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Kienzl P, Deinsberger J, Weber B. Chronic Venous Disease: Pathophysiological Aspects, Risk Factors, and Diagnosis. Hamostaseologie 2024; 44:277-286. [PMID: 38991541 DOI: 10.1055/a-2315-6206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024] Open
Abstract
Chronic venous disease (CVD) is highly prevalent in the general population and encompasses a range of pathological and hemodynamic changes in the veins of the lower extremities. These alterations give rise to a variety of symptoms, with more severe forms resulting in venous ulceration, which causes morbidity and high socioeconomic burden. The origins and underlying mechanisms of CVD are intricate and multifaceted, involving environmental factors, genetics, hormonal factors, and immunological factors that bring about structural and functional alterations in the venous system. This review offers the latest insights into the epidemiology, pathophysiology, and risk factors of CVD, aiming to provide a comprehensive overview of the current state of knowledge. Furthermore, the diagnostic approach for CVD is highlighted and current diagnostic tools are described.
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Affiliation(s)
- Philip Kienzl
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Julia Deinsberger
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Benedikt Weber
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
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2
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Almutiri BM, Alshammari AM, Alharbi SB, Alamri LM, Alsuhaibani AN, Alenazi RS, Alfarhan GK. Evaluating the Prevalence and Risk Factors of Varicose Veins in Surgeons and Operating Room Staff at Buraidah Center Hospital. Cureus 2024; 16:e51706. [PMID: 38187031 PMCID: PMC10768938 DOI: 10.7759/cureus.51706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2024] [Indexed: 01/09/2024] Open
Abstract
Background Varicose veins (VVs), which are characterized by visible, convoluted veins in the lower limbs, are a prevalent disorder that afflicts a substantial portion of the population. The purpose of this cross-sectional study was to look at the prevalence and risk factors for VVs among surgeons and operating room personnel at Buraidah Central Hospital in Saudi Arabia. They usually become worse over time once they develop, which highlights the importance of early intervention and preventive actions. Methodology Data from 91 participants were collected from diverse healthcare professionals between August 2023 and September 2023 via an online questionnaire covering demographics, health, and occupational factors. The chi-square and Fisher's exact tests were employed to examine the correlation between these variables and the occurrence of VVs. Results The data analysis revealed that several specific factors displayed notable associations. Occupations as Surgical Physicians, OR Staff, or Nurse (p=0.009), the number of days worked in the operating room (p=0.040), the role in the operating room, especially those mainly standing (p=0.001), contraceptive pill usage (p=0.000), and vaginal delivery (p=0.037) displayed statistically significant relationships with VVs. In contrast, factors like gender, age group, ethnicity, family history of VVs, social status, smoking habits, exercise frequency, BMI, lifting heavy objects, and years in the field did not reveal substantial associations with VVs, as indicated by p-values exceeding 0.05. Conclusion The study identified a low VV diagnosis prevalence, with an equal distribution among male and female respondents. Key factors that contribute to the risk of developing VVs include the number of days worked in the operating room, the role in the operating room, a family history of VVs, contraceptive pill usage, and the method of delivery.
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Affiliation(s)
| | - Ahmed M Alshammari
- General Surgery, Saudi Commission for Health Specialties, Buraidah Central Hospital, Buraidah, SAU
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3
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Keles A, Karaman SK, Duzgun AC, Buyuksireci M, Bayraktaroglu MS. Association between lower extremity venous insufficiency and increased choroidal thickness. J Fr Ophtalmol 2023:S0181-5512(23)00120-1. [PMID: 36948916 DOI: 10.1016/j.jfo.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 01/23/2023] [Indexed: 03/24/2023]
Abstract
PURPOSE The goal of this study is to investigate the association between the choroid and lower extremity venous insufficiency (LEVI). METHODS This prospective cross-sectional study includes 56 patients with LEVI and 50 age/sex-similar control subjects. Choroidal thickness (CT) measurements from 5 different points were captured from all participants by optical coherence tomography. In the group with LEVI on physical examination, reflux at the saphenofemoral junction, and the diameter of the great and small saphenous veins were evaluated via color Doppler ultrasonography. RESULTS The mean subfoveal CT was higher in the varicose group than in the control group (363.04±99.75μm vs. 320.30±73.46μm, P=0.013). In addition, the CTs at the temporal 3mm, temporal 1mm, nasal 1mm, and nasal 3mm distance from the fovea were higher in the LEVI group compared to the controls (for all, P<0.05). There was no correlation between CT and diameter of the great and small saphenous vein in patients with LEVI (for all, P>0.05). However, the great and small saphenous veins of patients with CT above 400μm were observed to be wider in patients with LEVI (P=0.027 and P=0.007, respectively). CONCLUSION Varicose veins can be a feature of systemic venous pathology. Another component of systemic venous disease may be increased CT. Patients with high CT should be investigated for susceptibility to LEVI.
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Affiliation(s)
- A Keles
- Department of Ophthalmology, Faculty of Medicine, Bilecik Seyh Edebali University, Bilecik, Turkey.
| | - S K Karaman
- Department of Ophthalmology, University of Health Sciences, Ankara Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - A C Duzgun
- Department of Cardiovascular Surgery, Ankara Training and Research Hospital, Ankara, Turkey
| | - M Buyuksireci
- Department of Radiology, Çorum Private Hospital, Çorum, Turkey
| | - M S Bayraktaroglu
- Department of Cardiovascular Surgery, Ankara Training and Research Hospital, Ankara, Turkey
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Aslam MR, Muhammad Asif H, Ahmad K, Jabbar S, Hayee A, Sagheer MS, Rehman JU, Khalid S, Hashmi AS, Rajpoot SR, Sharif A. Global impact and contributing factors in varicose vein disease development. SAGE Open Med 2022; 10:20503121221118992. [PMID: 36051783 PMCID: PMC9425889 DOI: 10.1177/20503121221118992] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 07/21/2022] [Indexed: 11/29/2022] Open
Abstract
Varicose veins are convoluted, expanded, and stretched subcutaneous veins of the lower leg and are the most frequently reported medical condition. This condition has a higher prevalence in Western and developed countries. Inadequacy of the valves results in reflux of blood in the veins of the lower leg. The present study aims to describe the epidemiology and contributing factors (risk factors and pathological factors) in the development of varicose veins disease. PubMed/Medline, Science Direct, Google Scholar, SciFinder, Scopus, and Web of Science databases were explored to include potential research and review articles. Finally, 65 articles were considered appropriate to include in the study. Pain, swelling, heaviness, and tingling of the lower limbs are the most common sign and symptoms caused by varicose veins while in some individuals it is asymptomatic. The Prevalence of varicose veins varies geographically. Currently, it is reported that globally about 2%–73% of the population is affected by varicose veins while the prevalence rate in Pakistan is 16%–20%. Different risk factors associated with the advancement of varicose veins are age, gender, occupation, pregnancy, family history, smoking, BMI and obesity, exercise, genetic factor, and current lifestyle. In varicose veins, some contributory elements may also play an important role in the disease development, incorporating constant venous wall aggravation, hereditary variation, and persistent venous hypertension. This condition has now turned into a curable issue that was previously viewed broadly as less important for treatment, determining the individual’s satisfaction. Moreover, the mechanisms behind the risk factors involve diet, physical work, and hormonal contribution. These are more likely to be explored.
