1
|
Ngatchou W, Barche B, Temgoua M, Metouguena SE, Jutcha I, Mvondo CM, Kamdem F, Dzudie A, Ndjoh S, Johne M, Metogo J, Ndom MS, Sango J, Ngo Yon C, Moulium S, Lade V, Kuaté LM, Menanga AP, Sobngwi E, Njock R, Blazquez SB, Ngowe Ngowe M. Prevalence, clinical presentation, and risk factors of chronic venous disease in Cameroon: A general population-based study. Phlebology 2024; 39:259-266. [PMID: 38158837 DOI: 10.1177/02683555231224111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Chronic venous disease is a global public health problem, with high morbidity and economic distress. There is scarcity of data on this disease in sub-Saharan Africa. METHODS We conducted the first population-based study over a period of 20 months from 1st February 2020 to 30th September 2021 in the 10 regions of Cameroon. A stratify sampling method was chose to select study site. Socio-demographic data, personal and family history, anthropometric parameters, clinical signs, illustrative images, CEAP (Clinical-Etiological-Anatomical-Pathophysiological) classification revised in 2004, VCSS (venous Clinical Severity Score) and risk factor assessment score were used to construct the survey form. Chi-squared test and Fischer exact test were used to compare the prevalence of chronic venous disease across different potential risk factors (sex, age category, previous history of deep vein thrombosis, hypertension, diabetes, smoking status, obesity). Simple and multiple logistic regression models were used to obtain crude and adjusted odds ratio for risk factors associated with chronic venous insufficiency. Statistical analyses were done with R version 4.2 for Linux and the threshold for statistical significance was 0.05. RESULTS A total of 6578 participants were included in the study, with a mean age of 41.09 ± 16.02 years with female predominance (54.3%). The prevalence of chronic venous disease was 21.8% (95% CI: 20.8-22.9) and the prevalence of chronic venous insufficiency (C3-C6) was 7.02% (n = 462). Night cramps (43.2%), oedema (21.7%), lower limbs pain (20.4%) mostly worsens by walking and heavy legs (16.2%) were more common symptoms. The mean total venous clinical severity score was 0.69 ± 1.76 and this score had a significant positive correlation with C classification (p < .001). In the multivariate analysis, the following factors were independently associated with CVD: Male gender (aOR: 1.27; 95%CI: 1.04-1.56; p = .021), retired people (aOR: 46.9; 95% CI: 12.6-174.5; p < .001), hypertension (aOR: 289.5; 95%CI: 169.69-493.1; p < .001), diabetes (aOR: 2.19; 95% CI: 1.21-3.96; p = .009), obesity (aOR: 10.22; 95%CI: 7.67-13.62; p < .001). Smoking appears as a protective factor (aOR: 0.18; 95%CI: 0.10-0.30; p < .001). CONCLUSION Chronic venous disease is frequent in Cameroon and main traditional cardiovascular risk factors are associated to this condition. Systematic screening of the CVD in these specific groups could reduce the burden of the disease and its economic impact.
