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Taengsakul N. Risk Factors for and Treatment of Chronic Venous Disease in Thai Patients. Vasc Health Risk Manag 2022; 18:667-676. [PMID: 36065282 PMCID: PMC9440698 DOI: 10.2147/vhrm.s382726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/29/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction The prevalence of chronic venous disease (CVD), a common health care problem, is still underestimated. A few previous epidemiologic studies have report Asian patients with this condition in western countries, but not in Asian countries. The aim of this study was to determine risk factors for CVD and its treatment in Thai individuals. Methods In this cross-sectional study, we collected data of patients with CVD visiting Chulabhorn Hospital Vascular Clinic from 1 December 2018–1 October 2021. We reviewed medical records for patient characteristics, comorbidities, Clinical, Etiology, Anatomy, Pathophysiology (CEAP) categories, Venous Clinical Severity Score (VCSS), ultrasound findings and treatment. Results The study cohort comprised 260 CVD patients with CVD of mean age 61.92 ± 12.82 years. Almost 80% of participants were female. A history of deep vein thrombosis (DVT) was the strongest risk factor for severe CVD. Other identified risk factors comprised body–mass index (BMI) >30 kg/m2, and older age. The most common CEAP categories were C2 (39%) and C1 (33.8%). Superficial venous reflux was the most common location of venous reflux in this study, 67.32% of participants having great saphenous vein reflux and 16.99% small saphenous vein reflux. Only 4.76% of our cohort had both reflux and obstruction. Most of the participants had undergone compression therapy, approximately half of them complying well with wearing of stockings. Nineteen percent of our cohort had undergone sclerotherapy and 14% surgery, which comprised radiofrequency ablation in 97% of them. Conclusion The major risk factors for severe CVD identified in this study were deep vein thrombosis, body mass index>30 kg/m2 and older age. The most common CEAP category was C2 (39%). GSV was the most commonly involved venous system. Involvement of numerous venous systems was a risk factor for severe CVD.
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Affiliation(s)
- Nawaphan Taengsakul
- Surgical Unit, Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
- Correspondence: Nawaphan Taengsakul, Surgical Unit, Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, 906 Kamphaeng Phet 6 Road, Talat Bang Khen, Lak Si, Bangkok, 10210, Thailand, Tel/Fax +66-2-576-6791, Email
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2
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Rusinovich Y, Rusinovich V. Earth’s gravity field and prevalence of varicose veins and chronic venous disease: Systematic review. Phlebology 2022; 37:486-495. [DOI: 10.1177/02683555221090054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Yury Rusinovich
- Department of Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Volha Rusinovich
- Institute of Hygiene and Environmental Medicine, University Hospital Leipzig, Leipzig, Germany
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3
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Hu WS, Lin CL. Association between varicose vein and atrial fibrillation-a population-based study in Taiwan. Phlebology 2022; 37:535-539. [PMID: 35466790 DOI: 10.1177/02683555221095299] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study retrospectively explores the association between varicose vein and atrial fibrillation (AF). METHODS The data are from Taiwan National Health Insurance Research Database. The univariate and multivariable-adjusted hazard ratios (HR), with corresponding 95% confidence intervals (CI), for the occurrence of AF between the varicose vein cohort and comparison cohort were estimated using cox proportional hazards models after adjustment for age, sex, and comorbidities. RESULTS The incidence rates of AF in the varicose vein and the comparison cohort were 4.82 per 1000 person-years and 3.47 per 1000-person years, respectively. After controlling for all the confounding variables, subjects with varicose vein were associated with a significantly higher risk of AF (adjusted HR = 1.23, 95% CI = 1.04-1.45) compared with the comparison cohort. CONCLUSIONS Our study is the first to show that varicose vein correlates to AF.