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Affiliation(s)
- Muhammad Rahil Aslam
- University College of Conventional Medicine, Faculty of Medicine and Allied Health Sciences, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Hafiz Muhammad Asif
- University College of Conventional Medicine, Faculty of Medicine and Allied Health Sciences, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Khalil Ahmad
- University College of Conventional Medicine, Faculty of Medicine and Allied Health Sciences, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Sana Jabbar
- Department of Eastern Medicine, Qarshi University, Lahore, Pakistan
| | - Abdul Hayee
- University College of Conventional Medicine, Faculty of Medicine and Allied Health Sciences, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Muhammad Shahid Sagheer
- University College of Conventional Medicine, Faculty of Medicine and Allied Health Sciences, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Jalil Ur Rehman
- University College of Conventional Medicine, Faculty of Medicine and Allied Health Sciences, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Sana Khalid
- Department of Eastern Medicine, Government College University Faisalabad, Faisalabad, Pakistan
| | - Abdul Sattar Hashmi
- University College of Conventional Medicine, Faculty of Medicine and Allied Health Sciences, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Sehrish Rana Rajpoot
- University College of Conventional Medicine, Faculty of Medicine and Allied Health Sciences, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Aamir Sharif
- Department of Pathology, Sargodha Medical College, University of Sargodha, Sargodha, Pakistan
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Ali SA, Najmi WK, Hakami FM, Almubarak AA, Alhassan RA, Maafa SH, Al-Amer MA, Dighriri IM. Prevalence of Varicose Veins Among Nurses in Different Departments in Jazan Public Hospitals, Saudi Arabia: A Cross-Sectional Study. Cureus 2022; 14:e24462. [PMID: 35637826 PMCID: PMC9131706 DOI: 10.7759/cureus.24462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2022] [Indexed: 11/05/2022] Open
Abstract
Varicose veins (VV) in the lower limbs are the most prevalent vascular condition in humans. They can cause significant signs and symptoms and, in extreme cases, death. This study aims to investigate the prevalence and identify the risk factors for varicose veins among nurses working in multiple departments at Jazan King Fahd Central Hospital and Prince Muhammad bin Nasser Hospital. A cross-sectional study was conducted by sending a questionnaire to female and male nurses in these hospitals. This study included 482 nurses, 415 (86.1%) of whom were female and 67 (13.9%) male. The prevalence of varicose veins among the nurses of both hospitals was 76 (15.8%), compared with 406 (84.2%) not diagnosed with varicose veins. The prevalence of varicose veins was 67 (88.2%) in female nurses, compared with 9 (11.8%) in male nurses. The risk factors associated with varicose veins were ethnicity (p = 0.007), carrying heavy items (p = 0.001), lack of exercise (p = 0.031), family history (p = 0.001), use of hormonal therapy (p = 0.001), use of contraceptive pills (p = 0.0035), type of delivery (p = 0.002), number of children (p = 0.004), and hours sitting per shift (p = 0.002). The comorbidities associated with varicose veins were deep vein thrombosis (p = 0.001), hypertension (p = 0.002), chronic constipation (p = 0.006), diabetes (p = 0.001), kidney disease (p = 0.001), rheumatoid arthritis (p = 0.001), coronary artery disease, and severe occupational injury to the lower extremities (p = 0.001). Nurses are responsible for most of the health system's services. Increasing the number of nursing workers for patient care, encouraging physical exercise, and lowering the pension age appear to be required to avoid the occurrence and development of varicose veins among nurses.
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Affiliation(s)
- Suhaila A Ali
- Family and Community Medicine Department, Jazan University, Jazan, SAU
| | - Waad K Najmi
- Medicine, College of Medicine, Jazan University, Jazan, SAU
| | | | | | | | - Shahad H Maafa
- Medicine, College of Medicine, Jazan University, Jazan, SAU
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DeCarlo C, Boitano LT, Waller HD, Pendleton AA, Latz CA, Tanious A, Kim Y, Mohapatra A, Dua A. Pregnancy Conditions and Complications Associated with the Development of Varicose Veins. J Vasc Surg Venous Lymphat Disord 2022; 10:872-878.e68. [PMID: 35074521 DOI: 10.1016/j.jvsv.2022.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 01/08/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pregnancy is a known risk factor for developing varicose veins (VV). However, pregnancy is often considered a homogeneous entity and few studies have examined if specific characteristics and complications of pregnancy may influence VV formation. This study sought to identify which pregnancy-specific factors are associated with the development of VV. METHODS All women who gave birth (live or still) between 1998-2020 within a multicenter healthcare system were retrospectively identified and followed through all hospital encounters (inpatient and outpatient). The primary outcome was VV, defined as any encounter with a primary diagnosis code for VV or procedure for VV. The study period for each woman was the time from the first to last encounter. Extended Cox regression modeling evaluated the association between VV and pregnancy-related factors as a time-varying covariates while controlling for patient comorbidities. RESULTS There were 156,622 women with a median follow-up of 8.3 years (IQR: 2.7-16.6 years) included. During this time, 225,758 deliveries occurred. The 10- and 20-year freedom from VV was 97.0% (95%CI: 96.8-97.1%) and 92.7% (95%CI: 92.4-93.0%), respectively, from the estimated start of first pregnancy. Overall, 4,028 (2.57%) developed VV during the follow-up period and 1,594 (1.02%) underwent a procedure for VV. After risk adjustment, increasing parity was significantly associated with VV, with each subsequent pregnancy increasing hazard of developing VV (parity=1: HR 1.78; 95%CI: 1.55-1.99; p<0.001; parity≥6: HR 4.83; 95%CI: 2.15-1.99-10.9; p<0.001), Other significant pregnancy factors included excessive weight gain in pregnancy (HR 1.44; 95%CI: 1.09-1.91; p=0.011), post-term pregnancy (HR 1.12; 95%CI: 1.02-1.21; p=0.021), preeclampsia (HR 0.79; 95%CI: 0.70-0.90; p<0.001), and postpartum transfusion of platelets, plasma, or cryoprecipitate (HR 2.05; 95%CI: 1.19-3.53; p=0.001). CONCLUSION Increasing parity, excessive weight gain in pregnancy, post-term pregnancy, and preeclampsia affect the development of VV after pregnancy. Though varicose veins after pregnancy are likely underreported and true incidence is unknown, women should be counseled about the impact of these factors on VV development after pregnancy.