Collapse
Affiliation(s)
- William Ngatchou
- Department of Surgery and Specialities, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Blaise Barche
- Clinical Research Education Networking and Consultancy, Douala, Cameroon
| | - Mazou Temgoua
- Department of Cardiology, Faculty of Medicine, University of Toulouse-Rangueil, Toulouse, France
| | - Serge Erwich Metouguena
- Department of Surgery and Specialities, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Ivan Jutcha
- Department of Surgery and Specialities, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Charles Mve Mvondo
- Department of Surgery and Specialities, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Félicité Kamdem
- Department of Cardiology General Hospital, Douala, Cameroon
- Department of Medicine and Specialities, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy, Douala, Cameroon
- Department of Cardiology General Hospital, Douala, Cameroon
| | - Samuel Ndjoh
- Department of Surgery and Specialities, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Marcel Johne
- Department of Surgery and Specialities, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Junette Metogo
- Department of Surgery and Specialities, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Marie Solange Ndom
- Department of Medicine and Specialities, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Joseph Sango
- Department of Surgery and Specialities, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Carole Ngo Yon
- Department of Surgery and Specialities, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Sidick Moulium
- Department of Cardiology General Hospital, Douala, Cameroon
- Department of Medicine and Specialities, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Viche Lade
- Department of Cardiology General Hospital, Douala, Cameroon
| | - Liliane Mfeukeu Kuaté
- Department of Medicine and Specialities, Faculty of Medicine and Biomedical Sciences, University of Yaounde, Yaounde, Cameroon
| | - Alain Patrick Menanga
- Department of Medicine and Specialities, Faculty of Medicine and Biomedical Sciences, University of Yaounde, Yaounde, Cameroon
| | - Eugène Sobngwi
- Department of Medicine and Specialities, Faculty of Medicine and Biomedical Sciences, University of Yaounde, Yaounde, Cameroon
| | - Richard Njock
- Department of Surgery and Specialities, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | | | - Marcelin Ngowe Ngowe
- Department of Surgery and Specialities, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| |
Collapse
|
2
|
Mulita F, Dimopoulos P, Verras GI, Mustaqe P, Jaho J, Leivaditis V, Tchabashvili L, Tasios K, Antzoulas A, Pitros C, Papadoulas S, Katsakiori PF. Demographic and clinical characteristics of patients with varicose veins in Albania: a retrospective, single-centre analysis. Arch Med Sci Atheroscler Dis 2024; 9:e41-e46. [PMID: 38846060 PMCID: PMC11155458 DOI: 10.5114/amsad/183653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 02/04/2024] [Indexed: 06/09/2024] Open
Abstract
Introduction Chronic venous disease (CVD) constitutes a frequently underdiagnosed pathological condition that progressively diminishes patients' quality of life and imposes an escalating strain on healthcare resources. This study aims to comprehensively investigate the epidemiological landscape of varicose vein disease, examining age group distributions, gender patterns, residence influences, marital status correlations, weight considerations, educational impacts, and various aspects related to varicose veins. Material and methods This was a single-centre retrospective analysis, in Albania from May 2018 to September 2023. Data were collected retrospectively through hospital records. Data collection involved administering a structured questionnaire to study participants, categorically organised into three sections. The first section focused on collecting demographic information, the second section involved self-perception of identifying risk factors associated with varicose veins, and the final section included inquiries about the history of variceal surgery. Results The CEAP classification distribution in our cohort revealed a predominant presence of C2 (varicose veins) in 53.3% of patients, followed by C3 (oedema) at 29.2%, and C4 (changes in skin and subcutaneous tissue secondary to CVD) at 10.5%, whereas C5 (healed venous ulcer) and C6 (active venous ulcer) were less frequent. Based on the body mass index (BMI) scale, data from patients indicated that 9.7% were in the category of underweight, 54.8% had a normal BMI, and 35.5% were categorised as overweight. Conclusions The study's thorough exploration of patient perspectives, risk factors, and treatment choices contributes to a holistic understanding of varicose vein management, emphasising the importance of personalised approaches that account for demographic variations and individual beliefs.
Collapse
Affiliation(s)
- Francesk Mulita
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Platon Dimopoulos
- Department of Interventional Radiology, General University Hospital of Patras, Patras, Greece
| | | | - Petraq Mustaqe
- University of Vlore “Ismail Qemali”, Faculty of Health, Scientific Research Center for Public Health, Vlore, Albania
- Department of Vascular Surgery, General Hospital of Vlore, Vlore, Albania
| | - Jerina Jaho
- University of Vlore “Ismail Qemali”, Faculty of Health, Scientific Research Center for Public Health, Vlore, Albania
| | - Vasileios Leivaditis
- Department of Cardiothoracic and Vascular Surgery, WestpfalzKlinikum, Kaiserslautern, Germany
| | - Levan Tchabashvili
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Konstantinos Tasios
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Andreas Antzoulas
