Varicose Veins and Epidemiology - Term Paper Example

Varicose Veins and Epidemiology Varicose Veins and Epidemiology Varicose veins otherwise known as chronic venous insufficiency is one of the most reported chronic surgical conditions in the western world. This condition usually affects the general adult population. “Chronic venous insufficiency is primarily the result of sustained ambulatory venous hypertension, which in turn arises from superficial or deep venous reflux with or without deep vein obstruction” (Bradbury, 2010). “Established risk factors for chronic venous insufficiency and varicosities are as follows: old age, female gender, and pregnancy, family history of venous disease, obesity, and occupations associated with orthostasis” (Beebe-Dimmer et al, 2005). Yet there are several factors that are not well documented. Venous disorders, including varicosities, have been found commonly among the western countries. Because of the high incidence and prevalence rates, many studies have been done on the said disorder. A variety of factors have been attributed to the development of venous disorders, specifically varicosities. More commonly, this disorder is attributed to old age and female gender, and most studies tried to prove association with the disorder and the aforementioned factors. Chronic venous insufficiency has been graded according to the extent of the disorder as C1 to C6, according to the Clinical Etiological Anatomical and Pathological (CEAP) Classification, C6 being the worst, having open ulceration (Bradbury, 2010). Symptomatology of varicose veins varies greatly. Complications like venous ulcers, bleeding or thrombophlebitis can be complained by patients (Kompally et al, 2009). This is due to the poor circulation and weakness of the vein walls which causes pooling of blood. According to studies, the most common symptoms of the disorder include heaviness, itching and cramping (Kompally et al, 2009). These symptoms may be caused by dull ache and pressure sensation from the varicose veins. Itching can be experienced because of the waste products building up in the legs and cramping develops when making a sudden move as standing up. Diagnosis for the disorder was made using the CEAP Classification, which was found out to be the most practical and clinically important. Doppler ultrasound examination has also been widely accepted and used. Treatment options for the disorder, on the other hand, include surgical intervention, if conservative management is not permissible (Kompally, et al, 2009). Various new treatment modalities are now being used in practice in management of this disorder. Some of which are radio frequency ablation, laser treatment, phlebectomy, and many others. It has been mentioned that there has been significant amount of studies that has been undertaken with regards to chronic venous insufficiencies including varicosities. Among the studies, a common trend can be seen, especially in terms of prevalence and incidence. Some studies even support a previous one. Among the six chosen studies on varicosities, predisposition almost always includes the following: old age, female gender, pregnancy, family history of venous disease, obesity and occupations associated with orthostasis. But this does not mean that the causation of this disorder is limited to the above mentioned factors. Diet, activity and exogenous hormone use are still needed to be studied more fully (Beebe-Dimmer, et al, 2005). Bradbury (2010) on the other hand, has identified several more technical factors that contribute to the development of the disease. Macrovascular and microvascular disease has been added to the picture, as well as calf muscle pump, uncontrolled inflammation, disordered extracellular matrix production, epithelialization failure and thrombophilia. He also cited malnutrition as one major contributing factor for varicosities. Deficiencies in protein, vitamin c and zinc intake have been shown to make a person prone to developing varicose veins and other chronic venous insufficiencies. Bacterial infection also plays a significant role. Especially when talking about C5 to C6. Varicosities that have open ulceration or have high probability of having one can have complications when exposed to bacterial infection or any other infective organisms. Having knowledge on the predisposition for the disorder can aid healthcare practitioners promote primary prevention on the said disease entity. Health education and screening can be more beneficial than allowing the patient to suffer from the actual disease itself. The public should bear in mind that this disorder has high prevalence and incidence rates. Also, having varicosities can be disabling and humiliating as far as the symptomatology is concerned. Chronic venous insufficiency, having been associated with the nature of work, also has an impact on primary prevention. There are certain jobs that are prone to different and specific disorders, and chronic venous insufficiencies and varicosities are one of them. Jobs that have high incidence of orthostasis are also included in the said category. Nursing, sales-related jobs and others are a few examples of this. Varicosities and chronic venous insufficiencies can be prevented if the possible causation can be identified early on. Having enough fiber-rich plant foods in the diet with zinc and other vitamins, exercising and controlling the weight (to prevent the risk of obesity), and avoiding prolonged