Chronic Venous Insufficiency

Abstract

C hronic venous disease is often overlooked by primary and cardiovascular care providers because of an underappreciation of the magnitude and impact of the problem. The importance of chronic venous disease is related to the number of people with the disease and the socioeconomic impact of its more severe manifestations. Unfortunately, the literature concerning the prevalence and incidence of chronic venous disease has varied greatly because of differences in the methods of evaluation, criteria for definition, and the geographic regions analyzed. The most common manifestations of chronic venous disease are dilated cutaneous veins, such as telangiectases and reticular veins, and varicose veins. The term chronic venous insufficiency (CVI) describes a condition that affects the venous system of the lower extremities with venous hypertension causing various pathologies including pain, swelling, edema, skin changes, and ulcerations. Although the term CVI is often used to exclude uncomplicated varicose veins, varicose veins have incompetent valves with increased venous pressure leading to progressive dilation and tortuosity. We will use the term CVI to represent the full spectrum of manifestations of chronic venous disease.Varicose veins have an estimated prevalence between 5% to 30% in the adult population, with a female to male predominance of 3 to 1, although a more recent study supports a higher male prevalence. 1 The Edinburgh Vein Study screened 1566 subjects with duplex ultrasound for reflux finding CVI in 9.4% of men and 6.6% of women, after age adjustment, which rose significantly with age (21.2% in men Ͼ50 years old, and 12.0% in women Ͼ50 years old). 2 The San Valentino Vascular Screening Project found among the 30 000 subjects evaluated by clinical assessment and duplex ultrasound a prevalence of 7% for varicose veins and 0.86% for "symptomatic" CVI. 3 As in previous studies, CVI was more common with increasing age, but there was no significant sex difference. The rate of varicose vein development may be estimated from the Framingham Heart Study, which found an annual incidence of 2.6% in women and 1.9% in men. 4 Risk factors found to be associated with CVI include age, sex, a family history of varicose veins, obesity, pregnancy, phlebitis, and previous leg injury. 5,6 There also may be environmental or behavioral factors associated with CVI such as prolonged standing and perhaps a sitting posture at work. 6,7 Varicose veins have a significant impact on healthcare resources, with millions of people seeking medical attention for their cosmetic appearance annually. Although often minimized, the cosmetic consequences may adversely affect an individual's quality of life and are associated with other manifestations.The more serious consequences of CVI such as venous ulcers have an estimated prevalence of Ϸ0.3%, although active or healed ulcers are seen in Ϸ1% of the adult population. 8 It has been estimated that Ϸ2.5 million people have CVI in the United States, and of those, Ϸ20% develop venous ulcers. 9 The ov...

Varicose Remodeling of Veins Is Suppressed by 3‐Hydroxy‐3‐Methylglutaryl Coenzyme A Reductase Inhibitors

“…Morphologically, the appearance of these veins is swollen and bulged and frequently accompanied by incompetent valves. Consequently, the increase in venous volume results in venous hypertension and thus a chronic increase in venous wall stress 2, 4. In this context, we showed that these environmental conditions activate the transcription factor activator protein 1 (AP‐1), which controls expression of genes with products that promote cellular activity and proliferation in the venous wall.…”

Management of Varicose Veins of the Lower Extremities: A 10-year Institutional Experience

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Peripheral edema: diagnostics and treatment

“…Существуют также инвазивные методы лечения (склеротерапия, радиоабляция, эндоваскулярная те-рапия, флеботомия и др.) [32].…”