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Christos Pitros
- Department of Vascular Surgery, General University Hospital of Patras, Patras, Greece
| | - Spyros Papadoulas
- Department of Vascular Surgery, General University Hospital of Patras, Patras, Greece
| | | |
Collapse
|
3
|
Gianesini S, De Luca L, Feodor T, Taha W, Bozkurt K, Lurie F. Cardiovascular Insights for the Appropriate Management of Chronic Venous Disease: A Narrative Review of Implications for the Use of Venoactive Drugs. Adv Ther 2023; 40:5137-5154. [PMID: 37768506 PMCID: PMC10611621 DOI: 10.1007/s12325-023-02657-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 08/17/2023] [Indexed: 09/29/2023]
Abstract
Evidence suggests that chronic venous disease (CVD) may be a cardiovascular disorder, as patients with CVD are prone to developing arterial (atherosclerosis) and venous (thromboembolism) diseases. This may be partly explained by shared risk factors. Thus, patients with CVD or cardiovascular disease require careful history-taking and physical assessment to identify coexisting pathologies and risk factors. This article summarises a symposium at the XIX World Congress of the International Union of Phlebology held in Istanbul, Turkey, in September 2022. Common pathophysiological features of CVD and cardiovascular disease are endothelial injury, hypercoagulability and systemic inflammation. In CVD, inflammation primarily affects the microcirculation, with changes in capillary permeability, vein wall and valve remodelling and increase in oxidative stress. Once patients develop symptoms/signs of CVD, they tend to reduce their physical activity, which may contribute to increased risk of cardiovascular disease. Data show that the presence of CVD is associated with an increased risk of cardiovascular disease, including peripheral arterial disease and heart failure (HF), and the risk of adverse cardiovascular events increases with CVD severity. In addition, patients with cardiovascular disease, particularly those with HF, are at increased risk of venous thromboembolism (VTE) and should be assessed for VTE risk if they are hospitalised with cardiovascular disease. Therefore, CVD management must include a multi-specialty approach to assess risk factors associated with both the venous and arterial systems. Ideally, treatment should focus on the resolution of endothelial inflammation to control both CVD and cardiovascular disease. International guidelines recommend various conservative treatments, including venoactive drugs (VADs), to improve the symptoms/signs of CVD. Micronized purified flavonoid fraction (MPFF) is a VAD, with high-quality evidence supporting its use in relieving symptoms/signs of CVD and improving quality of life. Moreover, in large-scale observational studies, MPFF has shown superior effectiveness in real-world populations compared with other VADs. Video Abstract. (MP4 97173 kb).
Collapse
Affiliation(s)
- Sergio Gianesini
- Translational Medicine Department, University of Ferrara, Via Porta a Mare 11, 45100, Ferrara, Rovigo, Italy.
| | - Leonardo De Luca
- Division of Cardiology, Department of Cardio-Thoracic and Vascular Medicine and Surgery, A.O. San Camillo-Forlanini, Rome, Italy
| | - Toni Feodor
- Medical Center for Diagnosis, Ambulatory Treatment and Medical Prevention, Surgery Clinic 'Sf. Nicolae', Bucharest, Romania
| | - Wassila Taha
- Non-Invasive Vascular Laboratory, AlSalam Hospital Mohandessin, Cairo, Egypt
| | - Kursat Bozkurt
- Department of Cardiovascular Surgery, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Fedor Lurie
- Jobst Vascular Institute, Toledo, OH, USA
- Division of Vascular Surgery, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
4
|
Savoliuk S, Dembitskyi A. Experience in the use of endovenous methods and cell technologies in the treatment of patients with chronic venous insufficiency C6. POLISH JOURNAL OF SURGERY 2023; 96:17-22. [PMID: 38348990 DOI: 10.5604/01.3001.0053.5995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
<b><br>Introduction:</b> Severe forms of chronic venous insufficiency (CVI) CEAP C3-C6 occur in 17-20% of all CVI cases among adults.</br> <b><br>Aim:</b> The aim of this study was to compare the standard treatment of CVI C6 with endovenous methods and cellular technologies.</br> <b><br>Materials and methods:</b> Group I consisted of 28 patients with trophic ulceration treated using modern wound coverings, cell technologies and minimally invasive operations. Group II had 42 patients with trophic ulceration who underwent crossectomy with stripping of the trunk of the target vein and local treatment with "standard" ointments. The results of the treatments were evaluated using the Venous Clinical Severity Score (VCSS), the Numeric Pain Rating Scale (NPRS), and ulcer healing time.</br> <b><br>Results:</b> After 1 month, the VCSS scores were 13.8 2.3 and 16.4 3.3 points in Groups I and II, respectively; after 3 months, they were 10.2 2.1 and 13.6 2.4 points. VLU was healed in 20 (71.43%) and 16 patients (38%) after 3 months in Groups I and II, respectively; in 26 (92.86%) and 30 patients (71.43%) after 6 months; and in 28 (100%) and 40 patients (95.24%) after 12 months. After 1, 3, and 6 months, occlusion of the target segment was achieved in 14 patients (100%) of Group I. NPRS was significantly lower in Group I. The hospital stay in Group I was 8.2 2.4 days, while for Group II it was 14.5 3.8 days.</br> <b><br>Conclusions:</b> The use of modern wound coverings, platelet-rich plasma (PRP), and negative-pressure wound therapy (NPWT) reduced the period of preoperative preparation and sped up the stage of cleaning and healing of VLU compared to conventional wound coverings in patients with CVI C6.</br>.