period of standing or sitting can help prevent the occurrence of varicosities. Patients with varicosities seek professional consult for varied reasons. One is that the condition is debilitating enough in the sense that the patient is in a tremendous amount of pain. The other is for cosmetic reasons, such as cases with pigmentation and lipodermatosclerosis. “Presence of symptoms like heaviness, aching or swelling, as well as ultrasound evidence, is generally accepted as indicators for surgery” (Kompally et al, 2009). According to the British Vascular Surgical Society, the most common indication for surgery is symptomatic and complicated varicose veins (Kompally, 2009). According to Kompally, et al. (2009), a little more than half of the cases of operation were performed for cosmetic reasons. At present, there are changes in trends showing that surgeons use the aid of hand-held Doppler for assessment of varicose veins as the clinical tests can be inaccurate. Aside from the fact that the hand-held Doppler is simple and inexpensive, it is useful more so in the outpatient setting to check venous system easily, yet accurately. Treatment for varicose veins is one of the most common procedures done in most hospitals and out-patient clinics (Kanwar, et al, 2009). Various treatment options are available for such cases. The main treatment forms for varicose veins include conservative management, surgery, and minimally invasive treatments. However, the criteria for each of the various treatments are not well defined and there is no general consensus over which intervention is the most effective (Kanwar, et al, 2009). Surgery is not the treatment of choice for varicosities. In fact, it is the last resort for complicated and symptomatic varicose veins. Conventional treatment and management is still the choice, and prevention of its occurrence is of prime importance to avoid all the unnecessary expenditures and turmoil that the disorder might bring. Robertson, et al. (2007), presented a different perspective on the epidemiology of chronic venous disease. The results showed that indeed there are some studies that have not found higher prevalence of varicose veins on women. It may seem so because aside from pregnancy, the study reported the presence of varicose veins more often than men. The authors postulated that the exact prevalence of chronic venous disease remains difficult to determine because of a variety of factors. It includes but is not limited to variations on study populations, selection criteria and disease definition between different studies. Other variables add to the cause such as family history, obesity, orthostasis (as in prolonged standing) and diet have been proposed as risk factors but more evidence is required (Robertson, et al, 2007). Because of the conflicting evidences, there is a need for high quality research measuring incidence and prevalence of chronic venous diseases. Summary and Conclusion In summary, chronic venous disease or insufficiency is one of the most common disorders noted in western countries. There are a variety of factors proposed to have caused the said condition, some of which needed additional data. These risk factors include but are not limited to: old age, gender (female), pregnancy, orthostasis, diet, smoking and others. But because of the complexity of the causation, further studies on its epidemiology are helpful. Symptomatology also varies. Heaviness, aches and swelling are the most common symptoms reported. However, there are cases having lipodermarosclerosis and pigmentation, which are usually the more severe ones. These manifestations make the client a good candidate for surgery. The disorder can be diagnoses using CEAP classification and best confirmed with hand-held Doppler and duplex scan of saphenous veins. There is no single most effective treatment for varicosities. Conventional treatment is still advocated, however, there are cases where an operation should be performed. Almost half of the surgical cases are performed due to cosmetic purposes, since women are the most likely to report the disorder. Varicosities and chronic venous insufficiencies can be prevented if the possible causation can be identified early on. It would be more beneficial to prevent the disorder rather than to treat them when they occur. Remember that varicosities can also be debilitating in the sense that a patient can be in a tremendous amounts of pain, especially when disregarded. And like any other disorder and condition, prevention still is better than cure. References Beebe-Dimmer, J. L., Pfeifer, J. R., Engle, J. S., & Schottenfeld, D. (2005). The Epidemiology of Chronic Venous Insufficiency and Varicose Veins. Annals Of Epidemiology, 15(3), 175-184. Bradbury, A. W. (2010). Epidemiology and aetiology of C4-6 disease. Phlebology, 252-8. Clark, A. A., Harvey, I. I., & Fowkes, F. R. (2010). Epidemiology and risk factors for varicose veins among older people: cross-sectional population study in the UK. Phlebology, 25(5), 236-240. Kanwar, A., Hansrani, M., Lees, T., Stansby, G. (2009). Trends in varicose vein therapy in England: radical changes in the last decade. Vascular Surgery, 92, 341-346. Kompally, G., Bharadwaj, R. N., & Singh, G. (2009). Varicose veins: clinical presentation and surgical management. Indian Journal Of Surgery, 71(3), 117-120. Robertson, L. L., Evans, C. C., & Fowkes, F. R. (2008). Epidemiology of chronic venous disease. Phlebology, 23(3), 103-111. Read More