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Affiliation(s)
- Charles DeCarlo
- Division of Vascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA.
| | - Laura T Boitano
- Division of Vascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Harold D Waller
- Division of Vascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Anna A Pendleton
- Division of Vascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Christopher A Latz
- Division of Vascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Adam Tanious
- Division of Vascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Young Kim
- Division of Vascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Abhisekh Mohapatra
- Division of Vascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Anahita Dua
- Division of Vascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA
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AlBader B, Sallam A, Moukaddem A, Alanazi K, Almohammed S, Aldabas H, Algmaizi S. Prevalence of Varicose Veins Among Nurses at Different Departments in a Single Tertiary Care Center in Riyadh. Cureus 2020; 12:e12319. [PMID: 33520517 PMCID: PMC7835718 DOI: 10.7759/cureus.12319] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background Varicose veins (VV) is a chronic venous disease that affects the lower extremities. It is the dilation of subcutaneous veins, three to four millimeters in diameter. VV can be attributed to several risk factors such as age, obesity, multiple parities, heavy lifting, and long-standing hours. Direct and indirect complications can occur due to VV. Several studies were conducted to estimate the prevalence of VV. Methods A self-administered questionnaire was used to estimate the prevalence of VV among nurses from different departments in the National Guard Health Affairs (NGHA), Riyadh, Saudi Arabia. The questionnaire included questions on weight, height, work history, lifestyle, and multiple diseases. The chi-square test and Fisher’s exact test were used for testing the association between the various predictors and the diagnosis of VV. Results A total of 366 nurses participated in the study. There were 40 (39 females and one male) cases of VV accounting for 11.0%. Variables that have a statistically significant association with VV were social status and lifting heavy objects (p=0.02), a family history of VV (p-value=<0.001), and the number of childbirths (p=0.04). The observation of each department was not statistically significant with VV (p=0.35). Conclusion Among nurses, positive family history, age, marital status, long-standing hours, and heavy object lifting were significant risk factors for the development of VV. However, the prevalence of VV in the four departments was low.
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Affiliation(s)
- Bader AlBader
- Family Medicine, King Abdulaziz Medical City, Riyadh, SAU
| | - Asma Sallam
- Medicine, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Afaf Moukaddem
- Medical Education, King Saud Bin Abdulaziz University for Health Science, Riyadh, SAU
| | - Kout Alanazi
- Medicine, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Sara Almohammed
- Medicine, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Haya Aldabas
- Medicine, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Shahad Algmaizi
- Medicine, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
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Global Epidemiology of Chronic Venous Disease: A Systematic Review with Pooled Prevalence Analysis. Ann Surg 2020; 274:971-976. [PMID: 33214466 DOI: 10.1097/sla.0000000000004631] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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.
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AGE, BODY MASS INDEX, BODY COMPOSITION IN POSTMENOPAUSAL WOMEN WITH CHRONIC VENOUS DISEASE. WORLD OF MEDICINE AND BIOLOGY 2020. [DOI: 10.26724/2079-8334-2020-2-72-94-98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Torres C, Machado R, Lima M. Flow cytometric characterization of the saphenous veins endothelial cells in patients with chronic venous disease and in patients undergoing bypass surgery: an exploratory study. Heart Vessels 2019; 35:1-13. [PMID: 31227876 DOI: 10.1007/s00380-019-01451-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 06/14/2019] [Indexed: 10/26/2022]
Abstract
Recent findings have suggested that the primary factors for development of chronic venous disease (CVD), which commonly manifests as varicose veins (VV), are due to structural and biochemical modifications of the vessel wall. The aim of this exploratory study was to characterize by flow cytometry the endothelial cells (EC) mechanically extracted from the varicose saphenous veins (VSV) segments of patients submitted to VV surgery, and to compare the expression of cell surface molecules in these EC with that observed in the EC from the graft SV (GSV) of patients undergoing bypass surgery. EC were isolated from distal- (varicose trunk) and from proximal- (nearly normal) VSV segments of 30 patients submitted to VV surgery, and from proximal GSV segments of 20 patients submitted to bypass surgery (control group), using a mechanical method, and their immunophenotype was characterized by flow cytometry. EC were identified as being CD45negCD146brightCD31bright, and analyzed for expression of activation-related (CD54, CD62E, CD106), procoagulant (CD142), and cell junction (CD31, CD146) molecules, and for the scavenger receptor, CD36. The EC harvested from the SV segments of CVD patients had lower expression of all the molecules evaluated, in comparison to controls; these differences were more evident for the EC isolated from the distal-VSV. The EC extracted from the proximal- and distal-VSV segments of the CVD patients also differ from each other, the first having lower levels of CD62E, CD106, CD142 and CD36. Groups did not match for gender and controls were heterogeneous concerning the underlying pathologies, which may have a confounding effect. Our study revealed that the EC isolated from varicose (distal) and nearly normal (proximal) VSV segments of the CVD patients differ phenotypically from each other, and from the EC of the control group. The VSV segments more affected by the CVD have the lowest expression of the studied markers. We hypothesize that CVD is associated with a decrease on the EC surface molecules, causing EC dysfunctionality. Further studies with a large number of gender-matched participants are needed, to confirm the results obtained in this exploratory study.