Collapse
Affiliation(s)
- Sergii Savoliuk
- Department of Surgery and Vascular Surgery, Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine
| | - Andrii Dembitskyi
- Department of Surgery and Vascular Surgery, Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine
| |
Collapse
|
5
|
Jarošíková R, Roztočil K, Husáková J, Dubský M, Bém R, Wosková V, Fejfarová V. Chronic Venous Disease and Its Intersections With Diabetes Mellitus. Physiol Res 2023; 72:280-286. [PMID: 37449742 PMCID: PMC10668996 DOI: 10.33549/physiolres.935033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 02/28/2023] [Indexed: 08/26/2023] Open
Abstract
Chronic venous disease (CVD) is a vascular disorder in which blood return is severely compromised and CVD is usually characterized by venous hypertension. Along with obesity and diabetes mellitus, CVD is one of the most common civilization diseases. In general, the estimated prevalence of CVD ranges from 60-80 %. Early diagnosis and adequate treatment are important for preventing progression to more severe stages of the disease like venous leg ulcers. Clinical manifestations of CVD in initial stages of the disease are often asymptomatic. However, as CVD progresses, symptoms begin to develop. Treatment of CVD could be divided into conservative and surgical. Conservative therapy consists of compression, pharmacological treatment and lifestyle change. In cases where conservative therapy is ineffective, surgical or endovascular treatment may be required. The intersections between diabetes mellitus (DM) and CVD are not to be underestimated. CVD and DM have often the same risk factors. Symptoms of CVD can be modified by late complications of DM, but the incidence of different CVD degrees seems to be the same as in diabetics as in non-diabetics population. We are particularly concerned in diabetics about worse compliance with treatment due to their often-poorer adherence to treatment of DM and lifestyle changes. Moreover, there exist a higher risk of CVD and peripheral arterial disease in diabetics patients. Patients with CVD should always be inspected for the presence of DM, considering its presence can have a bearing on CVD symptoms, diagnostic procedures, and therapeutic strategies.
Collapse
Affiliation(s)
- R Jarošíková
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Praha 4, Czech Republic.
| | | | | | | | | | | | | |
Collapse
|
6
|
Cher BAY, Brown CS, Obi AT, Wakefield TW, Henke PK, Osborne NH. Women benefit from endovenous ablation with fewer complications: Analysis of the Vascular Quality Initiative Varicose Vein Registry. J Vasc Surg Venous Lymphat Disord 2022; 10:1229-1237.e2. [PMID: 35933108 DOI: 10.1016/j.jvsv.2022.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/25/2022] [Accepted: 05/10/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate the association between gender and long-term clinician-reported and patient-reported outcomes after endovenous ablation procedures. METHODS This retrospective cohort study of prospectively collected data from the Vascular Quality Initiative's Varicose Vein Registry included patients undergoing endovenous ablation procedures on truncal veins with or without treatment of perforating veins between 2015 and 2019. A univariate analysis included comparisons of preprocedural, postprocedural, and periprocedural change in Venous Clinical Severity Score (VCSS) and total symptom score by gender. Rates of complications including deep vein thrombosis, endovenous heat-induced thrombosis, leg pigmentation, blistering, paresthesia, incisional infection, and any postprocedural complications were reported by gender. Multivariable analysis leveraged linear regression to examine how gender affected the relationships between patient characteristics, complication rates, and periprocedural change in VCSS score and total symptom score. RESULTS Of 9743 patients who met the inclusion criteria, 3090 (31.7%) were men and 6653 (68.2%) were women. The perioperative change in VCSS score was greater for men than women (average -4.46 for men vs -4.13 for women; P < .0001). Perioperative change in total symptom score was greater for women than for men (average -10.64 for women vs -9.64 for men; P < .0001). Women had lower incidence of any leg complication (6.1% vs 8.6%; P = .001) endovenous heat-induced thrombosis (1.1% vs 2.2%; P = .002), and infection (0.4% vs 0.7%; P = .001). In multivariable analysis, among patients with a body mass index of more than 40, presence of deep reflux, and preoperative Clinical, Etiologic, Anatomic, and Physiologic classification of 2, women had a greater periprocedural change in VCSS score than men. CONCLUSIONS Women benefited from endovenous ablation similarly as men, with a lower incidence of postprocedural complications. Gender may be useful for patient selection and counseling for endovenous ablation, with particular usefulness among patients with a high body mass index, presence of deep reflux, and preoperative Clinical, Etiologic, Anatomic, and Physiologic classification of 2.
