Characteristics of patients and patterns of chronic venous disease of the lower limbs in a referral hospital in Cameroon.

Abstract

The objective of this study was to investigate the magnitude of chronic venous disease (CVD) in sub-Saharan Africa, specifically the characteristics of the patients, the symptoms, the signs, and the severity. From December 2013 to December 2016, a cross-sectional study was conducted of all consecutive patients with CVD aged ≥18years and attending the outpatient clinic of the Yaoundé General Hospital in Cameroon. We recorded information on demographics, relevant medical history, symptoms, lifestyle, and clinical presentation. A duplex ultrasound examination investigated veins to seek obstruction and reflux (duration ≥0.5second). The full Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) classification was used to describe CVD, and severity was assessed by the Venous Clinical Severity Score (VCSS). Statistical significance was at P< .05. Altogether, 319 patients (503 affected legs) were enrolled; 54.3% of patients were men with a mean age of 44.5years (18-85years) and CVD duration of 3months to 45years (mean, 2.3years). Patients had such risk factors as obesity (32.6%), family history of CVD (17.7%), multiparity, and lifestyle requiring long standing periods (64.8%). Only 15% of women older than 49years were using birth control pills, and none older than 49years were receiving hormone replacement therapy. Only 42.9% of patients had previously been treated for CVD, mainly with venoactive drugs (34.1%). Of the 503 legs, 366 (72.76%) were symptomatic in the following proportion: leg heaviness, 236 (64.48%); sensation of swelling, 236 (64.48%); pain, 194 (53%); sensation of "pins and needles," 87 (23.77%); night cramps, 89 (24.39%); and itching, 66 (18.03%). Men had more symptoms (P= .027). The mean total VCSS was 4.62± 4.15 (range, 1-21). The most frequent VCSSs were 0, 2, 3, and 4, and the components of the VCSS most frequently represented were pain, varicose veins, and edema.Patients were assigned to CEAP classes as follows. The C class included C0, 6.1%; C1, 35.4%; C2, 39.6%; C3, 42.7%; C4a, 11.9%; C4b, 4.9%; C5, 1.5%; and C6, 10.13%. The E class designated etiology as primary in 446 (88.66%), secondary in 49 (9.7%), and congenital in 8 (1.59%). The A class identified superficial veins in 365 (72.56%), deep veins in 218 (43.33%), and perforator veins in 22 (4.37%); no venous location was identified in 31 (6.16%). According to the P classification, of the 466 legs of level II and III CEAP, 289 (62%) had reflux, 43 (9.2%) had obstruction, 22 (4.6%) had both reflux and obstruction, and 113 (24.3%) had no venous disease identifiable, with no sex influence on the frequency of reflux (P= .27) but a higher proportion of obstruction in men (P= .00029). Patients have many risk factors and are young with a male predominance. Most patients are symptomatic with advanced disease. The etiology is primary in most patients, and reflux is more common.