Effect of obesity on chronic venous insufficiency treatment outcomes

Deol, Zoe K.; Lakhanpal, Sanjiv; Franzon, Gavin; Pappas, Peter J.

doi:10.1016/j.jvsv.2020.04.006

Cited by 41 publications

(23 citation statements)

References 39 publications

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“…As highlighted above, obesity is an important negative prognostic factor in CVD; recently, a multicenter prospective study [64] clearly proved, in a large cohort of 65,329 patients, that a progressive increase in body mass index (BMI) negatively affects the QOL outcomes of any varicose vein treatment at 6 months. When BMI exceeded 35, the outcomes progressively deteriorated, and above the figure of 46, treatments had extremely negative outcomes.…”

Section: Varicose Veinsmentioning

confidence: 99%

Medicine and Phlebolymphology: Time to Change?

Cavezzi

2020

JCM

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Biomedical science is undergoing a reappraisal of its scientific advancement process and of the related healthcare management. Progress in medicine should combine improvements of knowledge, efficacy, and safety of diagnostic/therapeutic procedures, with adequate cost-effectiveness profiles. This narrative review is aimed at assessing in medicine, more specifically in phlebology and lymphology: (a) scientific literature possible biases, (b) the level of evidence, comprehensiveness, and cost-effectiveness of the main therapeutic options, and (c) the possible contribution of integrative and translational medicine. Current medical research may have cognitive biases, or industry-tied influences, which impacts clinical practice. Some reductionism, with an increasing use of drugs and technology, often neglecting the understanding and care of the root causative pathways of the diseases, is affecting biomedical science as well. Aging brings a relevant burden of chronic degenerative diseases and disabilities, with relevant socio-economic repercussions; thus, a major attention to cost-effectiveness and appropriateness of healthcare is warranted. In this scenario, costly and innovative but relatively validated therapies may tend to be adopted in venous and lymphatic diseases, such as varicose veins, leg venous ulcer, post-thrombotic syndrome, pelvic congestion syndrome, and lymphedema. Conversely, a more comprehensive approach to the basic pathophysiology of chronic venous and lymphatic insufficiency and the inclusion of pharmacoeconomics analyses would benefit overall patients’ management. Erroneous lifestyle and nutrition, together with chronic stress-induced syndromes, significantly influence chronic degenerative phlebo-lymphatic diseases. The main active epigenetic socio-biologic factors are obesity, dysfunctions of musculo-respiratory-vascular pumps, pro-inflammatory nutrition, hyperactivation of stress axis, and sedentarism. An overall critical view of the scientific evidence and innovations in phebolymphology could be of help to improve efficacy, safety, and sustainability of current practice. Translational and integrative medicine may contribute to a patient-centered approach. Conversely, reductionism, eminence/reimbursement-based decisional processes, patients’ lack of education, industry-influenced science, and physician’s improvable awareness, may compromise efficacy, safety, appropriateness, and cost-effectiveness of future diagnostic and therapeutic patterns of phlebology and lymphology.

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Section: Varicose Veinsmentioning

confidence: 99%

Medicine and Phlebolymphology: Time to Change?

Cavezzi

2020

JCM

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“…40 In addition, obesity itself can lead to signs and symptoms of CVD without major abnormalities in the venous system. 41 Furthermore, waist circumference is inversely correlated with venous haemodynamic. Venous outflow in obese compared to non-obese patients is reduced leading to an increased risk for venous thrombosis and venous insufficiency.…”

Section: Discussionmentioning

confidence: 99%

“…(37,39,40) Most patients experience multiple venous leg ulcer episodes over the years. (39,41) In conclusion, the prevalence of venous leg ulcers may be low, but they are hard to heal, recur often and can have a large impact on a person's quality of life.…”

Section: And Then Came the Venous Leg Ulcermentioning

confidence: 99%

“…The function of the Calf Muscle Pump (CMP) is reduced in CVD patients and even more so in patients with a VLU. 41,42 In a study comparing CVD patients with and without a VLU the venous reflux outcomes were similar, whereas patients with a VLU had a significantly reduced function of the CMP. 43 Furthermore, non-functioning of the CMP in permanent immobility leads to an outflow disorder which may lead to the development of oedema, skin changes and a VLU without evidence of venous reflux or venous obstruction on a duplex ultrasound.…”

Section: Reduced Mobility: Calf Muscle Pump Function and The Venous Leg Ulcermentioning

confidence: 99%

“…As mentioned before, obesity negatively impacts treatment outcomes of varicose vein removal, leading to less improvement in venous clinical score and quality of life when compared to non-obese varicose vein patients. (41) Obesity is also associated with a higher recurrence of varicose veins. (42) In addition, obesity and reduced physical activity impact the treatment outcomes of ambulatory compression therapy.…”

Section: Impact Of Obesity and Mobility On Chronic Venous Disease Treatmentmentioning

confidence: 99%

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Patients at risk of the progression of chronic venous disease.

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Ulcus cruris venosum

Weber

Deinsberger

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hautnah

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ZusammenfassungDas Ulcus cruris venosum entsteht im Rahmen einer fortgeschrittenen chronisch-venösen Insuffizienz und stellt die häufigste Entität chronischer Ulzerationen der unteren Extremität dar. Da die Prävalenz im Alter deutlich ansteigt, stellen venöse Ulzera in einer alternden Gesellschaft ein zunehmend relevantes Gesundheitsproblem dar, welches mit einer signifikanten Morbidität und einer hohen sozioökonomischen Belastung verbunden ist. Die Behandlung stellt aufgrund der niedrigen Heilungsrate, der häufigen Chronifizierung und der hohen Rezidivrate eine Herausforderung dar. Die Therapie umfasst in der Regel mehrere Modalitäten, wobei stets die Reduktion der venösen Hypertension in den zuführenden Gefäßen im Vordergrund steht. Bezüglich konservativer Therapieoptionen stehen die Kompressionstherapie, die pharmakologische Therapie sowie ergänzend die lokale Wundpflege zur Verfügung. Im Rahmen der kausalen, invasiven Therapie der dem Ulkus zugrunde liegenden Varkositas finden vor allem endoluminal-ablative Verfahren, die offene chirurgische Sanierung und die Schaumsklerotherapie ihre Anwendung. Neben einer Optimierung der invasiven Verfahren, liegt vor allem in der Entwicklung adjuvanter Therapiemodalitäten noch großes Potenzial.

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Effect of obesity on chronic venous insufficiency treatment outcomes

Cited by 41 publications

References 39 publications

Medicine and Phlebolymphology: Time to Change?

Medicine and Phlebolymphology: Time to Change?

Patients at risk of the progression of chronic venous disease.

Ulcus cruris venosum

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