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Affiliation(s)
- Wei-Syun Hu
- School of Medicine, College of Medicine, 38019China Medical University, Taichung, Taiwan.,Division of Cardiovascular Medicine, Department of Medicine, 38019China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
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4
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Kim HJ, Lee GW, Son JW, Shin K, Kim HS, Ko HC, Kim BS, Kim MB. Venous Insufficiency is a Clear Provoker of Pigmented Purpuric Dermatosis. Ann Dermatol 2022; 34:34-39. [PMID: 35221593 PMCID: PMC8831311 DOI: 10.5021/ad.2022.34.1.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/30/2021] [Accepted: 09/08/2021] [Indexed: 11/08/2022] Open
Affiliation(s)
- Hak-Jun Kim
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
- Department of Dermatology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Gi-Wook Lee
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
| | - Jin-Wha Son
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
- Department of Dermatology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Kihyuk Shin
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
- Department of Dermatology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hoon-Soo Kim
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
| | - Hyun-Chang Ko
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
- Department of Dermatology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Byung-Soo Kim
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
| | - Moon-Bum Kim
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
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5
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Chan SSJ, Chan YC, Walsh SR, Chong TT, Choke ETC, Tiwari A, Tang TY. Endovenous cyanoacrylate ablation for chronic venous insufficiency and
varicose veins among Asians. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2021. [DOI: 10.47102/annals-acadmedsg.2020346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction: Endovenous cyanoacrylate glue (CAG) ablation for the treatment of chronic venous
insufficiency (CVI) and varicose veins has shown non-inferior outcomes with an excellent safety profile,
high patient satisfaction rate, and excellent efficacy when compared to the gold standard of endothermal
ablation. A review of the current literature for CAG use in CVI showed that most studies and longer-term
data are from Caucasian-based populations, which are subject to different anatomical venous variations
and socio-economical contexts. This review aimed to gather the current evidence for CAG use in Asian
CVI patients.
Methods: Asian studies for the use of CAG in CVI were included in this review. Successful ablation
rates, quality of life improvement and novel complications such as glue hypersensitivity reactions are
described, along with anatomical descriptions of superficial venous anatomy in study patients. Use of
CAG in Singapore and Asia was addressed.
Results: CAG has been gaining traction as an option for CVI treatment in Asians. In Singapore, it has
been adopted with comparable low complication rates and significant improvement of quality of life
after treatment. As we increase our understanding of the variations in venous anatomy in the Asian
population, new techniques such as retrograde deployment of the device and use of CAG ablation for
venous leg ulcers have been developed.
Conclusion: Further robust evidence in terms of large randomised control trials along with costeffectiveness
studies are needed to determine the true value of CAG ablation in the Asian setting.
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6
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Chang SL, Hu S, Huang YL, Lee MC, Chung WH, Cheng CY, Hsiao YC, Chang CJ, Lee SR, Chang SW, Wen YW. Treatment of Varicose Veins Affects the Incidences of Venous Thromboembolism and Peripheral Artery Disease. Circ Cardiovasc Interv 2021; 14:e010207. [PMID: 33685215 DOI: 10.1161/circinterventions.120.010207] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Shyue-Luen Chang
- Department of Dermatology, Vein Clinic, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan (S.-L.C., S.H., Y.-L.H., M.-C.L., C.-Y.C., W.-H.C.).,Department of Cosmetic Science, Chang Gung University of Science and Technology, Linkou, Taiwan (S.-L.C., S.H., Y.-L.H., M.-C.L., C.-Y.C., W.-H.C.).,Department of Dermatology, Chang Gung Memorial Hospital, Xiamen, China (S.-L.C., S.H., Y.-L.H., M.-C.L., W.-H.C.)
| | - Sindy Hu
- Department of Dermatology, Vein Clinic, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan (S.-L.C., S.H., Y.-L.H., M.-C.L., C.-Y.C., W.-H.C.).,Department of Cosmetic Science, Chang Gung University of Science and Technology, Linkou, Taiwan (S.-L.C., S.H., Y.-L.H., M.-C.L., C.-Y.C., W.-H.C.).,Department of Dermatology, Chang Gung Memorial Hospital, Xiamen, China (S.-L.C., S.H., Y.-L.H., M.-C.L., W.-H.C.)