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Affiliation(s)
- Cláudia Torres
- Laboratório de Citometria, Serviço de Hematologia Clínica, Hospital de Santo António (HSA), Centro Hospitalar Universitário do Porto (CHUP), Rua D. Manuel II 57, 4050-014, Porto, Portugal. .,Unidade Multidisciplinar de Investigação Biomédica, Instituto de Ciências Biomédicas Abel Salazar da Universidade do Porto (UMIB/ICBAS/UP), Rua Jorge Viterbo Ferreira 228, 4050-343, Porto, Portugal.
| | - Rui Machado
- Serviço de Angiologia e Cirurgia Vascular, Hospital de Santo António (HSA), Centro Hospitalar Universitário do Porto (CHUP), Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Margarida Lima
- Laboratório de Citometria, Serviço de Hematologia Clínica, Hospital de Santo António (HSA), Centro Hospitalar Universitário do Porto (CHUP), Rua D. Manuel II 57, 4050-014, Porto, Portugal.,Unidade Multidisciplinar de Investigação Biomédica, Instituto de Ciências Biomédicas Abel Salazar da Universidade do Porto (UMIB/ICBAS/UP), Rua Jorge Viterbo Ferreira 228, 4050-343, Porto, Portugal
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Tuncer Çoban P, Dirimeşe E. Evaluation of quality of life after minimally invasive varicose vein treatment. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2019; 27:49-56. [PMID: 32082827 PMCID: PMC7021368 DOI: 10.5606/tgkdc.dergisi.2019.16867] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 10/25/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND This cross-sectional study aims to evaluate the changes in quality of life after minimally invasive procedures in patients with varicose veins. METHODS The study included 150 patients (58 males, 92 females; mean age 47.1±12.0; range, 19 to 80 years) with varicose veins who were treated using minimally invasive techniques. Data were collected using patient information forms and the Venous Insufficiency Epidemiological and Economic Study-Quality of life/Symptoms questionnaire. Before the minimally invasive procedures, patients were informed about varicose veins and medical approaches for relief. They were also provided information about the use of compression stockings. Varicose vein symptoms and quality of life were evaluated before the minimally invasive procedures and four weeks following the last operation. RESULTS Females, individuals aged between 51-60 years, those with Body Mass Index >30, or having had a pregnancy had higher prevalence of variceal disease and lower quality of life. Clinical severity of the disease decreased and the quality of life improved in patients treated with minimally invasive procedures. After treatment, 45.33% of patients put on compression stockings regularly for one month. CONCLUSION After minimally invasive treatment, severe disease symptoms decreased and quality of life increased in patients with varicose veins. Lifestyle modifications, use of compression stockings, and roles of nurses and healthcare workers are significant in maintaining healthy veins.
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Affiliation(s)
- Pelin Tuncer Çoban
- Department of Orthopedics and Traumatology, Tunceli State Hospital, Tunceli, Turkey
| | - Elif Dirimeşe
- Department of Nursing, Faculty of Health Sciences, Bulent Ecevit University, Zonguldak, Turkey
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Cappelli M, Molino-Lova R, Giangrandi I, Ermini S, Gianesini S. Ligation of the saphenofemoral junction tributaries as risk factor for groin recurrence. J Vasc Surg Venous Lymphat Disord 2017; 6:224-229. [PMID: 29290602 DOI: 10.1016/j.jvsv.2017.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 09/07/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The aim of this study was to compare the recurrence rate after high ties performed with or without sparing of the saphenofemoral junction tributaries. METHODS There were 867 lower limbs enrolled. All patients underwent a high tie with (group A) or without (group B) ligation of all the junctional tributaries for a great saphenous vein reflux (C2-5EpAsPr). A duplex ultrasound examination detected recurrences. RESULTS Median follow-up was 5 years (interquartile range, 3-8 years). Group A had a higher recurrence rate than group B (odds ratio, 7.52; P < .001). Group A recurrences (7.4%), compared with group B (1.1%), presented with a more frequent direct stump reconnection (3.7% vs 0.2%; P < .001) or newly developed pelvic shunts (3% vs 0.5%; P < .001). No significant difference was reported between the two groups in newly incompetent perforating veins. CONCLUSIONS Ligation of the junctional tributaries is associated with a higher recurrence risk. Further investigations are needed to determine the hemodynamic role of each single junctional tributary.
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Affiliation(s)
| | | | | | | | - Sergio Gianesini
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Md.
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Quality of life after great saphenous vein ablation in Thai patients with great saphenous vein reflux. Asian J Surg 2017; 40:295-300. [DOI: 10.1016/j.asjsur.2015.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 09/21/2015] [Accepted: 10/01/2015] [Indexed: 11/18/2022] Open
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14
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Abelyan G, Abrahamyan L, Yenokyan G. A case-control study of risk factors of chronic venous ulceration in patients with varicose veins. Phlebology 2017; 33:60-67. [DOI: 10.1177/0268355516687677] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background/objectives Venous ulcers carry psychological and high financial burden for patients, causing depression, pain, and limitation of mobility. The study aimed to identify factors associated with an increased risk of venous ulceration in patients with varicose veins in Armenia. Methods A case-control study design was utilized enrolling 80 patients in each group, who underwent varicose treatment surgery in two specialized surgical centers in Armenia during 2013–2014 years. Cases were patients with varicose veins and venous leg ulcers. Controls included patients with varicose veins but without venous leg ulcers. Data were collected using interviewer-administered telephone interviews and medical record abstraction. Multiple logistic regression analysis was used to identify the risk factors of venous ulceration. Results There were more females than males in both groups (72.5% of cases and 85.0 % of controls). Cases were on average older than controls (53.9 vs. 39.2 years old, p ≤ 0.001). After adjusting for potential confounders, the estimated odds of developing venous ulcer was higher in patients with history of post thrombotic syndrome (odds ratio = 14.90; 95% confidence interval: 3.95–56.19; p = 0.001), with higher average sitting time (odds ratio = 1.32 per hour of sitting time; 95% confidence interval: 1.08–1.61; p = 0.006), those with reflux in deep veins (odds ratio = 3.58; 95% confidence interval: 1.23–10.31; p = 0.019) and history of leg injury (odds ratio = 3.12; 95% confidence interval: 1.18–8.23; p = 0.022). Regular exercise in form of walking (≥5 days per week) was found to be a protective factor from venous ulceration (odds ratio = 0.26; 95% confidence interval: 0.08–0.90; p = 0.034). Conclusion We found that reflux in deep veins, history of leg injury, history of post thrombotic syndrome, and physical inactivity were significant risk factors for venous ulceration in patients with varicose veins, while regular physical exercise mitigated that risk. Future studies should investigate the relationships between the duration and type of regular exercise and the risk of venous ulceration to make more specific recommendations on preventing ulcer development.