Collapse
Affiliation(s)
- Benjamin A Y Cher
- Section of Vascular Surgery, Department of General Surgery, University of Michigan Medical School, Ann Arbor, MI.
| | - Craig S Brown
- Section of Vascular Surgery, Department of General Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Andrea T Obi
- Section of Vascular Surgery, Department of General Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Thomas W Wakefield
- Section of Vascular Surgery, Department of General Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Peter K Henke
- Section of Vascular Surgery, Department of General Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Nicholas H Osborne
- Section of Vascular Surgery, Department of General Surgery, University of Michigan Medical School, Ann Arbor, MI
| |
Collapse
|
7
|
Azar J, Rao A, Oropallo A. Chronic venous insufficiency: a comprehensive review of management. J Wound Care 2022; 31:510-519. [PMID: 35678787 DOI: 10.12968/jowc.2022.31.6.510] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Chronic venous insufficiency is an extensive progressive disease in need of public health attention. This insidious disease is a growing burden on patient quality of life and the health economy. Chronic venous insufficiency has become more pronounced in global populations, especially in regions exhibiting a higher rate of risk factors. It is critical for healthcare providers to recognise and intervene early to prevent ongoing and debilitating complications. This article provides a comprehensive review of chronic venous insufficiency outlining the anatomy, pathophysiology, clinical presentation, assessment and management options.
Collapse
Affiliation(s)
- Julian Azar
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, US
| | - Amit Rao
- Comprehensive Wound Healing & Hyperbarics Center, Northwell Health, Lake Success, NY US
| | - Alisha Oropallo
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, US.,Comprehensive Wound Healing & Hyperbarics Center, Northwell Health, Lake Success, NY US
| |
Collapse
|
8
|
Gastaldi G, Pannier F, Roztočil K, Lugli M, Mansilha A, Haller H, Rabe E, VAN Rijn MJ. Chronic venous disease and diabetic microangiopathy: pathophysiology and commonalities. INT ANGIOL 2021; 40:457-469. [PMID: 34547884 DOI: 10.23736/s0392-9590.21.04664-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Chronic venous disease and diabetes mellitus are highly prevalent and debilitating conditions affecting millions of individuals globally. Although these conditions are typically considered as separate entities, they often co-exist which may be important in both understanding their pathophysiology and determining the best treatment strategy. Diabetes mellitus is twice as common in patients with chronic venous disease compared with the general population. Notably, a large proportion of patients with diabetes mellitus present with venous disorders, although this is often overlooked. The etiology of chronic venous disease is multifactorial, involving hemodynamic, genetic, and environmental factors which result in changes to the venous endothelium and structural wall as well as inflammation. Inflammation, endothelial dysfunction and hyperfiltration or leakage, are commonly observed in diabetes mellitus and cause various diabetic microvascular complications. Both diseases are also influenced by the increased expression of adhesion molecules, chemokines, and cytokines, and are characterized by the presence of vessel hypertension. Consequently, despite differences in etiology, the pathophysiology of both chronic venous disease and diabetic microangiopathy appears to be driven by endothelial dysfunction and inflammation. Treatment strategies should take the co-existence of chronic venous disease and diabetic microangiopathy into account. Compression therapy is recommended in inflammatory conditions that have an edema component as seen in both chronic venous disease and diabetes mellitus. Lifestyle changes like weight loss and exercise, will improve metabolic state and lower inflammation and should be promoted in these patients. Additionally, both patient populations may benefit from venoactive drugs.