| | - Yau-Li Huang
- Department of Dermatology, Vein Clinic, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan (S.-L.C., S.H., Y.-L.H., M.-C.L., C.-Y.C., W.-H.C.).,Department of Cosmetic Science, Chang Gung University of Science and Technology, Linkou, Taiwan (S.-L.C., S.H., Y.-L.H., M.-C.L., C.-Y.C., W.-H.C.).,Department of Dermatology, Chang Gung Memorial Hospital, Xiamen, China (S.-L.C., S.H., Y.-L.H., M.-C.L., W.-H.C.)
| | - Mei-Ching Lee
- Department of Dermatology, Vein Clinic, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan (S.-L.C., S.H., Y.-L.H., M.-C.L., C.-Y.C., W.-H.C.).,Department of Cosmetic Science, Chang Gung University of Science and Technology, Linkou, Taiwan (S.-L.C., S.H., Y.-L.H., M.-C.L., C.-Y.C., W.-H.C.).,Department of Dermatology, Chang Gung Memorial Hospital, Xiamen, China (S.-L.C., S.H., Y.-L.H., M.-C.L., W.-H.C.)
| | - Wen-Hung Chung
- Department of Dermatology, Vein Clinic, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan (S.-L.C., S.H., Y.-L.H., M.-C.L., C.-Y.C., W.-H.C.).,Department of Cosmetic Science, Chang Gung University of Science and Technology, Linkou, Taiwan (S.-L.C., S.H., Y.-L.H., M.-C.L., C.-Y.C., W.-H.C.).,Department of Dermatology, Chang Gung Memorial Hospital, Xiamen, China (S.-L.C., S.H., Y.-L.H., M.-C.L., W.-H.C.)
| | - Chun-Yu Cheng
- Department of Dermatology, Vein Clinic, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan (S.-L.C., S.H., Y.-L.H., M.-C.L., C.-Y.C., W.-H.C.).,Department of Cosmetic Science, Chang Gung University of Science and Technology, Linkou, Taiwan (S.-L.C., S.H., Y.-L.H., M.-C.L., C.-Y.C., W.-H.C.)
| | - Yen-Chang Hsiao
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan (Y.-C.H.)
| | - Chee Jen Chang
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan (C.J.C., Y.-W.W.).,Research Services Center for Health Information (C.J.C., S.R.L.), Chang Gung University, Taoyuan, Taiwan.,Clinical Informatics and Medical Statistics Research Center (C.J.C., S.-W.C., Y.-W.W.), Chang Gung University, Taoyuan, Taiwan
| | - Shu Ru Lee
- Research Services Center for Health Information (C.J.C., S.R.L.), Chang Gung University, Taoyuan, Taiwan
| | - Su-Wei Chang
- Clinical Informatics and Medical Statistics Research Center (C.J.C., S.-W.C., Y.-W.W.), Chang Gung University, Taoyuan, Taiwan
| | - Yu-Wen Wen
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan (C.J.C., Y.-W.W.).,Clinical Informatics and Medical Statistics Research Center (C.J.C., S.-W.C., Y.-W.W.), Chang Gung University, Taoyuan, Taiwan
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Elshafei MN, Mohamed MFH, El-Bardissy A, Ahmed MB, Abdallah I, Elewa H, Danjuma M. Comparative effectiveness and safety of direct oral anticoagulants compared to warfarin in morbidly obese patients with acute venous thromboembolism: systematic review and a meta-analysis. J Thromb Thrombolysis 2020; 51:388-396. [PMID: 32556939 PMCID: PMC7886743 DOI: 10.1007/s11239-020-02179-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Direct oral anticoagulant (DOAC) agents are becoming the anticoagulation strategy of choice. However, their use in the treatment of acute venous thromboembolism (VTE) in morbidly obese patients (bodyweight of > 120 kg