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General Issues

“Part of the disease comes only from the way of life”

Hippocrates / Ιπποκράτης

Chronic venous disease (CVD) of the lower extremities is a very common pathology, affecting up to 50% of the adult population; among CVD, varicose veins of the lower extremities is the most common.

Incidence of venous disease

According to various sources, up to 88% of women and up to 66% of men from among the inhabitants of developed countries have signs of venous diseases. Among the adult population, the prevalence ranges from 24% to 50%. According to the WHO, every third adult on the planet suffers from varicosity. Studies over the past few years indicate that different degrees of the venous system damage of the lower extremities occur and reduce the quality of life in 80% of people of working age. One of the largest studies that describe cases of chronic venous diseases was the Vein Consult Program, which included 91,545 people from 20 countries. Diseases of the veins were found in 83%. Among patients with CVD, women (68.4%) prevailed over men (31.6%). The average age of those who surveyed with CVD was 53.3 years. Age dependence of the prevalence of venous diseases. The prevalence of varicosity in people aged 18 to 24 years is from 11%, men in the age group from 30 to 40 years is about 3%, and men over 70 years old is 40%. For women: from 30 to 40 years old is about 20%, and for women over 70 years old, more than 50%. From 55 to 64 years old is about 55.7%. The prevalence of skin changes in chronic venous unsufficiency (CVI) for women from 30 to 39 years old is 1.8%, while at the age of over 70 they are already found in 20.7% of those who surveyed. The increase in the prevalence of CVD with age is also confirmed by a study conducted in 2010 in Germany, in which molecular genetic methods were used for the first time.

Geography of chronic venous diseases

There is a well-defined dependence on the level of development of the country and diseases of the veins, therefore WHO classifies these diseases as diseases of civilization, in other words, to pathologies associated with urbanization and scientific and technological development.

Russia: the detection rate between men and women is 2 to 1, 38—40% for women and 18—20% for men;

USA: varicose veins among men in the age group 30—40 years old – 22%, 50 years old – 42% of cases, among women – in the age group 30—40 years old – 45%, 50 years old – 64% of cases.

England: about 11 – 18%

Europe: women and men – 2: 1;

In the countries of Central Europe, the prevalence of varicose veins in women is 30%, in men – 15%;

Mediterranean countries 18—19%;

China, Japan, India, the incidence rates in these countries are low, about 9%;

Africa 5—6%;

Arab countries approximately 11.5%;

New Zealand – about 33—40%.

In developing countries, varicose veins of the lower extremities are much less common than in economically developed countries, however, such indices may indicate a low quality of diagnosis, in contrast to countries where diagnostic rates are much higher, as well as the number of visits to a doctor with these kind of problems.

What is the circulatory system?

The circulatory system performs one of the most important functions in the body – it delivers to organs and tissues oxygen and nutrients what are necessary for the body’s vital activity, while simultaneously removing carbon dioxide and waste products from them. The blood vessels through which blood moves from the heart are called arteries, and the vessels through which blood returns to the heart are called veins. Small vessels that permeate all organs are capillaries.

What are the veins in our legs?

The veins of the lower extremities are divided into several groups depending on the depth of their location: cutaneous veins (the most superficial), superficial (located under the skin), deep, and also connecting the superficial veins and deep veins – perforant.

Cutaneous veins (small, their diameter is up to 3—4mm),while expanding, they form vascular “asterisks” and reticules which is a cosmetic defect. They do not cause health problems.

– Superficial veins (saphenous).

Superficial veins develop varicose veins. It can develop as an independent disease, and this condition is called varicose veins of the lower extremities. Perhaps as a secondary, when there is a pathology in the deep veins of the leg, which for its part causes overload and secondary expansion of the saphenous veins (superficial). In addition to varicose veins, they may have thrombosis, the so-called thrombophlebitis.

– Deep veins.

Deep veins do not develop varicose veins, they may have congenital defects and local expansion of deep veins (aneurysm) which is rather rare occurrence.

– Perforant.

Perforating veins are veins that connect superficial veins to deep veins.

What diseases are attributed to diseases of the veins?

Spider veins, varicose veins, thrombosis, chronic venous insufficiency, trophic ulcers.

Which doctor should you contact due to vein diseases and what is “phlebology”?

The treatment of blood vessels is done by “cardiovascular surgeons”, “general” surgeons, but specifically by venous diseases – phlebologists. Phlebology comes from the Greek phlebos (φλεβός) – “vein” and logos (λόγος) – “doctrine”, “science”) – a branch of medicine that studies the structure, functions of veins, and also develops methods of diagnosis, treatment and prevention of diseases. A phlebologist is a doctor specializing in vein diseases. Ideally, you need to contact him. Generally, phlebologists are proficient in ultrasound methods and all modern minimally invasive technologies, laser or radiofrequency ablation, sclerotherapy, and others.

What are the symptoms of venous diseases and when to consult a phlebologist?

When the following symptoms appear: spider veins and meshes, the appearance of varicose veins, ooedema, sudden one-sided ooedema (urgently), redness of the skin along the veins, heaviness or pain in the legs, the appearance of pigmentation on the skin of the legs, trophic changes, ulcers, during pregnancy for the prevention or treatment (varicose veins, thrombosis) and others.

What are the diagnoses for venous diseases, what is written in the doctor’s conclusion?

Chronic venous disease is diagnosed according to the CEAP classification.

CEAP is a clinical, etiological, anatomopathophysiological classification that takes into account: clinical manifestations (C – clinic), etiology (E – etiology), anatomical localization (A – anatomy) and pathogenesis (P – pathogenesis) of the disease. The reason for attributing a patient to a particular class is the presence of the most pronounced objective symptom of chronic venous diseases.

Examples of diagnoses:

CEAP: C2, S, Ep, As, p, Pr, 2.18 denotes: Symptomatic varicose veins, primary disease. Reflux along the great saphenous vein in the thigh and the perforating vein of the lower leg.

CEAP: C 3, S, Es, Ad, Po, 11,13,14,15 means: Post-thrombotic disease of the lower limb veins with oedema. Deep vein obstruction of the femoral-popliteal segment and tibial veins of the lower leg.

Interesting fact.

In 400 BC, Hippocrates first described varicose veins and how to treat it.