Collapse
Affiliation(s)
- Giacomo Gastaldi
- Division of Endocrinology Diabetology Nutrition and Patient Education, Geneva University Hospitals, Geneva, Switzerland
| | - Felizitas Pannier
- Private Clinic Phlebology and Dermatology, Bonn, Germany.,Department of Dermatology, University of Cologne, Cologne, Germany
| | - Karel Roztočil
- Department of Transplantational and Vascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Marzia Lugli
- Unit of Vascular Surgery, Cardiovascular Department, Hesperia Hospital, Modena, Italy
| | - Armando Mansilha
- Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Angiology and Vascular Surgery, Hospital de S. João, Porto, Portugal
| | - Hermann Haller
- Hannover Medical School, Department of Nephrology and Hypertension, Hannover, Germany
| | - Eberhard Rabe
- Department of Dermatology (Emeritus), University of Bonn, Bonn, Germany
| | - Marie Josee VAN Rijn
- Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, the Netherlands -
| |
Collapse
|
9
|
Ammermann F, Meinel FG, Beller E, Busse A, Streckenbach F, Teichert C, Weinrich M, Neumann A, Weber MA, Heller T. Concomitant chronic venous insufficiency in patients with peripheral artery disease: insights from MR angiography. Eur Radiol 2020; 30:3908-3914. [PMID: 32100090 PMCID: PMC7305257 DOI: 10.1007/s00330-020-06696-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 12/23/2019] [Accepted: 01/31/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The clinical presentation of peripheral artery disease (PAD) and chronic venous insufficiency (CVI) can overlap and the conditions may co-exist. The purpose of our study was to investigate the prevalence and clinical significance of concomitant CVI in patients with PAD examined with run-off MR angiography (MRA). METHODS We analysed 180 patients (median age 69 years, range 27 to 91) with known or suspected PAD who underwent MRA at our institution between 2012 and 2018. MRA datasets were re-evaluated for manifestations of CVI. Electronic charts were reviewed to analyse whether diagnosis of CVI was documented and to determine Fontaine stage of PAD. RESULTS Evidence of possible CVI on MRA was found in 38 (21%) patients. Only seven (18%) of these patients had a documented diagnosis of CVI. Patients with co-existing PAD and CVI were more likely obese (median BMI 29.7 vs. 26.3 kg/m2, p = 0.001) and diabetic (55 vs. 35%, p = 0.039) than patients without CVI. The frequency of concomitant CVI manifestations decreased from distal to proximal with the lower leg affected in all 38 patients and the thigh in 17 patients (45%). Patients with co-existing PAD and CVI were more likely to have a clinical diagnosis of stage IV PAD than patients without co-existing CVI (57% vs. 34%, relative risk 1.68, p = 0.018). CONCLUSIONS Signs of possible concomitant CVI can be seen in approximately one-fifth of patients with known or suspected PAD examined with run-off MRA. If present, these findings should be reported since CVI may mimic or contribute to symptoms attributed to PAD. KEY POINTS • In total, 21% of patients with PAD patients examined with MR angiography show signs of possible co-existing CVI. • Patients with co-existing CVI were 1.7-fold more likely to have a clinical diagnosis of stage IV PAD. • Our data also showed that co-existing chronic venous insufficiency is under-diagnosed in patients with PAD.