or BMI > 40 kg/m2) guarded. This is due to the scarce data supporting their use in this population. As a result, the International Society on Thrombosis and Haemostasis recommended against their use in this cohort of patients. New data emerged supporting the use of DOACs in these patients. Hence, we aimed to systematically review the literature exploring the efficacy and safety of these agents compared to warfarin in VTE treatment in morbidly obese patients. A systematic review of PubMed and EMBASE since inception until 01/04/2020. Subsequently, a non-inferiority (NI of 1.75) meta-analysis utilizing the random-effects model. Five observational studies (6585 patients) were included in our meta-analysis. DOAC analogs were non-inferior compared to warfarin in reducing the primary efficacy outcome of VTE recurrence (OR 1.07, 95% CI 0.93-1.23) and the primary safety outcome (major bleeding events) (OR 0.80, 95% CI 0.54-1.17). Our meta-analysis comprising real-world observational data concludes that the use of DOAC analogs in morbidly obese patients (bodyweight of > 120 kg or BMI > 40 kg/m2) is non-inferior with regards to efficacy and safety compared to warfarin. This finding helps to resolve the uncertainty associated with the use of DOACs in this cohort. Additionally, it invites for a confirmatory non-inferiority randomized controlled trial testing DOAC vs. Warfarin in this group of patients.
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Affiliation(s)
| | | | | | | | - Ibtihal Abdallah
- Clinical Pharmacy Department, Hamad General Hospital, Doha, Qatar
| | - Hazem Elewa
- College of Pharmacy, QU Health, Qatar University, Doha, Qatar.
| | - Mohammed Danjuma
- Internal Medicine Department, Hamad Medical Corporation, Doha, Qatar.,College of Medicine, QU Health, Qatar University, Doha, Qatar
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8
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Jun H, Hwang JW. The 100 most-cited articles on chronic venous disease: a bibliometric analysis. J Int Med Res 2020; 48:300060520918711. [PMID: 32340501 PMCID: PMC7218469 DOI: 10.1177/0300060520918711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To use bibliometric analysis to understand characteristics and trends in the research on chronic venous disease (CVD), which affects patients’ quality of life by causing pain, swelling, and ulceration. Methods We searched the Thomson Reuters Web of Science citation indexing database to identify the 100 most-cited manuscripts on CVD. The resulting articles were analyzed by title, author, institution, topic, year of publication, and country of origin. Results The Journal of Vascular Surgery published the most manuscripts on CVD (n = 36) and was the most-cited journal (n = 5356). The United Kingdom was the country with the greatest number of publications (n = 32). Imperial College London was the institution with the highest number of publications (n = 6). Endovenous thermal ablation was the most widely studied research specialty (n = 30). Conclusions Our analysis showed that the majority of CVD research is carried out in Western countries, and that the number of research studies is increasing in line with recent advances in CVD.
