Bonner Venenstudie der Deutschen Gesellschaft für Phlebologie

Ziel: Die Bonner Venenstudie zur Frage der Häufigkeit und Ausprägung von chronischen Venenkrankheiten in der städtischen und ländlichen deutschen Wohnbevölkerung im Alter von 18-79 Jahren fand zwischen dem 13. 11. 2000 und 15. 3. 2002 statt. Es nahmen insgesamt 3072 Probanden teil, die Response-Proportion lag insgesamt bei 59%. Ergebnisse: Eine Beinschwellung in der Anamnese trat bei jedem 6. Mann (16,2%) und bei nahezu jeder 2. Frau (42,1%) auf. Eine kurz zurückliegende ein- oder beidseitige Beinschwellung in den letzten vier Wochen gab jeder 6. Teilnehmer an. Dies entspricht 14,8% (7,9% der Männer, 20,2% der Frauen). Für Gefäßerkrankungen typische Beinbeschwerden innerhalb der letzten vier Wochen gab insgesamt jeder 2. der Probanden (56,4%) an. Bei der Beurteilung der klinischen Ausprägung gemäß der CEAP-Klassifikation fällt auf, dass lediglich 9,6% der Probanden keinerlei Venenveränderungen aufweisen. Bei 59% bestehen isoliert Teleangiektasien oder retikuläre Venen, bei 14,3% Krampfadern (C2) ohne weitere Zeichen einer chronischen venösen Insuffizienz. Auffällig ist, dass bei 13,4% ein prätibiales Ödem im Rahmen von Venenveränderungen zum Untersuchungszeitpunkt vorlag. Demgegenüber liegt die Zahl der fortgeschrittenen Zeichen der chronischen venösen Insuffizienz bei 3,3%. Die Häufigkeit des floriden oder abgeheilten Ulcus cruris lag bei 0,7%. Schlussfolgerungen: Jeder 6. Mann und jede 5. Frau hat somit chronische Veneninsuffizienz (C3–C6). Die Zahlen zeigen, dass Venenkrankheiten insgesamt nach wie vor eine hohe Prävalenz aufweisen, dass aber die schweren Ausprägungen der chronischen venösen Insuffizienz in den vergangenen 20 Jahren zurückgegangen sind.

Cutaneous ulcers following hydroxyurea therapy

Hydroxyurea (HU) is usually a well tolerated antineoplastic agent and is commonly used in the treatment of chronic myeloproliferative diseases. Dermatological side effects are frequently seen in patients receiving longterm HU therapy. Cutaneous ulcers have been reported occasionally.

We report on four patients with cutaneous ulcers whilst on long-term hydroxyurea therapy for myeloproliferative diseases. In all patients we were able to reduce the dose, or stop HU altogether and their ulcers markedly improved. Our observations suggest that cutaneous ulcers should be considered as possible side effect of long-term HU therapy and healing of the ulcers can be achieved not only by cessation of the HU treatment, but also by reducing the dose of hydroxyurea for a limited time.

Guidelines for sclerotherapy of varicose veins (ICD 10: I83.0, I83.1, I83.2, and I83.9)

BACKGROUND

Sclerotherapy is the targeted elimination of intracutaneous, subcutaneous, and/or transfascial varicose veins (perforating veins) as well as the sclerosation of subfascial varicose vessels in the case of venous malformation by the injection of a sclerosant. With duplex-guide sclerotherapy and foam sclerotherapy, modified methods came into use.

OBJECTIVE

The objective was to create a guideline, based on the available publications and on the European Consensus Document on foam sclerotherapy from April 2003.

METHODS

This guideline was drafted on behalf of the German Society of Phlebology (Deutsche Gesellschaft für Phlebologie) and adopted by the committee and scientific advisory board of the Deutsche Gesellschaft für Phlebologie on June 15, 2001, and amended on December 5, 2003. The guideline considers the present state of knowledge as reflected in the literature.

CONCLUSIONS

This guideline represents the recent state of the art of sclerotherapy of varicose veins in Germany including foam sclerotherapy.

Lassen sich geschlechtsspezifische Unterschiede bei Venenerkrankungen durch Schwangerschaften und Hormoneinnahme erklären?

AIM OF THE STUDY

Diseases of the venous system are among the most frequently occurring diseases in the German population. However, the last comprehensive population-based German data were obtained in 1979. Since then, diagnostic methods have improved substantially. Here, we examine the prevalence of venous diseases in women and their association with pregnancies and intake of hormones.

