Prevalence Of Venous Disease Research Articles

Exploring the perception of venous disease within vascular surgery

BackgroundBiases and gender disparities influence career pathways within medicine, and vascular surgery is no exception. Venous disease comprises an estimated 1% to 3% of total health care expenditures. However, its value among vascular surgeons is poorly understood. This study aims to investigate the factors that influence vascular surgeons' current perceptions of superficial and deep venous disease treatments. MethodsAn anonymous survey was distributed electronically to practicing vascular surgeons in December 2021. The respondents were stratified by gender and practice breakdown. A venous-heavy practice was defined as a practice with venous work comprising ≥25% of the total volume. Changes in practice patterns over the respondent's career were also explored. Descriptive, univariate, and multivariate analyses were performed using STATA (StataCorp). ResultsA total of 315 practicing vascular surgeons responded, with 81.5% from the United States. Their mean age was 46.6 ± 9.6 years, and most identified as men (63.3%). The race and ethnicity breakdown was as follows: White (non-Hispanic), 63.0%; Asian or Asian Indian, 17.1%; Hispanic, Latinx, or Spanish, 8.4%; Black, 1.6%; and unknown, 9.9%. The practice settings were academic for 47.0%, private practice for 26.5%, hospital employed for 23.3%, and other for 3.2%. The female respondents were significantly younger (P < .0001), with fewer years in practice (P < .0001) and were more likely to perceive a gender bias within a career encompassing venous disease compared with the male respondents (P = .02). Of the 315 participants, 143 (45.4%) had a venous-heavy practice. No differences were found in age or gender between the venous-heavy and venous-light practices. Those with a venous-heavy practice had significantly more years in practice statistically (P = .02), had sought more venous training after graduation (P < .0001), were more likely to be in private practice (P < .0001), and were more likely to desire a practice change (P = .001) compared with those with a venous-light practice. Overall, 74.3% of respondents indicated that venous work might be less “valued” than arterial work in the field of vascular surgery. On multivariable regression, the predictors for the perception of venous work being less valued were female gender (odds ratio, 2.01; 95% confidence interval, 1.14-4.03) and completion of a vascular surgery fellowship (odds ratio, 2.0; 95% confidence interval, 1.15-3.57). ConclusionsVascular surgeons overwhelmingly perceived the management of venous disease to be of less value than that of arterial disease, particularly by women and fellowship-trained vascular surgeons. The prevalence of venous disease, as measured by its proportion of the U.S. healthcare budget, cannot be overstated. Thus, efforts to elevate the importance of chronic venous disease within the scope of vascular surgery practices are essential to ensure patients are provided with appropriate specialty care.

Multidisciplinary Approach to Venous Disease: Enhancing Patient Care and Trainee Education Through Collaboration

The full spectrum of venous disease poses a significant burden on individuals and health-care systems globally. Venous disease can lead to a wide range of symptoms based on the level of disease and underlying pathology. In general, underlying pathologies are due to nonthrombotic (reflux/obstructive) and thrombotic causes. Most conditions are a sequela of the long-term effects of chronic venous insufficiency, deep vein thrombosis (DVT), or nonthrombotic deep vein obstruction. The prevalence of venous disease is substantial, impacting the quality of life of a considerable proportion of the adult population. Untreated and progressive lower extremity venous disease can lead to venous ulceration and other complications. Additionally, poorly recognized and poorly understood venous conditions of the abdomen and pelvis leave many patients "orphaned" in health-care systems that lack expertise in complex venous conditions. Addressing the burden and breadth of venous disease requires comprehensive management approaches, early diagnosis, appropriate treatment interventions, and provider and patient education. Multidisciplinary collaborations and further research are essential to enhance our understanding, develop innovative therapies, and improve patient outcomes in the field of venous disease. In this paper, we highlight the importance of multidisciplinary collaboration and our journey to building an institutional venous team, as well as lessons learned.

IS FLAT FOOT A PREVENTABLE FACTOR IN CHRONIC VENOUS INSUFFICIENCY?