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Affiliation(s)
- Heungman Jun
- Department of Surgery, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Ji Woong Hwang
- Department of Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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9
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Lee QWS, Gibson K, Chan SL, Rathnaweera HP, Chong TT, Tang TY. A comparison between Caucasian and Asian superficial venous anatomy and reflux patterns – Implications for potential precision endovenous ablation therapy. Phlebology 2019; 35:39-45. [DOI: 10.1177/0268355519845984] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Objectives The aim of this study is to investigate whether there are differences between predominantly Caucasians and Asians from two disparate cohorts around the globe, with regard to their pre-operative venous reflux patterns and truncal vein characteristics, which could potentially help clinicians tailor venous treatment for chronic venous insufficiency on a more individualised basis in different parts of the world. Methods A total of 200 lower limb chronic venous insufficiency duplex studies (127 Singaporean (predominantly Asian) patients) and 200 lower limb chronic venous insufficiency duplex scans (137 Americans predominantly Caucasians) were analysed and compared for differences in venous anatomy and reflux characteristics. Results Asian patients from Singapore presented with higher CEAP scores compared to the predominantly Caucasian cohort from the US (30% CEAP 4a or greater vs. 17.5%; p < 0.01). Singaporeans had more great saphenous vein reflux starting at the sapheno-femoral junction (86% vs. 73%; p < 0.01) and ending at the ankle (93% vs. 46%; p < 0.01). Vein diameters were generally larger in the US cohort of patients (median 5.7 mm vs. 2.9 mm; p < 0.01). Conclusions The predominantly Asian cohort from Singapore had smaller diameter truncal veins, longer segments of truncal vein reflux and present later with more advanced chronic venous insufficiency compared to their American counterparts. This information could help tailor endovenous ablation on a more individualised basis in the future.
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Affiliation(s)
- QWS Lee
- Department of Vascular Surgery, Singapore General Hospital, Singapore, Singapore
| | - K Gibson
- Lake Washington Vascular Surgeons, Bellevue, WA, USA
| | - SL Chan
- Health Services Research Center, SingHealth, Singapore, Singapore
| | - HP Rathnaweera
- Department of General Surgery, Changi General Hospital, Singapore, Singapore
| | - TT Chong
- Department of Vascular Surgery, Singapore General Hospital, Singapore, Singapore
| | - TY Tang
- Department of Vascular Surgery, Singapore General Hospital, Singapore, Singapore
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10
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Chang SL, Huang YL, Lee MC, Hu S, Hsiao YC, Chang SW, Chang CJ, Chen PC. Association of Varicose Veins With Incident Venous Thromboembolism and Peripheral Artery Disease. JAMA 2018; 319:807-817. [PMID: 29486040 PMCID: PMC5838574 DOI: 10.1001/jama.2018.0246] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Varicose veins are common but rarely associated with serious health risks. Deep venous thrombosis (DVT), pulmonary embolism (PE), and peripheral artery disease (PAD) are also vascular diseases but associated with serious systemic effects. Little is known about the association between varicose veins and the incidence of other vascular diseases including DVT, PE, and PAD. OBJECTIVE To investigate whether varicose veins are associated with an increased risk of DVT, PE, or PAD. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study using claims data from Taiwan's National Health Insurance program. Patients aged 20 years and older with varicose veins were enrolled from January 1, 2001-December 31, 2013, and a control group of patients without varicose veins were matched by propensity score. Patients previously diagnosed with DVT, PE, or PAD were excluded. Follow-up ended December 31, 2014. EXPOSURES Presence of varicose veins. MAIN OUTCOMES AND MEASURES Incidence rates of DVT, PE, and PAD were assessed in people with and without varicose veins. Cox proportional hazards models were used to estimate relative hazards, with the control group as reference. RESULTS There were 212 984 patients in the varicose veins group (mean [SD] age, 54.5 [16.0] years; 69.3% women) and 212 984 in the control group (mean [SD] age, 54.3 [15.6] years; 70.3% women). The median follow-up duration was 7.5 years for DVT, 7.8 years for PE, and 7.3 years for PAD for patients with varicose veins, and for the control group, follow-up duration was 7.6 years for DVT, 7.7 years for PE, and 7.4 years for PAD. The varicose veins group had higher incidence rates than the control group for DVT (6.55 vs 1.23 per 1000 person-years [10 360 vs 1980 cases]; absolute risk difference [ARD], 5.32 [95% CI, 5.18-5.46]), for PE (0.48 for the varicose veins group vs 0.28 for the control group per 1000 person-years [793 vs 451 cases]; ARD, 0.20 [95% CI, 0.16-0.24]), and for PAD (10.73 for the varicose veins group vs 6.22 for the control group per 1000 person-years [16 615 vs 9709 cases]; ARD, 4.51 [95% CI, 4.31-4.71]). The hazard ratios for the varicose veins group compared with the control group were 5.30 (95% CI, 5.05-5.56) for DVT, 1.73 (95% CI, 1.54-1.94) for PE, and 1.72 (95% CI, 1.68-1.77) for PAD. CONCLUSIONS AND RELEVANCE Among adults diagnosed with varicose veins, there was a significantly increased risk of incident DVT; the findings for PE and PAD are less clear due to the potential for confounding. Whether the association between varicose veins and DVT is causal or represents a common set of risk factors requires further research.