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Affiliation(s)
- Gohar Abelyan
- School of Public Health, American University of Armenia, Yerevan, Armenia
| | - Lusine Abrahamyan
- School of Public Health, American University of Armenia, Yerevan, Armenia
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
| | - Gayane Yenokyan
- School of Public Health, American University of Armenia, Yerevan, Armenia
- Johns Hopkins Biostatistics Center, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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15
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Soydan E, Yılmaz E, Baydur H. Effect of socio-demographic characteristics and clinical findings on the quality of life of patients with chronic venous insufficiency. Vascular 2016; 25:382-389. [DOI: 10.1177/1708538116685945] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective This study was planned and implemented to evaluate the effect of socio-demographic characteristics and clinical findings on the quality of life of patients with chronic venous insufficiency. Methods The sample of this cross-sectional study consisted of 163 patients that presented with the diagnosis of chronic venous insufficiency to the cardiovascular surgery clinic of an education and research hospital in the west of Turkey. The data were collected during face-to-face interviews using a personal information form, clinical, etiology, anatomy, pathophysiology classification, venous insufficiency epidemiological and economic study-quality of life/symptoms scales and the Short Form-36. Descriptive statistics as well as univariate and multivariate analyses were used to analyze the data. Results The chronic venous insufficiency patients were found to have a low quality of life. Advanced age, higher body mass index, longer working times, being on regular medication, hypertension and presence of pigmentation according to the clinical, etiology, anatomy, pathophysiology classification were found to be associated with a reduced physical score in SF-36. Furthermore, longer weekly working hours and presence of pigmentation reduced the Venous Insufficiency Epidemiological and Economic Study-Quality of Life/Symptoms scores. Undertaking physical exercise at twice and more than twice a week increased the overall physical scores in SF-36. Conclusions The results of the study showed that the quality of life of chronic venous insufficiency patients are affected by not only physical characteristics, working hours and physical activity but also presence of edema and pigmentation.
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Affiliation(s)
- Ebru Soydan
- Department of Surgical Nursing, Institute of Health Science, Celal Bayar University, Manisa, Turkey
| | - Emel Yılmaz
- Department of Surgical Nursing, Faculty of Health Science, Celal Bayar University, Manisa, Turkey
| | - Hakan Baydur
- Department of Social Work, Faculty of Health Science, Celal Bayar University, Manisa, Turkey
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Cushman M, O'Meara ES, Heckbert SR, Zakai NA, Rosamond W, Folsom AR. Body size measures, hemostatic and inflammatory markers and risk of venous thrombosis: The Longitudinal Investigation of Thromboembolism Etiology. Thromb Res 2016; 144:127-32. [PMID: 27328432 PMCID: PMC4980192 DOI: 10.1016/j.thromres.2016.06.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/25/2016] [Accepted: 06/12/2016] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Obesity is an important venous thrombosis (VT) risk factor but the reasons for this are unclear. MATERIALS AND METHODS In a cohort of 20,914 individuals aged 45 and older without prior VT, we calculated the relative risk (RR) of VT over 12.6years follow-up according to baseline body size measures, and studied whether associations were mediated by biomarkers of hemostasis and inflammation that are related to adiposity. RESULTS Greater levels of all body size measures (weight, height, waist, hip circumference, calf circumference, body-mass index, waist-hip ratio, fat mass and fat-free mass) were associated with increased risk of VT, with 4th versus 1st quartile RRs of 1.5-3.0. There were no multiplicative interactions of biomarkers with obesity status. Adjustment for biomarkers associated with VT risk and body size (factors VII and VIII, von Willebrand factor, partial thromboplastin time, D-dimer, C-reactive protein and factor XI) only marginally lowered, or did not impact, the RRs associated with body size measures. CONCLUSIONS Greater body size, by multiple measures, is a risk factor for VT. Associations were not mediated by circulating levels of studied biomarkers suggesting that body size relates to VT because of physical factors associated with blood flow, not the hypercoagulability or inflammation associated with adiposity.
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Affiliation(s)
| | | | | | | | - Wayne Rosamond
- University of North Carolina, Chapel Hill, United States
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17
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Matic M, Matic A, Djuran V, Gajinov Z, Prcic S, Golusin Z. Frequency of Peripheral Arterial Disease in Patients With Chronic Venous Insufficiency. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e20781. [PMID: 26889387 PMCID: PMC4752728 DOI: 10.5812/ircmj.20781] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Revised: 08/08/2014] [Accepted: 09/06/2014] [Indexed: 11/27/2022]
Abstract
Background: It is estimated that about 15% (10% - 30% in most of the studies) of the total adult population has some aspects of the Chronic Venous Insufficiency (CVI). Frequency of the Peripheral Arterial Disease (PAD) in the adult population is 3% - 4%. Studies dealing with etiopathogenesis of leg ulcers show that between 10% and 18% of all ulcers are of mixed, arterial-venous origin. Objectives: The purpose of this study was to find out if there is a higher frequency of PAD among CVI patients in comparison with the control group, as well as to discover some common risk factors for CVI and PAD. Patients and Methods: This cross-sectional descriptive study was conducted at the dermatovenereological clinic, clinical center of Vojvodina, Serbia. A total of 162 examinees were included. All patients were examined for the existence of CVI and staged according to CEAP (Clinical, etiology, anatomy and patophysiology) classification. In this way, 3 groups were formed: Patients with the mild forms of CVI (stage 1 - 4 by CEAP classification), 57 patients; patients with the severe forms of CVI (stage 5 and 6 by CEAP classification), 55 patients; control group (no CVI), 50 patients. Also, the Ankle Brachial Pressure Index (ABPI) was assessed in all subjects, and its value of ≤ 0.9 was set as criteria for diagnosis of PAD. The same sample was divided according to the presence of PAD into two groups. The most important risk factors for CVI and PAD were identified for each patient through complete examination, medical record and appropriate questionnaire. Results: Our results showed that the risk factors for CVI were high Body Mass Index (BMI), hypertension, predominantly standing position during work and positive family history for CVI. In the same sample it was found that 28 (17.28%) patients had PAD. Relevant risk factors for PAD in the present study were: high BMI, hypertension, diabetes and a positive family history for PAD. Comparison of frequency of PAD among patients with severe forms of CVI and control group showed that this difference was statistically significant (P = 0.0275; OR 3.375; 95% CI 1.125 - 10.12). After multivariate analyses, adjusted odds ratio OR was still statistically significant. Conclusions: The peripheral arterial disease is more frequent in patients with the severe form of CVI, than in patients without CVI. Concomitant risk factors for CVI and PAD were high BMI and hypertension. In each patient with severe CVI it is necessary to determine the ABPI, in order to exclude the presence of PAD.