The presence of a venous pumping mechanism in the foot may be significant for venous return in the lower extremities. The anatomy and physiology of venous foot pump {VFP} is essential of effective interventions for prevention, treatment, and management of venous disease in the lower limbs. Though many studies have identified the risk factors for prevalence of venous disease, only few have investigated for risk factors for venous disease progression. Therefore, the aim of this study was to investigate the relationship of flatfoot and varicose vein and the progression of venous disease. We did a pilot study on 12 patients with bilateral varicose vein with bilateral pes planus where we presume the cause of CVI is secondary to VFP dysfunction.

Abstract MP077: Longitudinal Associations Between Venous Disease Progression and Change in Quality of Life: San Diego Population Study

Background: Chronic venous disease, one of the most common chronic diseases in the United States, is associated with lower quality of life (QOL). Although earlier studies have identified a significant association between the cross-sectional prevalence of venous disease and QOL, few studies have investigated the association between venous disease progression and change in QOL. Therefore, the aim of this study was to investigate the relationship between progression of venous disease and change in QOL in a longitudinal cohort. Methods: A population-based cohort of 1103 participants were examined at baseline and 11 years later. At both visits, QOL and risk factors were assessed by questionnaire, anthropometric measures obtained by clinical examination, and venous disease assessed by visual inspection and duplex ultrasound. QOL was measured with the Medical Outcomes Study 36-Item Short Form (SF-36) with the resulting physical component (PCS) and mental component scores (MCS) being used in the analysis. Using ANCOVA methods to control for age, gender, and ethnicity, changes in venous disease were compared against QOL stratified into tertiles. Then, linear regression models were used to examine the longitudinal association of venous disease at baseline and change in QOL score at follow-up after controlling for covariates. Results: In the study population of 1103 individuals, 78 had regression, 340 had progression, and 685 were stable. The average age was 58.7 years (SD 10.4); 33% were male, 61% were non-Hispanic White, 15% were Hispanic, 12% were African American, and 12% were Asian. Mean BMI was 27.1 (SD 5.3), 45.4% had hypertension, 9.9% were diabetic, 3.6% were current smokers, and 34.8% were on medication for hyperlipidemia. Progression of venous disease was significantly associated with change in PCS after controlling for age, gender, and ethnicity ( β =-0.075; p =.04). The association was only slightly attenuated ( β =-.065, p=.08) after adjustment for BMI, high blood pressure, injury to either leg, smoking history, previous vein procedure, previous hernia surgery, flat feet, marital status, education level, occupation, cardiovascular-related morbidity, diabetes, and heaviness in either leg. No association was found with MCS before or after multiple covariate adjustment. Conclusions: This study confirms that individuals with progression of chronic venous disease have a greater decrease in QOL as identified by the physical component score of SF-36. Prevention of chronic venous disease progression may help retain QOL.

Association of foot and ankle characteristics with progression of venous disease.

Although risk factors have been identified for the cross-sectional prevalence of venous disease, few studies have investigated risk factors for venous disease progression. Therefore, the aim of this study was to investigate the relationship between foot and ankle characteristics and the progression of venous disease. A total of 1025 participants from the San Diego Population Study were assessed at baseline and at follow-up 11 years later. Risk factors were assessed by questionnaire and physical measurements, while venous disease was determined by physical examination and Duplex ultrasound. Change in venous disease from baseline to 11-year follow-up was characterized as stable or progression. Those with venous disease progression were less likely to spend increased time lying per day, more likely to have a history of hypertension, lie supine for a surgical procedure greater than an hour, and report an occupation that was professional, technical, administrative, or management. Those with a normal arch reported the greatest degree of plantar flexion. In multivariable logistic regression, including adjustment for weight-bearing arch characteristics, greater dorsiflexion (per 5 degrees) was significantly associated with progression of venous disease (OR = 1.11, p = 0.01). A weight-bearing flat arch compared to a weight-bearing normal arch was of borderline significance as a protective factor against progression of venous disease with adjustment for dorsiflexion (OR = 0.56, p = 0.07). Our results indicate that the ability to have higher levels of dorsiflexion is a risk factor for the progression of venous disease, and suggest a role for connective tissue laxity in the pathogenesis of venous disease.