Collapse
Affiliation(s)
- Felix Ammermann
- Institute of Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, University Medical Centre Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
| | - Felix G Meinel
- Institute of Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, University Medical Centre Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany.
| | - Ebba Beller
- Institute of Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, University Medical Centre Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
| | - Anke Busse
- Institute of Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, University Medical Centre Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
| | - Felix Streckenbach
- Institute of Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, University Medical Centre Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
| | - Christine Teichert
- Institute of Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, University Medical Centre Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
| | - Malte Weinrich
- Department of General, Thoracic, Vascular and Transplantation Surgery, University Medical Centre Rostock, Rostock, Germany
| | - Andreas Neumann
- Department of General, Thoracic, Vascular and Transplantation Surgery, University Medical Centre Rostock, Rostock, Germany
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, University Medical Centre Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
| | - Thomas Heller
- Institute of Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, University Medical Centre Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
| |
Collapse
|
10
|
2019 Guideline for Management of Wounds in Patients With Lower-Extremity Venous Disease (LEVD): An Executive Summary. J Wound Ostomy Continence Nurs 2020; 47:97-110. [PMID: 32150136 DOI: 10.1097/won.0000000000000622] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article provides an executive summary of the 2019 Guideline for Management of Wounds in Patients with Lower-Extremity Venous Disease (LEVD) published by the Wound, Ostomy and Continence Nurses Society (WOCN). The executive summary presents an overview of the systematic process used to update and develop the guideline. It also lists the specific recommendations from the guideline for assessment, prevention, and management of LEVD and venous leg ulcers (VLUs). In addition, the guideline includes a new section regarding implementation of clinical practice guidelines. The LEVD guideline is a resource for WOC nurse specialists and other nurses, physicians, therapists, and health care professionals who work with adults who have or who are at risk for VLU.
Collapse
|
11
|
Meulendijks AM, Welbie M, Tjin EPM, Schoonhoven L, Neumann HAM. A qualitative study on the patient's narrative in the progression of chronic venous disease into a first venous leg ulcer: a series of events. Br J Dermatol 2019; 183:332-339. [PMID: 31677155 DOI: 10.1111/bjd.18640] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND A venous leg ulcer (VLU) has a significant negative impact on quality of life. Prevention of a VLU is not yet imbedded in clinical practice because risk factors for developing a first VLU are not well known. OBJECTIVES To explore further the progression of chronic venous disease (CVD) into a first VLU from the patient's perspective. METHODS A qualitative study using semistructured interviews was conducted among male and female patients with a VLU. Patients from primary and secondary care, under and over 50 years of age, and with first and recurrent VLUs were included. The interviews were transcribed and analysed using a narrative approach to a thematic analysis. Transcripts were organized in chronological order and an iterative process was used to code the transcripts. RESULTS Four key themes and the connections made between them emerged from the 11 narratives on the progression of CVD towards a first VLU: 'comorbidity', 'mobility', 'work and lifestyle' and 'acknowledgment of CVD'. Comorbidity was linked to reduced mobility and late acknowledgment of CVD. Comorbidity also affected work and lifestyle and vice versa. Work and lifestyle affected mobility and was linked to the acknowledgment of CVD. CONCLUSIONS A reduction in mobility as a result of comorbidity and work and lifestyle occurred before the VLU developed. Patients did not recognize symptoms of CVD and did not acknowledge the chronicity of CVD. Healthcare professionals should be aware of reductions in mobility and the knowledge deficit in patients with CVD. What's already known about this topic? Not all patients with chronic venous disease (CVD) develop a venous leg ulcer (VLU). A patient's quality of life decreases significantly when a VLU develops. Risk factors for the development of a first VLU in patients with CVD are not well known, unlike risk factors for other chronic wounds like diabetic foot ulcer and pressure ulcers. What does this study add? The patient's narrative towards the development of a first VLU, a series of events. Insight into the events (comorbidity, mobility, work and lifestyle) that patients themselves link to the development of a VLU. Insight into the patients' acknowledgment of CVD in the progression of CVD towards a first VLU. What are the clinical implications of this work? More awareness is needed of CVD symptoms among patients and healthcare providers, as well as more awareness for prevention of a VLU in clinical practice. New insights (for further studies) are needed into the concept of mobility and the development of a VLU. Improved patient education and follow-up are needed for patients with CVD.
