Is There a Relationship Between Increased Body Mass Index and Primary Venous Disease Severity And Concomitant Primary Deep Venous Reflux?

Abstract

The role of overweight in chronic venous disease is still controversial. The aim of this study was to evaluate the impact of overweight and obesity in chronic primary venous disease in relation to disease severity, using the CEAP and VCSS as well as well as bodyweight on the presence of concomitant primary deep venous reflux. Between October 2005 and September 2010, 1445 consecutive patients (2023 limbs) presenting with duplex-ultrasound confirmed chronic primary venous disease and planned for intervention were evaluated retrospectively from a prospectively collected database. The patients were classified according to CEAP classification, the venous clinical severity score (VCSS) and body mass index (kg/m2), using the WHO definition. Concomitant primary deep venous reflux was evaluated and reexamined following eradication of the superficial reflux. There were 636 normal weight patients (890 limbs), BMI <25, 526 overweight patients (740 limbs), BMI 25 to 29.9, and 283 obese patients (393 limbs), BMI ≥30 kg/m2. Overweight patients had more incompetent perforators (P<.001), hypertension (P<.001) and diabetes (P=.019) than normal weight patients and higher C-class and VCSS (P<.001). Obese patients had more incompetent perforators (P<.001), hypertension (P<.001), diabetes (P=.004) and primary deep insufficiency (P<.001) than overweight patients as well as higher C-class and VCSS (P<.001). Correlation between the C-class (CEAP classification) and the severity score (VCSS) was found excellent (r=0.80). Obese patients had more axial reflux than the two other groups. There was no relationship between disease duration, bodyweight, and severity within each group. After eradication of superficial reflux, disappearance of preoperative deep reflux was lowest among obese patients (13.7%) compared to overweight patients, 22.5%. There was a close relation between bodyweight and clinical severity of primary venous disease. Both overweight and obesity appears to be a separate risk factor for increased severity in patients with chronic primary venous disease without correlation to disease duration. CEAP and VCSS seem to accurately evaluate disease severity with an excellent correlation between the two scores. Concomitant primary deep venous reflux is more often observed in the obese patients, with less abolishment following eradication of the superficial reflux than observed for normal weight and overweight patients.