Modern wound treatment with devices working according to various physical principles

The prevalence of venous diseases in Europe is 25.2%. According to studies of the University of Bonn this number can be as high as 90%. Optimistic estimates suggest this number to be 27.5% in Hungary, 21.5% in Germany. Treatment costs of varicosis and its complications are covered by 2% of the annual healthcare expenditure in Western countries. Chronic venous insufficiency (CVI, or chronic venous disease, CVD) affects 1.7% of European population, and can lead to venous ulcers. In Hungary 0.5-1% of the population suffers from venous ulcers, which is a result of primary or secondary varicosity. Although an increasing number of modern wound dressings have appeared during the last decade, the treatment of ulcerous wounds in necrotic and exudative phases requires additional methods, either conventional or surgical. Infrared light is used to discover pathologic veins. Beside sclerotherapy and surgical treatment external and internal (so called intraluminal) methods are used. Leg ulcers of venous origin in various phases can be cleaned with ultrasound devices, vacuum therapy or high pressure water. Hyperbaric oxygen treatment, keratinocytes, magnetic treatment, laser wound care and skin transplantation can be used as adjuvant. Authors present the aforementioned procedures with examples. New devices and methods help to reduce healing time and to avoid amputation in cases that are often considered hopeless. Technical advancement and modern wound dressings permit successful treatment and healing of wounds that earlier were untreatable, however monetary shortage and the current status of healthcare. DOI: 10.17489/biohun/2013/1/02

Pathogenesis of chronic venous insufficiency by obesity

SummaryObesity (body mass index: BMI ≥30 kg/m2) is named as a risk factor for chronic venous insufficiency (CVI) in phlebologic studies, even though the mechanisms of effects are still unclear. Therefore we examined literature for current data and hypotheses and described them.On the one hand, the correlation between obesity and CVI is explained by chronically inflammatory processes, affected by the lipometabolism of obese and the metabolic syndrome. On the other hand, this particular correlation is explained by a mechanical approach based on an elevated intraabdominal pressure (IAP), which is transmitted to the venous system of the lower extremities. Recent studies show that the chronically inflammatory processes promote the frequency and manifestation of thrombosis. In regard to the IAP, only the pressure of the elevated abdominal mass (paunch) seems to have a minimal effect in the supine position.Several studies relativised the correlation between obesity and CVI because of the rising prevalence of venous disease with age, which correlates with a higher BMI as well. Furthermore, studies have shown the phenomena of so-called venous hydrostatic ulcerations in obese patients. That means those patients show the typical skin changes of the CVI without any venous reflux. Depending on the study, their proportion is estimated between 21% and 64% of venous leg ulcers. Additionally, it was shown that after weight loss the skin seems to regenerate from the typical signs of CVI. At the moment, the pathomechanism causing hydrostatic ulcers in obese is unclear.

The Prevalence of Venous Disease by Gender and Ethnicity in a Balanced Sample of Four Ethnic Groups in Southern California

Objective: To determine the prevalence of venous disease in a community. Design: Cross-sectional study Setting: Southern California university. Participants: Current and retired university employees and spouses were randomly invited within strata based on gender, ethnicity (Caucasian, Hispanic, Black, Asian) and age. These analyses used a random subsample of 75 participants of each gender and ethnicity. Main outcome measures: Cosmetic and functional venous disease determined by standardised examination including ultrasound and visual inspection. Results: Telangiectases were present in 83% of women and 51% of men. Rates increased with age and were highest in Caucasians and lowest in Blacks. Corresponding rates for varicose veins were 33% and 17% with no ethnic differences. Superficial functional disease was found in 26% of women and 15% of men, without ethnic variation. Deep disease was present in 11% without gender or ethnic effects. Conclusions: Telangiectases varied by gender, ethnicity, and age. Varicose veins varied by gender. All conditions except deep disease were more common in women.