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Affiliation(s)
- Shyue-Luen Chang
- Vein Clinic, Department of Dermatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Chang Gung University College of Medicine, Taoyuan, Taiwan
- Department of Cosmetic Science, Chang Gung University of Science and Technology, Linkou, Taiwan
| | - Yau-Li Huang
- Vein Clinic, Department of Dermatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Chang Gung University College of Medicine, Taoyuan, Taiwan
- Department of Cosmetic Science, Chang Gung University of Science and Technology, Linkou, Taiwan
| | - Mei-Ching Lee
- Vein Clinic, Department of Dermatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Chang Gung University College of Medicine, Taoyuan, Taiwan
- Department of Cosmetic Science, Chang Gung University of Science and Technology, Linkou, Taiwan
| | - Sindy Hu
- Vein Clinic, Department of Dermatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Chang Gung University College of Medicine, Taoyuan, Taiwan
- Department of Cosmetic Science, Chang Gung University of Science and Technology, Linkou, Taiwan
- Department of Dermatology, Xiamen Chang Gung Hospital, Xiamen, China
| | - Yen-Chang Hsiao
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Su-Wei Chang
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University College of Medicine, Taoyuan, Taiwan
- Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chee Jen Chang
- Research Services Center for Health Information, Graduate Institute of Clinical Medicine, Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan
- Department of Cardiovascular Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Pei-Chun Chen
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University College of Medicine, Taoyuan, Taiwan
- Department of Public Health, China Medical University, Taichung, Taiwan
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11
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Kanchanabat B, Stapanavatr W. Venous ultrasonography findings and clinical correlations in 104 Thai patients with chronic venous insufficiency of the legs. Singapore Med J 2017; 59:155-158. [PMID: 28503700 DOI: 10.11622/smedj.2017043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The pattern of venous reflux in Thai patients with chronic venous insufficiency (CVI) was studied in correlation with clinical manifestations. METHODS Ultrasonography findings and clinical data were prospectively collected and retrospectively reviewed. RESULTS CVI was found in 104 legs of 79 patients (mean age 59.8 ± 12.5 years; C4: 24.1%, C5: 8.9%, C6: 67.1%). 6.7% of the legs had a history of deep vein thrombosis (DVT). The prevalence of superficial vein reflux (SVR), deep vein reflux (DVR), and combined SVR and DVR in 90 legs without previous venous surgery was 82.2%, 63.3% and 57.8%, respectively. In legs with SVR, the prevalence of great saphenous vein reflux (GSVR), small saphenous vein reflux (SSVR), and combined GSVR and SSVR was 91.9%, 33.8% and 25.7%, respectively. 77.0% of SVR involved the calf segment. For medial ulceration, 79.6% had GSVR and 35.2% had SSVR. For lateral ulceration, 46.7% had SSVR and 33.3% had isolated GSVR. Pulsatile venous signal was found in 3.3% of legs. In 17 legs with ulceration after previous surgical treatment, calf vein reflux (residual calf great saphenous vein or small saphenous vein) was found in 13 (76.5%) legs. CONCLUSION Calf vein reflux plays an important role in CVI and in patients with recurrent ulceration after previous superficial venous surgery. Although GSVR was present in most patients with CVI in the legs, SSVR may present in one-third of patients, especially those with lateral ulceration. The high prevalence of DVR in the absence of DVT and the presence of a pulsatile venous signal in some patients highlight the incomplete understanding of CVI aetiology.
