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Chronic Venous Disease
“Chronic Venous Disease (CVD) of the lower limbs is manifested by a range of signs, the most obvious of which are varicose veins and venous ulcers. CVD can be graded according to the descriptive clinical, etiologic, anatomical, and pathophysiological classification (CEAP) which provides an orderly framework for communication and decision making. Clinical symptoms in the legs include aching, heaviness, a sensation of swelling, and skin irritation. The term chronic venous insufficiency is generally restricted to disease of greater severity. Therefore, varicose veins in the absence of the skin changes are not indicative of chronic venous insufficiency. Chronic venous disease is associated with a reduced quality of life, particularly in relation to pain, physical function, and mobility” (p. 488).
Symptoms and Quality of Life
Bergan, J.J., Boisseau, M.R., Eklof, B., Nicolaides, M.S., Coleridge Smith, P.D., &
Schmid-Schonbein, G.W. (2006) found that symptoms conventionally ascribed to CVD include aching, heaviness, a feeling of swelling, cramps, itching, tingling, and restless legs. The proportion of patients presenting with any venous symptom with increasing CEAP class, after controlling for age, sex, body-mass index, coexisting conditions, and the duration of chronic venous disease.
Implications for Treatment
“Early treatment aimed at preventing venous hypertension, reflux, and inflammation could alleviate symptoms of chronic venous disease and reduce the risk of ulcers, both of which reduce the quality of life and are expensive to treat. Compression stockings improve venous hemodynamics, reduce edema and skin discoloration, and improve the quality of life in patients with CVD. Currently available drugs can attenuate various elements of the inflammatory cascade. Overall, a determined and proactive approach to the treatment of the early stages of chronic venous disease could reduce the number of patients needing treatment for intractable ulcers” (p. 495).
Conclusion
“The high prevalence of varicose veins and the chronicity of leg ulcers mean that the chronic venous disease has a considerable impact of health care resources. Despite the diversity of signs and symptoms associated with chronic venous disease, it seems likely that all are related to venous hypertension. In most cases, this is caused by reflux through incompetent valves, but other causes include venous overflow obstruction and failure of the calf-muscle pump owing to obesity or leg immobility” (p. 490).
“Histologic and ultra structural studies of varicose saphenous veins have found hypertrophy of the vein wall with increased collagen content, together with disruption of the orderly arrangements of smooth-muscle cells elastin fibers” (p. 491). “Because venous valves are operated by pressure rather than flow-driven devices, little or no reflux is needed to bring complete closure to the valve. Therefore, sheer stress is transduced in endothelial cells by several promising mechanisms. It is mediated by a complex network of signaling pathways that have the ability to modify the expression of several genes” (p. 492).
References
Bergan, J.J., Boisseau, M.R., Eklof, B., Nicolaides, M.S., Coleridge Smith, P.D., & Schmid-
Schonbein, G.W. (2006). Chronic venous disease. The New England Journal of
Medicine, 355. 488-498.
Chronic Venous Insufficiency - Chronic Venous Disease
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