Collapse
Affiliation(s)
- A M Meulendijks
- University of Applied Sciences Utrecht, Research Group Healthy and Sustainable Living, Utrecht, the Netherlands.,Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - M Welbie
- University of Applied Sciences Utrecht, Research Group Healthy and Sustainable Living, Utrecht, the Netherlands
| | - E P M Tjin
- University of Applied Sciences Utrecht, Research Group Healthy and Sustainable Living, Utrecht, the Netherlands
| | - L Schoonhoven
- Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - H A M Neumann
- Department of Dermatology, Erasmus University Medical Centre Rotterdam, Rotterdam, the Netherlands
| |
Collapse
|
12
|
Meulendijks AM, Franssen WMA, Schoonhoven L, Neumann HAM. A scoping review on Chronic Venous Disease and the development of a Venous Leg Ulcer: The role of obesity and mobility. J Tissue Viability 2019; 29:190-196. [PMID: 31668667 DOI: 10.1016/j.jtv.2019.10.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 10/02/2019] [Accepted: 10/07/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The risk factors obesity and reduced mobility are not well known in the development of a Venous Leg Ulcer (VLU). The aim of this scoping review is to explore the mechanisms by which obesity and reduced mobility contribute the development of a VLU in patients with Chronic Venous Disease (CVD). METHODS For this scoping review a search was performed in May 2019 in the Cochrane Library and Pubmed to identify studies on the working mechanisms of obesity and mobility in developing a VLU. Hand searches were performed to find additional studies explaining the working mechanisms (indirectly related to the VLU). Two reviewers independently reviewed the abstracts and full-text articles. RESULTS Twenty-eight studies met our eligibility criteria. Disturbed range of ankle motion and gait can lead to a reduced Calf Muscle Pump (CMP) function which leading to a venous outflow disorder. Increased abdominal pressure due to obesity can lead to a venous outflow obstruction and increased adipose tissue mass results in an increase in adipokine secretion. The venous outflow disorder, outflow obstruction and increased adipokine secretion can all lead to chronic systemic inflammation, increased endothelial permeability and hence microcirculatory dysfunction. This alone can result in a VLU. CONCLUSION Obesity and reduced mobility can lead to a reduction of the CMP function, an increase in abdominal pressure and an increase in adipose tissue mass. This can simultaneously lead to haemodynamic changes in the macro- and microcirculation of the lower extremities and eventually in a VLU. In patients with obesity and reduced mobility the microcirculation alone can lead to skin changes and eventually a VLU. Therefore, early recognition of CVD symptoms in patients with obesity and reduced mobility is crucial to diagnose and treat CVD to prevent a VLU.
Collapse
Affiliation(s)
- A M Meulendijks
- University of Applied Sciences Utrecht, Research Group Healthy and Sustainable Living, Utrecht, the Netherlands; University Medical Centre Utrecht, Department Julius Centre for Health Sciences and Primary Care, Nursing Studies, Utrecht, the Netherlands.
| | - W M A Franssen
- University of Hasselt, REVAL, Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - L Schoonhoven
- University Medical Centre Utrecht, Department Julius Centre for Health Sciences and Primary Care, Nursing Studies, Utrecht, the Netherlands
| | - H A M Neumann
- Erasmus University Medical Centre Rotterdam, Department of Dermatology, Rotterdam, the Netherlands
| |
Collapse
|
13
|
Meulendijks A, de Vries F, van Dooren A, Schuurmans M, Neumann H. A systematic review on risk factors in developing a first‐time Venous Leg Ulcer. J Eur Acad Dermatol Venereol 2019; 33:1241-1248. [DOI: 10.1111/jdv.15343] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 10/16/2018] [Indexed: 11/30/2022]
Affiliation(s)
- A.M. Meulendijks
- Julius Center of Health Care Sciences Nursing Science University Medical Centre Utrecht Utrecht The Netherlands
- Research Centre for Healthy and Sustainable Living University of Applied Sciences Utrecht Utrecht The Netherlands
| | - F.M.C. de Vries
- Research Centre for Healthy and Sustainable Living University of Applied Sciences Utrecht Utrecht The Netherlands
- Raboud University Nijmegen The Netherlands
| | - A.A. van Dooren
- Research Centre for Healthy and Sustainable Living University of Applied Sciences Utrecht Utrecht The Netherlands
| | - M.J. Schuurmans
- Julius Center of Health Care Sciences Nursing Science University Medical Centre Utrecht Utrecht The Netherlands
- Research Centre for Healthy and Sustainable Living University of Applied Sciences Utrecht Utrecht The Netherlands
| | - H.A.M. Neumann
- Department of Dermatology Erasmus Medical Center Rotterdam The Netherlands
| |
Collapse
|