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Affiliation(s)
- Burapa Kanchanabat
- Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Waigoon Stapanavatr
- Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
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Khan AFA, Chaudhri R, Ashraf MA, Mazaffar MS, Zawar-ul-Imam S, Tanveer M. Prevalence and presentation of chronic venous disease in Pakistan: a multicentre study. Phlebology 2013; 28:74-9. [DOI: 10.1258/phleb.2012.011122] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Our objective was to study the prevalence and clinical pattern of chronic venous disease (CVD) in the Pakistani population. This was a multicentre cross-sectional study in which 100 primary care physicians examined 3000 subjects. The study population was aged 18–95 years (mean ± SD = 39 ± 13.2) comprised 47.4% women and 52.6% men. The prevalence of CVD was 34.8%, being significantly higher ( P < 0.04) among men (36.4%) than women (33.0%). The maximum prevalence was of C3 (36.7%), followed by C2 (15.8%). The most frequent symptom was pain in the legs (59.2%) followed by heavy legs (42.7%) and night cramps (34.4%). The prevalence of symptoms increased with age but was similarly distributed between men and women. Family history of CVD, blood clots in veins and lack of exercise were significant risk factors. The roles of age or gender as risk factors could not be established. In conclusion, the prevalence and presentation of CVD in Pakistan is similar to most other countries.
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Affiliation(s)
| | | | - M A Ashraf
- Social Security Hospital, Model Town, Faisalabad
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13
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Kanchanabat B, Wongmahisorn Y, Stapanavatr W, Kanchanasuttirak P, Manomaiphiboon A. Clinical Presentation and Patterns of Venous Reflux in Thai Patients with Chronic Venous Insufficiency (CVI). Eur J Vasc Endovasc Surg 2010; 40:399-402. [DOI: 10.1016/j.ejvs.2010.04.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2009] [Accepted: 04/17/2010] [Indexed: 10/19/2022]
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Kelechi TJ, McNeil RB. A pilot study of venous photoplethysmography screening of patients with chronic venous disorders. Appl Nurs Res 2010; 23:178-83. [PMID: 20643329 DOI: 10.1016/j.apnr.2008.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2008] [Revised: 06/24/2008] [Accepted: 06/30/2008] [Indexed: 11/24/2022]
Abstract
In office and clinical practice settings, standard methods do not exist to objectively quantify lower extremity venous dysfunction. This pilot feasibility study examined venous refill time, an objective measure of skin microcirculation reflux, using photoplethysmography in 13 patients with known chronic venous disorders. The test was found to be feasible and easy to administer and provided objective data to corroborate clinical signs. Further research is needed to evaluate and validate the relationships among clinical signs, comorbid conditions, and objective findings with the severity of venous dysfunction in patients with suspected or known chronic venous disorders.
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Affiliation(s)
- Teresa J Kelechi
- College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas Street, MSC 160, USA.
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Robertson L, Lee AJ, Gallagher K, Carmichael SJ, Evans CJ, McKinstry BH, Fraser SC, Allan PL, Weller D, Ruckley CV, Fowkes FG. Risk factors for chronic ulceration in patients with varicose veins: A case control study. J Vasc Surg 2009; 49:1490-8. [DOI: 10.1016/j.jvs.2009.02.237] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2008] [Revised: 02/20/2009] [Accepted: 02/23/2009] [Indexed: 10/20/2022]
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Kelechi TJ, Bonham PA. Measuring venous insufficiency objectively in the clinical setting. JOURNAL OF VASCULAR NURSING 2008; 26:67-73. [DOI: 10.1016/j.jvn.2008.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2008] [Revised: 05/11/2008] [Accepted: 05/13/2008] [Indexed: 10/21/2022]
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