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Affiliation(s)
- Milan Matic
- Dermatovenereological Clinic, Clinical Center of Vojvodina, Novi Sad, Serbia
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Corresponding Author: Milan Matic, Dermatovenereological Clinic, Clinical Center of Vojvodina, Novi Sad, Serbia. Tel: +381-637722423, Fax: +381-21421215, E-mail:
| | - Aleksandra Matic
- Pediatric Clinic, Institute for Child and Youth Health Care of Vojvodina, Novi Sad, Serbia
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Verica Djuran
- Dermatovenereological Clinic, Clinical Center of Vojvodina, Novi Sad, Serbia
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Zorica Gajinov
- Dermatovenereological Clinic, Clinical Center of Vojvodina, Novi Sad, Serbia
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Sonja Prcic
- Pediatric Clinic, Institute for Child and Youth Health Care of Vojvodina, Novi Sad, Serbia
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Zoran Golusin
- Dermatovenereological Clinic, Clinical Center of Vojvodina, Novi Sad, Serbia
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
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18
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Siribumrungwong B, Noorit P, Wilasrusmee C, Leelahavarong P, Thakkinstian A, Teerawattananon Y. Cost-utility analysis of great saphenous vein ablation with radiofrequency, foam and surgery in the emerging health-care setting of Thailand. Phlebology 2015; 31:573-81. [PMID: 26341394 DOI: 10.1177/0268355515604258] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To conduct economic evaluations of radiofrequency ablation, ultrasound-guided foam sclerotherapy and surgery for great saphenous vein ablation. METHOD A cost-utility and cohort analysis from societal perspective was performed to estimate incremental cost-effectiveness ratio. Transitional probabilities were from meta-analysis. Direct medical, direct non-medical, indirect costs, and utility were from standard Thai costings and cohort. Probabilistic sensitivity analysis was performed to assess parameter uncertainties. RESULTS Seventy-seven patients (31 radiofrequency ablation, 19 ultrasound-guided foam sclerotherapy, and 27 surgeries) were enrolled from October 2011 to February 2013. Compared with surgery, radiofrequency ablation costed 12,935 and 20,872 Baht higher, whereas ultrasound-guided foam sclerotherapy costed 6159 lower and 1558 Bath higher for outpatient and inpatient, respectively. At one year, radiofrequency ablation had slightly lower quality-adjusted life-year, whereas ultrasound-guided foam sclerotherapy yielded additional 0.025 quality-adjusted life-year gained. Because of costing lower and greater quality-adjusted life-year than other compared alternatives, outpatient ultrasound-guided foam sclerotherapy was an option being dominant. Probabilistic sensitivity analysis resulted that at the Thai ceiling threshold of 160,000 Baht/quality-adjusted life-year gained, ultrasound-guided foam sclerotherapy had chances of 0.71 to be cost-effective. CONCLUSIONS Ultrasound-guided foam sclerotherapy seems to be cost-effective for treating great saphenous vein reflux compared to surgery in Thailand at one-year results.
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Affiliation(s)
- Boonying Siribumrungwong
- Department of Surgery, Faculty of Medicine, Thammasat University Hospital, Thammasat University, Pathumthani; Center of Excellence in Applied Epidemiology, Faculty of Medicine, Thammasat University Hospital, Thammasat University, Pathumthani, Thailand
| | - Pinit Noorit
- Department of Surgery, Chonburi Hospital, Chonburi, Thailand
| | - Chumpon Wilasrusmee
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pattara Leelahavarong
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, Nonthaburi, Thailand
| | - Ammarin Thakkinstian
- Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, Nonthaburi, Thailand
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Reszke R, Pełka D, Walasek A, Machaj Z, Reich A. Skin disorders in elderly subjects. Int J Dermatol 2015; 54:e332-8. [DOI: 10.1111/ijd.12832] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 07/22/2014] [Accepted: 07/26/2014] [Indexed: 02/02/2023]
Affiliation(s)
- Radomir Reszke
- Department of Dermatology, Venereology and Allergology; Wroclaw Medical University; Wroclaw Poland
| | - Dorota Pełka
- Department of Dermatology, Venereology and Allergology; Wroclaw Medical University; Wroclaw Poland
| | - Angela Walasek
- Department of Dermatology, Venereology and Allergology; Wroclaw Medical University; Wroclaw Poland
| | - Zbigniew Machaj
- Department of Internal Diseases, Geriatrics and Allergology; Wroclaw Medical University; Wroclaw Poland
| | - Adam Reich
- Department of Dermatology, Venereology and Allergology; Wroclaw Medical University; Wroclaw Poland
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20
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Matic P, Jolic S, Tanaskovic S, Soldatovic I, Katsiki N, Isenovic E, Radak D. Chronic Venous Disease and Comorbidities. Angiology 2015; 66:539-544. [DOI: 10.1177/0003319714541988] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
We report the relations between comorbidities and chronic venous disease. In this cross-sectional study, information was gathered from 1679 Serbian patients. The majority (65.0%) of patients were women. Mild forms of chronic venous disease (clinical, etiologic, anatomic and pathophysiologic [CEAP] classification; C0s-C1) were more frequent in women (11.6%), while severe forms (CEAP C4-C6) were more commonly encountered in men (42.1%). The most frequent comorbidity was emphysema/chronic obstructive pulmonary disease in both groups (74.3% in males and 70.6% in females). For females, diabetes mellitus ( P < .005), arterial hypertension ( P < .000), and skeletal/joint diseases ( P < .042) were more commonly found in the C4 to C6 category. Both males and females, with severe form of chronic venous disease, may benefit from additional screening for comorbidities. Further studies are needed to clarify the nature of association among comorbidities and chronic venous disease.
