ◽  
Current Knowledge ◽  
Varicose Veins ◽  
Clinical Signs ◽  
Clinical Manifestations ◽  
Significant Loss ◽  
Venous Hypertension ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Environmental Agents

Chronic venous disease (CVD) is a multifactorial condition affecting an important percentage of the global population. It ranges from mild clinical signs, such as telangiectasias or reticular veins, to severe manifestations, such as venous ulcerations. However, varicose veins (VVs) are the most common manifestation of CVD. The explicit mechanisms of the disease are not well-understood. It seems that genetics and a plethora of environmental agents play an important role in the development and progression of CVD. The exposure to these factors leads to altered hemodynamics of the venous system, described as ambulatory venous hypertension, therefore promoting microcirculatory changes, inflammatory responses, hypoxia, venous wall remodeling, and epigenetic variations, even with important systemic implications. Thus, a proper clinical management of patients with CVD is essential to prevent potential harms of the disease, which also entails a significant loss of the quality of life in these individuals. Hence, the aim of the present review is to collect the current knowledge of CVD, including its epidemiology, etiology, and risk factors, but emphasizing the pathophysiology and medical care of these patients, including clinical manifestations, diagnosis, and treatments. Furthermore, future directions will also be covered in this work in order to provide potential fields to explore in the context of CVD.

Characteristics of venous insufficiency in western Turkey: VEYT-I study

2012 ◽  
Vol 27 (7) ◽  
pp. 374-377 ◽  
Author(s):  
B Akbulut ◽  
H İ UÇAr ◽  
M Öç ◽  
M İKizler ◽  
C Yorgancoğlu ◽  
...  
Keyword(s):  
Venous Insufficiency ◽  
Demographic Data ◽  
Adult Population ◽  
Signs And Symptoms ◽  
Turkish Population ◽  
Venous Hypertension ◽  
Venous Disease ◽  
Health Care Centre ◽  
Western Turkey ◽  
Study Population

Objectives Syndromes of venous hypertension and reduced venous clearance are important causes of morbidity and disability in patients with varicose venous disease. Published estimates of the prevalence of varicosities range from 7% to 55% in the adult population, with most studies demonstrating clinical varicose reflux in about 40% of the population where the frequency of venous insufficiency is believed to be higher in Westernized and industrialized nations, most likely due to differences in lifestyle and activity. Unfortunately, the prevalence in a Turkish population is not known. The goal of the VEYT-I study was to determine the characteristics of venous insufficiency in a Turkish population. Method Randomized patients who applied to a health-care centre were included in this study. The Tübingen questionnaire was used to evaluate the signs and symptoms of venous insufficiency and their seriousness in a Turkish population. Patients were additionally questioned on demographic data, education, working, living habits, quality of life and actual health status. Results A total of 2167 patients were involved in this study. Four patients with chronic renal failure and 40 patients with congestive heart failure were excluded. In patients with venous insufficiency, 90.1% did not receive any therapy. In all, 51.53% of patients with venous insufficiency were men, and mean age was 56.9 ± 9.4. Conclusion The prevalence of venous insufficiency seems to be somewhat higher when compared with Western populations. One of the most prominent facts is that about 90% of patients with venous insufficiency did not receive any therapy. Therefore, disease-related complications or discomfort might emerge soon, and so more importance should be given to venous insufficiency. The VEYT-I study is a continuing database study and the target is to enlarge the study population.

Endovenous management of varicose veins

2004 ◽  
Vol 19 (4) ◽  
pp. 163-169 ◽  
Author(s):  
S Soumian ◽  
A H Davies
Keyword(s):  
Varicose Veins ◽  
Signs And Symptoms ◽  
Venous Hypertension ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Foam Sclerotherapy ◽  
High Prevalence ◽  
Promising Treatment ◽  
Developed World

Objective: Chronic venous disease has made a considerable socio-economical impact in the developed world due to its high prevalence and cost of management. Venous hypertension gives rise to significant signs and symptoms that are indications for treatment. Though the mainstay of treatment currently is surgery, it may not be the ideal choice in some cases considering the heterogeneous spectrum of venous disease. Recent alternative endovenous treatments have shown a lot of promise in successfully treating this condition. The aim of this review was to assess the long-term effectiveness of these treatments. Methods: A Medline-based review of literature was carried out. Results: Foam sclerotherapy seems to be a very promising treatment for venous disease, as short-term results have shown good results in terms of outcomes, low morbidity and cost. New endovenous techniques such as radiofrequency and laser ablation are attractive considering the absence of groin scar and subsequent neovascularization, as well as very little bruising and discomfort. Conclusions: There is no clear evidence yet regarding the long-term effectiveness of these relatively new endovenous techniques.

The Epidemilogy of Chronic Venous Ulcer: Some Unanswered Questions

2000 ◽  
Vol 15 (3-4) ◽  
pp. 106-109
Author(s):  
C. V. Ruckley
Keyword(s):  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Varicose Veins ◽  
Clinical Manifestations ◽  
Epidemiological Studies ◽  
Therapeutic Interventions ◽  
Venous Disease ◽  
Clinical Classification ◽  
Age Related

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.

scholarly journals Venous ulcers of the lower limb: Where do we stand?

2012 ◽  
Vol 45 (02) ◽  
pp. 266-274 ◽  
Author(s):  
Chatterjee Sasanka S.
Keyword(s):  
Lower Limb ◽  
Varicose Veins ◽  
Valsalva Maneuver ◽  
Adhesion Formation ◽  
Venous Hypertension ◽  
Long Term Results ◽  
Venous Disease ◽  
High Morbidity ◽  
Venous Ulcers ◽  
Vein Segment

ABSTRACTVenous ulcers are the most common ulcers of the lower limb. It has a high morbidity and results in economic strain both at a personal and at a state level. Chronic venous hypertension either due to primary or secondary venous disease with perforator paucity, destruction or incompetence resulting in reflux is the underlying pathology, but inflammatory reactions mediated through leucocytes, platelet adhesion, formation of pericapillary fibrin cuff, growth factors and macromolecules trapped in tissue result in tissue hypoxia, cell death and ulceration. Duplex scan with colour flow is the most useful investigation for venous disease supplying information about patency, reflux, effects of proximal and distal compression, Valsalva maneuver and effects of muscle contraction. Most venous disease can be managed conservatively by leg elevation and compression bandaging. Drugs of proven benefit in venous disease are pentoxifylline and aspirin, but they work best in conjunction with compression therapy. Once ulceration is chronic or the patient does not respond to or cannot maintain conservative regime, surgical intervention treating the underlying venous hypertension and cover for the ulcer is necessary. The different modalities like sclerotherapy, ligation and stripping of superficial varicose veins, endoscopic subfascial perforator ligation, endovenous laser or radiofrequency ablation have similar long-term results, although short-term recovery is best with radiofrequency and foam sclerotherapy. For deep venous reflux, surgical modalities include repair of incompetent venous valves or transplant or transposition of a competent vein segment with normal valves to replace a post-thrombotic destroyed portion of the deep vein.

Sign in / Sign up

Export Citation Format

Share Document