The Prevalence of Venous Disease by Gender and Ethnicity in a Balanced Sample of Four Ethnic Groups in Southern California

The Prevalence of Venous Disease by Gender and Ethnicity in a Balanced Sample of Four Ethnic Groups in Southern California

Venous insufficiency at work.

Chronic venous disease of the lower limbs is one of the most common conditions affecting humankind. It has been postulated that certain workplace conditions may be risk factors for venous insufficiency and varicose veins in particular. This paper examines the evidence for a link between occupation and the prevalence of venous disease. It also reviews recent French research carried out to estimate the prevalence of chronic venous insufficiency in a working population; work and nonwork risk factor and the cost to industry from this condition are also examined.

Epidemiology and costs of venous diseases in central Italy. The San Valentino Venous Disease Project.

The Prevalence of Early Atherosclerosis study aims to define the prevalence of subclinical atherosclerosis in a typical population of central Italy. A concomitant study evaluates the prevalence of venous diseases. The prevalence of superficial and deep venous disease, the prevalence of venous thrombosis and pulmonary embolism, and the prevalence of the most common venous malformations were studied through use of medical history, a questionnaire, and noninvasive investigations. The costs of venous problems were also considered. Of some 2000 inhabitants, 746 (379 women; mean age 46.3 +/- 7 years; range eight to ninety-four) have been screened. No significant difference in trend increase of the relationship age/percent of subjects with venous problems was observed for superficial venous disease. The increase in the proportion of subjects with lipodermatosclerosis and venous ulcerations appeared to be correlated with age (r = 0.543). Evidence accepted for pulmonary embolisms was pulmonary angiogram or evidence on ventilation+perfusion lung scans. According to these criteria the number of documented deep vein thromboses and pulmonary embolisms was very limited with a larger number of suspected disease entities. There was no significant correlation between age and pulmonary embolism or deep venous thrombosis distribution. The number of venous and/or arteriovenous malformations was comparable along the age axis in the different age groups. Only a limited number of these malformations (in less that 1% of subjects) had caused a clinical problem. The treatments used for venous problems have been reported in a questionnaire and subdivided into occasional treatments and chronic treatments (when used for periods longer than twelve months). The percent of subjects using different treatment was also studied. Treatments were divided in: (1) over-the-counter products (or any treatment not requiring prescription); (2) specialized drug (for venous diseases); (3) compression; (4) surgery (any type of surgical treatment); (5) sclerotherapy; (6) combined treatments (ie, sclerotherapy and surgery); (7) alternative treatments (herbal products etc). Finally, the average costs per year for treatment, for investigations, and the costs due to lost working days were recorded. In conclusion some 12% of the evaluated population sample (male population 46%) had or had been affected in the past by a venous problem and 50% of them had received some type of treatment.

The Prevalence of Venous Disease in Primary Lymphoedema

Objective: To assess the prevalence of venous incompetence in primary lymphoedema. Design: Retrospective study. Setting: Outpatients attending St George's Hospital, London, UK. Patients: Forty-six patients (61 limbs) with primary lymphoedema extracted from a consecutive series of patients presenting with swollen legs. Only those with clinical and lymphoscintigraphic evidence of lymphoedema were included. Patients with any clinical evidence of venous disease were excluded. Controls: Seventeen subjects (33 limbs) with no history or clinical evidence of either lymphoedema or venous disease. Methods: Light reflective rheography (LRR) and quantitative isotopic lymphoscintigraphy. Main outcome measures: Venous refilling times (RT) with and without tourniquet control. Statistical analysis: Prevalence of venous incompetence in lymphoedema patients compared with normal controls and literature values. Results: In the patients, seven of 61 limbs (11.5%) had a venous RT of less than 25 s; eight limbs (13.1%) had a venous RT between 25 and 40 s. An above-knee tourniquet corrected the RT in all 15 limbs indicating superficial venous incompetence. In the controls, one of 33 limbs (3%) had a venous RT between 25 and 40 s. An above-knee tourniquet corrected the RT indicating superficial venous incompetence. Conclusion: Covert venous insufficiency may complicate primary lymphoedema. This has implications for both the pathophysiology of the oedema and its management.