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Affiliation(s)
- P. Matic
- Cardiovascular Institute Dedinje, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - S. Jolic
- Department of Dermatology, Medical Centre Kikinda, Kikinda, Serbia
| | - S. Tanaskovic
- Cardiovascular Institute Dedinje, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - I. Soldatovic
- Faculty of Medicine, Institute of Medical Statistics and Informatics, University of Belgrade, Belgrade, Serbia
| | - N. Katsiki
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - E. Isenovic
- Laboratory of Radiobiology and Molecular Genetics, Institute Vinca, University of Belgrade, Belgrade, Serbia
| | - Dj. Radak
- Cardiovascular Institute Dedinje, School of Medicine, University of Belgrade, Belgrade, Serbia
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21
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Vuylsteke ME, Colman R, Thomis S, Guillaume G, Degrande E, Staelens I. The influence of age and gender on venous symptomatology. An epidemiological survey in Belgium and Luxembourg. Phlebology 2015; 31:325-33. [DOI: 10.1177/0268355515589224] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aim The aim of this study is to measure the incidence of the symptoms in patients with chronic venous disease (CVD) and to look for the influence of age on the severity of symptoms for both genders. Materials and methods A survey was carried out in Belgium and Luxembourg between May and September 2013. Patient recruitment was done by 406 general practitioners (GPs). Each GP screened 10–20 consecutive patients older than 18 years. Inquiries were made regarding the presence of symptoms and possible signs of CVD. Patients with diagnosed CVD filled out a questionnaire including a quality of life score (CIVIQ-14). These data were converted into a CIVIQ Global Index Score (GIS). Statistical analysis was performed in order to calculate the effect of age and gender on the number of symptoms and the estimated probabilities of having CVD. Results Totally 6009 patients were included in this survey. The mean age was 53.4 years. Of all, 61.3% of the patients have CVD (C1-C6). Of all, 64.7% of patients were symptomatic. Age and female gender were major risk factors for developing CVD. Most common symptoms were ‘heavy legs’ (70.4%), pain (54.0%), and sensation of swelling (52.7%). The number of symptoms increases with age ( p < 0.001). Female patients have significantly more symptoms in comparison with male patients in all age groups. In both females and males, age is negatively correlated with GIS score ( p < 0.001). The estimated probability of having CVD was significantly higher for woman compared to men and increases with age for both gender. Conclusion CVD is a very common progressive disease with age as a major risk factor. Increasing age results in a higher C-classification, more symptoms, and a lower GIS score (quality of life). Female gender interacts significantly with age and results in a more advanced stage of CVD.
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Affiliation(s)
- Marc E Vuylsteke
- Department of Vascular Surgery, Sint-Andries Ziekenhuis, Tielt, Belgium
| | - Roos Colman
- Department of Public Health, Biostatistics unit, University of Ghent, Ghent, Belgium
| | - Sarah Thomis
- Department of Vascular Surgery, University Hospitals Leuven, Belgium
| | - Geneviève Guillaume
- Department of Cardiovascular and Thoracic Surgery, University Hospital Mont-Godinne, Mont-Godinne, Belgium
| | - Evy Degrande
- Department of Internal Medicine, Sint-Andriesziekenhuis, Tielt, Belgium
| | - Ivan Staelens
- Department of Vascular Surgery, UZ Brussels, Brussels, Belgium
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Pfisterer L, Meyer R, Feldner A, Drews O, Hecker M, Korff T. Bortezomib protects from varicose-like venous remodeling. FASEB J 2014; 28:3518-27. [PMID: 24769668 DOI: 10.1096/fj.14-250464] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Despite the high prevalence of venous diseases that are associated with and based on the structural reorganization of the venous vessel wall, not much is known about their mechanistic causes. In this context, we demonstrated that the quantity of myocardin, a transcriptional regulator of the contractile and quiescent smooth muscle cell phenotype, was diminished in proliferating synthetic venous smooth muscle cells (VSMCs) of human and mouse varicose veins by 51 and 60%, respectively. On the basis of the relevance of proteasomal activity for such phenotypic changes, we hypothesized that the observed VSMC activation is attenuated by the proteasome inhibitor bortezomib. This drug fully abolished VSMC proliferation and loss of myocardin in perfused mouse veins and blocked VSMC invasion in collagen gels by almost 80%. In line with this, topical transdermal treatment with bortezomib diminished VSMC proliferation by 80%, rescued 90% of VSMC myocardin abundance, and inhibited varicose-like venous remodeling by 67 to 72% in a mouse model. Collectively, our data indicate that the proteasome plays a pivotal role in VSMC phenotype changes during venous remodeling processes. Its inhibition protects from varicose-like vein remodeling in mice and may thus serve as a putative therapeutic strategy to treat human varicose veins.
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Affiliation(s)
- Larissa Pfisterer
- Institute of Physiology and Pathophysiology, Division of Cardiovascular Physiology, University of Heidelberg, Heidelberg, Germany
| | - Ralph Meyer
- Institute of Physiology and Pathophysiology, Division of Cardiovascular Physiology, University of Heidelberg, Heidelberg, Germany
| | - Anja Feldner
- Institute of Physiology and Pathophysiology, Division of Cardiovascular Physiology, University of Heidelberg, Heidelberg, Germany
| | - Oliver Drews
- Institute of Physiology and Pathophysiology, Division of Cardiovascular Physiology, University of Heidelberg, Heidelberg, Germany
| | - Markus Hecker
- Institute of Physiology and Pathophysiology, Division of Cardiovascular Physiology, University of Heidelberg, Heidelberg, Germany
| | - Thomas Korff
- Institute of Physiology and Pathophysiology, Division of Cardiovascular Physiology, University of Heidelberg, Heidelberg, Germany
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Vlajinac H, Marinkovic J, Maksimovic M, Radak D. Factors related to venous ulceration: a cross-sectional study. Angiology 2013; 65:824-30. [PMID: 24165114 DOI: 10.1177/0003319713508218] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of the study was to determine the factors related to venous ulceration. Patients with venous ulceration (278 patients) were compared with 1401 patients in other categories of clinical classification of venous disease (clinical, etiologic, anatomic, and pathophysiological [CEAP]). Demographic, anthropometric, and clinical data were collected. Univariate and multivariate logistic regression analyses were used. According to multivariate analyses, risk factors for venous ulceration were age, male sex, personal history of superficial and deep venous thrombosis, diabetes, high blood pressure, skeletal or joint disease in the legs and emphysema or chronic obstructive pulmonary disease, higher body mass index and physical inactivity, parental history of ankle ulcer as well as reflux in deep and perforator veins, deep obstruction, and combination of reflux and obstruction. It seems reasonable to pay special attention to patients in whom the postulated risk factors for venous ulceration are present.
