Severe Chronic Venous Insufficiency: Magnitude of the Problem and Consequences

Abstract

The aim of this study was to characterize patients requiring hospitalization for severe chronic venous insufficiency (CVI) at the local and national levels and to analyze factors related to primary amputation. An administrative database (Nationwide Inpatient Sample, 1988-2000) and a single institution (1992-2000) were reviewed using the International Classification of Diseases, 9th ed., Clinical Modification, codes for CVI, excluding phlegmasia and concomitant peripheral vascular occlusive disease codes. Demographics, clinical course, and outcomes were assessed. Descriptive, univariate, and multivariate statistical analyses were used; p < 0.05 was considered significant. Nationally, CVI occurred with a mean incidence of 92/100,000 admissions, of which 55% were women, having a mean age of 65 years and a median length of stay of 7 days. Mean hospital charges were $13,900 and did not change significantly over time. Acute deep vein thrombosis affected 1.3%, amputation was performed in 1.2%, and in-hospital mortality was 1.6% The local cohort included 67 patients with a mean age of 51 years; a majority were men (60%), and 85% were C6 (of Clinical-Etiologic-Anatomic-Pathophysiology [CEAP]). Patients averaged 23 clinic visits and a median of one hospitalization for CVI care over a 44-month follow-up. Twelve patients (18%) underwent a CVI-related amputation (one transmetatarsal amputation, nine below-knee amputations, and two above-knee amputations). They had fourfold more CVI-related hospitalizations, greater preoperative chronic narcotic use than nonamputee patients (85% vs. 58%), but less ongoing wound care needs (25% vs. 89%) (all p values < 0.05). However, no significant difference in long-term mortality, number of clinic visits, duration of symptoms, antibiotic courses, or prior venous-related surgeries was found. In those with amputation, ambulatory status was maintained in 75% at 15-month follow-up. The physiological and economic costs of severe CVI are significant and have not decreased over more than a decade. Amputation for CVI-related nonhealing wounds has a reasonable outcome. Future therapy must focus on prevention of CVI sequelae.

Manual Lymphatic Drainage in the Treatment of Chronic Venous Disease

“…Over the last decade, neither CVD-associated and inflation-adjusted mean hospital charge, nor length of hospital stay decreased, possibly as a result of poor advancements in prevention and treatment of this disease [49]. It is estimated that 4.6 million of working days per year are lost as a result of CVD [40].…”

“…Other important complications, such as hemorrhage, thrombosis and pulmonary embolism, also compound the unhealthy profile of these patients [42]. Deep venous thrombosis may cause chronic conditions like post-thrombotic syndrome and CVD, increasing the costs of the treatment [49].…”

“…Painful leg ulcers, the odor, the dressing, the frequent need for treatment, with their associated restrictions and social isolation result in a heavy psychosocial burden [50]. In severe CVD, venous ulcers require wound care, compression, chemical and mechanical debridement, and, in frequent cases, antibiotic therapy [49]. While ulcer treatment is usually done in outpatient settings, in some particularly critical situations it may require hospitalization [40].…”

“…The economic burden is not just associated with clinical visits and outpatient treatments, but also with travel time, loss of work hours for patients and family, and physiological impairment related to analgesic and antibiotic use [49]. Limb amputation is a radical outcome of this disease, although in many of cases these are also related to comorbidities, for instance diabetes and arterial vascular disease [49]. Other important complications, such as hemorrhage, thrombosis and pulmonary embolism, also compound the unhealthy profile of these patients [42].…”

“…Western European countries spend 1.5-2% of their annual health budget in the treatment of this disease [51]. The economic burden is not just associated with clinical visits and outpatient treatments, but also with travel time, loss of work hours for patients and family, and physiological impairment related to analgesic and antibiotic use [49]. Limb amputation is a radical outcome of this disease, although in many of cases these are also related to comorbidities, for instance diabetes and arterial vascular disease [49].…”