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Progression of varicose veins and chronic venous insufficiency in the general population in the Edinburgh Vein Study.

Abstract

OBJECTIVE

The natural history in the general population of chronic venous disease in the legs is not well understood. This has limited our ability to predict which patients will deteriorate and to assign clinical priorities. The aims of this study were to describe the progression of trunk varicose veins and chronic venous insufficiency (CVI) in the general population, to identify important lifestyle and clinical prognostic factors, and to determine the relationship between venous reflux and progression.

METHODS

The Edinburgh Vein Study is a population-based cohort study in which randomly selected adults aged 18 to 64 years had an examination at baseline. This included a questionnaire on lifestyle and clinical factors, standardized assessment and classification of venous disease in the legs, and duplex scan to detect venous reflux in eight segments of each leg. A follow-up examination 13 years later included a reclassification of venous disease to ascertain progression in the development or increase in severity of varicose veins and CVI.

RESULTS

Among 1566 adults seen at baseline, 880 had a follow-up examination, of whom 334 had trunk varicose veins or CVI at baseline and composed the study sample. The mean (standard deviation) duration of follow-up was 13.4 (0.4) years. Progression was found in 193 (57.8%), equivalent to 4.3% (95% confidence interval [CI], 3.7-4.9) annually. In 270 subjects with only varicose veins at baseline, 86 (31.9%) developed CVI, with the rate increasing consistently with age (P = .04). Almost all subjects (98%) with both varicose veins and CVI at baseline deteriorated. Progression of chronic venous disease did not differ by gender or leg, but a family history of varicose veins and history of deep venous thrombosis increased risk (odds ratio [OR], 1.85 [95% CI, 1.14-1.30] and 4.10 [95% CI, 1.07-15.71], respectively). Overweight was associated with increased risk of CVI in those with varicose veins (OR, 1.85; 95% CI, 1.10-3.12). Reflux in the superficial system increased the likelihood of progression, especially in combination with deep reflux (OR, 2.57; 95% CI, 1.55-4.25) and when located in the small saphenous vein (OR, 4.73; 95% CI, 1.37-16.39).

CONCLUSIONS

Nearly half of the general population with chronic venous disease deteriorated during 13 years, and almost one third with varicose veins developed skin changes of CVI, increasing their risk of ulceration. Age, family history of varicose veins, history of deep venous thrombosis, overweight, and superficial reflux, especially in the small saphenous vein and with deep reflux, might influence the risk of progression.

Authors+Show Affiliations

Medical Statistics Team, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom.Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom.Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom.Radiology Department, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, United Kingdom.Division of Health Sciences: Clinical Surgery, University of Edinburgh, Edinburgh, United Kingdom.Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom. Electronic address: gerry.fowkes@ed.ac.uk.Public Health Department, NHS Lothian, Edinburgh, United Kingdom.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26993676

Citation

Lee, Amanda J., et al. "Progression of Varicose Veins and Chronic Venous Insufficiency in the General Population in the Edinburgh Vein Study." Journal of Vascular Surgery. Venous and Lymphatic Disorders, vol. 3, no. 1, 2015, pp. 18-26.
Lee AJ, Robertson LA, Boghossian SM, et al. Progression of varicose veins and chronic venous insufficiency in the general population in the Edinburgh Vein Study. J Vasc Surg Venous Lymphat Disord. 2015;3(1):18-26.
Lee, A. J., Robertson, L. A., Boghossian, S. M., Allan, P. L., Ruckley, C. V., Fowkes, F. G., & Evans, C. J. (2015). Progression of varicose veins and chronic venous insufficiency in the general population in the Edinburgh Vein Study. Journal of Vascular Surgery. Venous and Lymphatic Disorders, 3(1), pp. 18-26. doi:10.1016/j.jvsv.2014.09.008.
Lee AJ, et al. Progression of Varicose Veins and Chronic Venous Insufficiency in the General Population in the Edinburgh Vein Study. J Vasc Surg Venous Lymphat Disord. 2015;3(1):18-26. PubMed PMID: 26993676.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Progression of varicose veins and chronic venous insufficiency in the general population in the Edinburgh Vein Study. AU - Lee,Amanda J, AU - Robertson,Lindsay A, AU - Boghossian,Sheila M, AU - Allan,Paul L, AU - Ruckley,C Vaughan, AU - Fowkes,F Gerald R, AU - Evans,Christine J, Y1 - 2014/11/01/ PY - 2014/05/21/received PY - 2014/09/24/accepted PY - 2016/3/20/entrez PY - 2015/1/1/pubmed PY - 2017/9/19/medline SP - 18 EP - 26 JF - Journal of vascular surgery. Venous and lymphatic disorders JO - J Vasc Surg Venous Lymphat Disord VL - 3 IS - 1 N2 - OBJECTIVE: The natural history in the general population of chronic venous disease in the legs is not well understood. This has limited our ability to predict which patients will deteriorate and to assign clinical priorities. The aims of this study were to describe the progression of trunk varicose veins and chronic venous insufficiency (CVI) in the general population, to identify important lifestyle and clinical prognostic factors, and to determine the relationship between venous reflux and progression. METHODS: The Edinburgh Vein Study is a population-based cohort study in which randomly selected adults aged 18 to 64 years had an examination at baseline. This included a questionnaire on lifestyle and clinical factors, standardized assessment and classification of venous disease in the legs, and duplex scan to detect venous reflux in eight segments of each leg. A follow-up examination 13 years later included a reclassification of venous disease to ascertain progression in the development or increase in severity of varicose veins and CVI. RESULTS: Among 1566 adults seen at baseline, 880 had a follow-up examination, of whom 334 had trunk varicose veins or CVI at baseline and composed the study sample. The mean (standard deviation) duration of follow-up was 13.4 (0.4) years. Progression was found in 193 (57.8%), equivalent to 4.3% (95% confidence interval [CI], 3.7-4.9) annually. In 270 subjects with only varicose veins at baseline, 86 (31.9%) developed CVI, with the rate increasing consistently with age (P = .04). Almost all subjects (98%) with both varicose veins and CVI at baseline deteriorated. Progression of chronic venous disease did not differ by gender or leg, but a family history of varicose veins and history of deep venous thrombosis increased risk (odds ratio [OR], 1.85 [95% CI, 1.14-1.30] and 4.10 [95% CI, 1.07-15.71], respectively). Overweight was associated with increased risk of CVI in those with varicose veins (OR, 1.85; 95% CI, 1.10-3.12). Reflux in the superficial system increased the likelihood of progression, especially in combination with deep reflux (OR, 2.57; 95% CI, 1.55-4.25) and when located in the small saphenous vein (OR, 4.73; 95% CI, 1.37-16.39). CONCLUSIONS: Nearly half of the general population with chronic venous disease deteriorated during 13 years, and almost one third with varicose veins developed skin changes of CVI, increasing their risk of ulceration. Age, family history of varicose veins, history of deep venous thrombosis, overweight, and superficial reflux, especially in the small saphenous vein and with deep reflux, might influence the risk of progression. SN - 2213-3348 UR - https://www.unboundmedicine.com/medline/citation/26993676/Progression_of_varicose_veins_and_chronic_venous_insufficiency_in_the_general_population_in_the_Edinburgh_Vein_Study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S2213-333X(14)00176-0 DB - PRIME DP - Unbound Medicine ER -