METHODS

We conducted a population-based cross-sectional study in Bonn and rural environments (Recruitment period: 11/2000 - 11/2001; response: 59 %; 3072 study participants (1350 men, 1722 women), 18 to 79 years of age; investigation: standardised medical history, physical examination, duplex sonography, photography and CEAP-classification of veins of the legs). The following definitions were used: 1) Varicosis: clinical classification C2-C6 (primary varicosis only, excluding those showing spider-bursts exclusively); 2) Chronic venous insufficiency (CVI): C3-C6. For women, the risk factors examined were the number of pregnancies (P) and intake of hormones. Odds ratios (OR) and 95 % confidence intervals (95 %-CI) were calculated by multiple logistic regression (adjusted for age, region of residence and socioeconomic status). In addition, never pregnant women and men were compared regarding the two outcome variables.

RESULTS

713 participants (23 %) had varicosis and 522 (17 %) CVI. The OR for women (reference group: men) was OR = 1.4, 95 %-CI: 1.25 - 1.79 (varicosis) and OR = 1.2, 95 %-CI: 0.93 - 1.42 (CVI). There was a positive dose-response relationship between the number of pregnancies and varicosis: 1 P: OR = 1.3 (95 %-CI: 0.89 - 1.96), 2 P: OR = 1.4 (95 %-CI: 1.00 - 2.07), 3 P: OR = 1.6 (95 %-CI: 1.05 - 2.41), 4 P: OR = 1.9 (95 %-CI: 1.18 - 3.20), > or = 5 P: OR = 2.2 (95 %-CI: 1.28 - 3.74) and this trend was similar for CVI. Never-pregnant women (n = 518) and men had a similar prevalence. We did not see a consistent effect of intake of hormones in varicosis (OR = 0.9 [95 %-CI: 0.68 - 1.22]), but a negative association with CVI (OR = 0.6 [95 %-CI: 0.47 - 0.89]).

CONCLUSIONS

Our results confirm the known association between diseases of the venous system and pregnancies, which seem to explain a big share of the sex-specific differences in the prevalence of these diseases.

Epidemiologie der chronischen Venenerkrankungen

Chronic venous diseases such as varicosis, post-thrombotic syndrome, and chronic venous insufficiency are among the most frequent clinical pictures in the Western world. The resultant consequences are persistent complaints such as a feeling of heaviness, tendency for swelling, and leg pain as well as vast skin changes culminating in an open leg ulcer. Although a series of past epidemiological studies are available, they are quite inconsistent with regard to implementation and definition of the clinical picture so that they cannot always be compared. Some are based solely on registration of disease history by questionnaires, which are inadequate to reliably assess actual prevalence. In only a very few studies are the results based on the actual examination of the subjects. Moreover, entirely difference age intervals and random samples are evaluated. The present study summarizes the most important epidemiological results with particular regard to the current Bonn Vein Study.

Powered phlebectomy (TriVex) in treatment of varicose veins

This study assesses the operation of transilluminated powered phlebectomy for removal of varicose veins. It was a prospective, noncomparative, multicenter, pilot study designed to evaluate the safety and efficacy of the powered varicose vein extractor for ablation of primary varicose veins. A total of 114 patients (117 limbs) were recruited from four centers in Europe and four centers in the United States. Safety of the varicose vein extractor was evaluated by recording nature and severity of all adverse events and complications. Efficacy was assessed by the patient, an independent study nurse, and the surgeon. Operations were performed under general, spinal, or epidural anesthesia and tumescent anesthesia was added with infusions of dilute lidocaine with epinephrine. Transillumination was achieved with a specially designed cannula, and the vein extraction was done using a vein resector with a rotating tubular inner cannula encased in a stationary outer sheath dissector. Demographic information regarding the 28 men and 89 women included in the study are detailed. Eighty-four percent of the limbs were CEAP class 2 with only 16% being in classes 3 and 4. Accompanying greater saphenous vein stripping was done in 67% of the limbs in the United States and 88% in those in Europe. Proximal ligation only was used in one limb in the United States and eight in Europe. The study showed that transilluminated powered phlebectomy used in varicose vein removal is swift and efficacious with a conservation of operating time and the results being satisfactory to the patient and clinician alike.