Clinical Predictors of the Severity of Chronic Venous Insufficiency of the Lower Limbs: A Multivariate Analysis

Abstract

Introduction: Chronic venous insufficiency (CVI) affects a large proportion of individuals and, with the ageing of the Western European population, its prevalence is bound to increase. Epidemiological data, particularly regarding risk factors, are scarce and controversial. Objective: Identification of clinical factors associated with an increase in severity of CVI. Setting: Community-based study of patients presenting to their general practitioner. Methods: Four hundred and seventy-four unselected patients with symptoms suggesting CVI were evaluated by 18 general practitioners. CVI was diagnosed and assessed by clinical examination and portable continuous-wave Doppler. Severity of CVI was graded according to the nomenclature of the International Society for Cardiovascular Surgery. Patient demographic and clinical factors showing a linear relationship with the severity of CVI were analysed with the proportional odds model to evaluate the simultaneous effect of several factors in the severity of CVI. Results: A multivariate model is proposed, where age is a major risk factor for increased severity. Other factors that are independently correlated with the severity of CVI are body weight, environmental heat, sedentarily, CVI in both parents, high-dose oestrogen formulations, osteoarticular disease of the lower limbs, presence of truncal varices, involvement of the internal saphena, lymphoedema and history of thrombophlebitis. Conclusion: Because most studies do not adjust for age when testing for risk factors, this may be an important reason for the multiplicity of reported factors and the lack of consistency of their results.