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Affiliation(s)
- Hristina Vlajinac
- Faculty of Medicine, Institute of Epidemiology, University of Belgrade, Belgrade, Serbia
| | - Jelena Marinkovic
- Faculty of Medicine, Institute of Medical Statistics and Informatics, University of Belgrade, Belgrade, Serbia
| | - Milos Maksimovic
- Faculty of Medicine, Institute of Hygiene and Medical Ecology, University of Belgrade, Belgrade, Serbia
| | - Djordje Radak
- Department of Vascular Surgery, Dedinje Cardiovascular Institute, Belgrade, Serbia Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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24
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Kuo CJ, Liang SS, Hsi E, Chiou SH, Lin SD. Quantitative proteomics analysis of varicose veins: identification of a set of differentially expressed proteins related to ATP generation and utilization. Kaohsiung J Med Sci 2013; 29:594-605. [PMID: 24183353 DOI: 10.1016/j.kjms.2013.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 12/19/2012] [Indexed: 01/12/2023] Open
Abstract
Although morphological and anatomical studies indicate that varicose veins are characterized by venous wall weakening and subendothelial fibrosis, the exact underlying biochemical mechanism of their development remains unknown. Additionally, no quantitative proteomic study of venous proteins leading to decreased contractility of varicose veins has been reported to date. Therefore, to elucidate the molecular mechanism of altered vascular contractility, this study performed shotgun proteomic analysis to obtain protein expression profiles in patients with varicose veins. Stable isotope dimethyl labeling coupled with nanoLC-MS/MS revealed downregulation in 12 polypeptides, including myosin light chain kinase, creatine kinase B-type, ATP synthase, phosphoglycerate kinase, and pyruvate kinase. However, analyses of protein species associated with cytoskeletal assembly or with cellular morphology showed no clear up- or down-regulation. These results indicate that defects in ATP generation and utilization may account for the dysfunction of vascular smooth muscle following formation of varicose veins. Collectively, the severity of varicose veins depends on the regulatory roles of various protein factors in the metabolic coordination of physiological functions. This pilot study improves understanding of the pathogenesis of varicose veins and lays the foundation for further validation and clinical translation of biomarkers for targeted therapies in treating this disease.
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Affiliation(s)
- Chao-Jen Kuo
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Center for Research Resources and Development, Kaohsiung Medical University, Kaohsiung, Taiwan
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25
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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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26
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Body mass index and primary chronic venous disease--a cross-sectional study. Eur J Vasc Endovasc Surg 2013; 45:293-8. [PMID: 23337196 DOI: 10.1016/j.ejvs.2012.12.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 12/17/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVES This study aims to investigate whether overweight and obesity are related to the clinical (C) category of clinical, etiologic, anatomic and pathophysiologic (CEAP) classification of chronic venous disease (CVD). DESIGN A cross-sectional study. MATERIALS AND METHODS The study was conducted in Serbia, in the year 2011. Men and women aged >18 years, consecutively coming to venous specialists because of venous problems in the legs, were included in the study. Patients demographic, anthropometric and clinical data were collected. For the analysis, univariate and multivariate logistic regressions were used. RESULTS The study comprised 1116 subjects with primary CVD, 384 (34.4%) men and 732 (65.6%) women. Among them 464 (41.6%) were normal-weight patients (body mass index (BMI) < 25.0 kg m(-2)), 476 (42.7%) were overweight (BMI = 25.0-29.9 kg m(-2)) and 176 (15.8%) were obese (BMI ≥ 30.0 kg m(-2)). According to multivariate analysis, the CEAP C category of CVD was significantly more advanced in overweight and obese patients, the association being more pronounced in obese. Compared groups did not differ in the presence of venous reflux. In univariate analysis, venous obstruction was related to overweight and obesity but this association did not substantially affect the relationship between obesity and CEAP C categories of CVD. CONCLUSION The CEAP C categories of CVD were significantly related to overweight and obesity, and this association was independent of age, sex and some other postulated risk factors.
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Robertson L, Lee AJ, Evans CJ, Boghossian S, Allan PL, Ruckley CV, Fowkes F. Incidence of chronic venous disease in the Edinburgh Vein Study. J Vasc Surg Venous Lymphat Disord 2013; 1:59-67. [DOI: 10.1016/j.jvsv.2012.05.006] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 05/22/2012] [Accepted: 05/25/2012] [Indexed: 11/24/2022]
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Ciuti G, Grifoni E, Pavellini A, Righi D, Livi R, Perfetto F, Abbate R, Prisco D, Pignone AM. Incidence and characteristics of asymptomatic distal deep vein thrombosis unexpectedly found at admission in an Internal Medicine setting. Thromb Res 2012; 130:591-5. [DOI: 10.1016/j.thromres.2012.05.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 04/25/2012] [Accepted: 05/19/2012] [Indexed: 11/15/2022]
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Vlajinac HD, Radak DJ, Marinkovic JM, Maksimovic MZ. Risk factors for chronic venous disease. Phlebology 2012; 27:416-22. [PMID: 22345329 DOI: 10.1258/phleb.2011.011091] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Chronic venous disease (CVD) is a common problem in developing and developed countries. METHODS A cross-sectional study, conducted in two major towns in Serbia, comprised 3225 subjects over 18 years old, enrolled in the survey consecutively by general practitioners (GPs) within their normal framework. Diagnosis of CVD was made by GPs on the basis of symptoms and visual examination. Data on potential risk factors were collected by the use of a questionnaire. RESULTS The prevalence of CVD was significantly higher in women (73.7%) than in men (70.1%), although severe forms of CVD were significantly more frequent in men. Risk factors for CVD were age, body mass index ≥ 25.00 kg/m(2), family history of CVD, history of blood clots in veins and ever-smoking in both sexes, and menopause, increased number of child births and physical inactivity in women. CONCLUSION The results obtained suggest the possibility of CVD prevention by modification of some behavioural risk factors.
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Affiliation(s)
- H D Vlajinac
- Faculty of Medicine, Institute of Epidemiology, University of Belgrade, Visegradska 26, 11000 Belgrade, Serbia.
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