Chronic venous insufficiency in persons with a history of injection drug use¶

Abstract

Persons with a history of injection drug use have many risk factors for the development of chronic venous insufficiency (CVI), yet this phenomenon has not been studied systematically in this population. Persons (N = 204) with a history of injection drug use who were in enrolled in a treatment center were examined for clinical manifestations of CVI. The CVI clinical classification was graded on a 7-point scale for each leg. Most participants (n = 179, 87.7%) exhibited clinical evidence of CVI. Significant predictors of CVI clinical manifestations were leg infections/cellulitis (rho =.53); years injection in the veins of the groin, legs, and feet (rho =.47); deep vein thrombosis (rho =.37); and total years injection heroin (rho =.27). There was a linear functional relationship between years of injection drug use and the CVI clinical classification, but only when the injections were in the veins of the groin, legs, or feet; otherwise, the specific mechanisms of this relationship were not evident. The findings indicate that CVI is a common occurrence in persons who have injected drugs.

A very low response rate in an on‐line survey of medical practitioners

“…[1][2][3] Some IRIDs (e.g. endocarditis, tetanus) are extremely serious and require urgent medical attention; some (abscesses, cellulitis) are easily treated, but potentially life-threatening, while others (hives, swelling) are minor but common conditions.…”

Ankle Mobility in Relation to Chronic Venous Insufficiency in HIV-Positive Persons With and Without a History of Injection Drug Use

“…This classification has seven categories: Class 0 (no visible or palpable sign of venous disease), Class 1 (telangiectasis, reticular veins, malleolar flare), Class 2 (varicose veins), Class 3 (edema without skin changes), Class 4 (skin changes ascribed to venous disease such as increased pigmentation, venous eczema, and lipodermatosclerosis), Class 5 (skin changes as defined previously with healed ulceration), and Class 6 (skin changes as defined previously with active ulceration) (Porter et al, 1996). The authors' previous work assessed the reliability of the clinical classification on 20 randomly chosen participants; the result was perfect (Kappa ϭ 1.0) (Pieper & Templin, 2001). Researchers who used the clinical classification with objective venous testing concluded that it accurately identified categories of chronic venous disease (Kistner, Eklof, & Masuda, 1996).…”

“…Previous research on persons who had a history of IDU showed that injection in the groin, legs, and feet rather than injection in other parts of the body was primarily responsible for increased CVI risk (Pieper & Templin, 2001). In the current sample, a small number, 5 persons, injected drugs only in the arms or upper parts of the body.…”

Dermatologic Signs and Symptoms of Substance Abuse

“…Repeated infections also lead to damage to lymphatic vessels, which impairs lymphatic drainage. Chronic lower extremity edema often results from the combination of lymphatic obstruction and venous insufficiency [4,20,21].…”