Abstract
Aims and Objective
- To study the association between asymptomatic in Deep vein thrombosis (DVT) in patients with varicose veins in different gender and age groups.
- To study the risk of developing DVT in patients having superficial venous thrombophlebitis with varicose veins.
- To study the Clinical correlation of CEAP classification with DVT in patients with varicose veins.
Materials and Methods
- Patients presenting to department of General surgery of SS Medical College, Hospital and Research Centre during the period from June 2017 to June 2019 with Varicose veins of lower limbs and without clinical signs of DVT were included in this study.
- Patients were categorised according to CEAP classification.
- All patients were subjected to duplex scanning of lower limbs to look for presence of superficial vein thrombosis (SVT) and DVT.
Results: In our study, 73% patients were males and 27% patients were females. Maximum patients were in age group of 40-60 years.16 patients had DVT, 38 patients had SVT, 166 patients belonged to C2 and 56 patients belonged to CEAP class C3 and beyond.
Conclusion: There is strong associations between Varicose veins and asympyomatic DVT .The presence of STP is not a risk factor for concomitant DVT in varicose vein patients. Clinical presentation with C3 or more CEAP grade is one of the potential risk factors for concomitant DVT in varicose vein patients .
Keywords: Varicose veins, Deep vein thrombosis, CEAP.
References
- Bergan JJ. Lymphedema: introduction and clinical evaluation in: Handbook of Venous Disorders, Guidelines of American Venous Forum. Chapman-Hall Medical. 1996;33:569-79.
- Földi M. Insufficiency of lymph flow. Lymphangiology. Stuttgart: Schattauer. 1983:195-210.
- Beebe-Dimmer JL, Pfeifer JR, Engle JS, et al. The epidemiology of chronic venous insufficiency and varicose veins. Ann Epidemiol 2005; 15: 175–184.
- National Clinical Guideline Centre. Varicose Veins in the Legs: The Diagnosis and Management of Varicose Veins. http://www.nice.org.uk/guidance/cg168/evidence/ varicose-veins-in-the-legs-fullguideline-191485261 (2013, accessed 15 November 2015).
- Robertson L, Evans C and Fowkes FG. Epidemiology of chronic venous disease. Phlebology 2008; 23: 103–111.
- Piazza G. Varicose veins. Circulation. 2014;130(7): 582-587.
- Poredos P, Spirkoska A, Rucigaj T, Fareed J, Jezovnik MK. Do blood constituents in varicose veins differ from the systemic blood constituents? Eur J Vasc Endovasc Surg. 2015;50(2):250-256.
- Riva N, Donadini MP, AgenoW. Epidemiology and pathophysiology of venous thromboembolism: similarities with atherothrombosis and the role of inflammation. Thromb Haemost. 2015;113(6):1176- 1183.
- Lee AJ, MacGregor AS, Hau CM, et al. The role of haematological factors in diabetic peripheral arterial disease: the Edinburgh Artery Study. Br J Haematol. 1999;105(3):648-654.
- Hansen AT, Juul S, Knudsen UB, Hvas AM. Low risk of venous thromboembolism following early pregnancy loss in pregnancies conceived by IVF. Hum. Reprod. 2018 Oct 01;33(10):1968-1972. [PubMed].
- Sharif S, Eventov M, Kearon C, Parpia S, Li M, Jiang R, Sneath P, Fuentes CO, Marriott C, de Wit K. Comparison of the age-adjusted and clinical probabilityadjusted D-dimer to exclude pulmonary embolism in the emergency department. Am J Emerg Med. 2018 Jul 30; [PubMed].
- Delluc A, Le Mao R, Tromeur C, Chambry N, Rault-Nagel H, Bressollette L, Mottier D, Couturaud F, Lacut K. Incidence of upper-extremity deep vein thrombosis in western France: a community-based study. Haematologica. 2019 Jan;104(1):e29-e31. [PMC free article] [PubMed].
- Kearon C. Natural history of venous thromboembolism. Circulation 2003;107:I2230. 10.1161/01.CIR.0000078464.82671.78 [PubMed] [CrossRef] [Google Scholar]
- Galanaud JP, Kahn SR. Postthrombotic syndrome: a 2014 update. CurrOpin Cardiol 2014;29:514-9. 10.1097/HCO.0000000000000103 [PubMed] [CrossRef] [Google Scholar].
- Kahn SR, Shrier I, Julian JA, et al. Determinants and time course of the postthrombotic syndrome after acute deep venous thrombosis. Ann Intern Med 2008;149:698-707. 10.7326/0003-4819-149-10-200811180-00004 [PubMed] [CrossRef] [Google Scholar]
- Søgaard KK, Schmidt M, Pedersen L, et al. 30-year mortality after venous thromboembolism: a population-based cohort study. Circulation 2014;130:829-36. 1161/CIRCULATIONAHA.114.009107 [PubMed] [CrossRef] [Google Scholar]
- LK Widmer, HB Stähelin, C Nissen, A da Silva Venen-, Arterienkrankheiten, koronare Herzkrankheitbei Berufstätigen: Prospektivepidemiologische Untersuchung. Basler Studie I-III, 1959-1978Switzerland: Huber, Bern (1981) Google Scholar
- HJ Leu Phlebitides: A survey Vasa, 23 (1994), pp. 289-298
- Beebe HG, Bergan J, Bergqvist D, Eklof B, Eriksson I, Goldman MP. Classification of chronic venous disease of the lower limbs: a consensus statement. Eur J Vasc Endovasc Surg 1996;12:487-92.
- Lee AJ, Evans CJ, Allan PL, Ruckley CV, Fowkes FG. Lifestyle factors and the risk of varicose veins: Edinburgh Vein Study. Journal of clinical epidemiology. 2003 Feb 1;56(2):171-9.
- Vashist M, Godara R, Sen J, Panwar S. Management of varicose veins: Status of clinical examination and colour Doppler in the present Indian scenario. Internet J Surg 2008;20:1-4.
- Müller-Bühl U, Leutgeb R, Engeser P, Achankeng EN, Szecsenyi J, Laux G. Varicose veins are a risk factor for deep venous thrombosis in general practice patients. Vasa. 2012;41(5):360-365.
- Engbers MJ, Karasu A, Blom JW, Cushman M, Rosendaal FR, van Hylckama Vlieg A. Clinical features of venous insufficiency and the risk of venous thrombosis in older people. Br J Haematol.2015;171(3):417-423.
- Chang SL, Huang YL, Lee MC, Hu S, Hsiao YC, Chang SW, Chang CJ, Chen PC. Association of varicose veins with incident venous thromboembolism and peripheral artery disease. Jama. 2018 Feb 27;319(8):807-17.
- Hafner CD, Cranley JJ, Krause RJ, Strasser ES. A method of managing superficial thrombophlebitis. Surgery. 1964 Feb 1;55(2):201-6.
- Skillman JJ, Kent KC, Porter DH, Kim D. Simultaneous occurrence of superficial and deep thrombophlebitis in the lower extremity. Journal of vascular surgery. 1990 Jun 1;11(6):818-24.
- Bounameaux H, Reber-Wasem MA. Superficial thrombophlebitis and deep vein thrombosis: a controversial association. Archives of internal medicine. 1997 Sep 8;157(16):1822-4.
- Chengelis DL, Bendick PJ, Glover JL, Brown OW, Ranval TJ. Progression of superficial venous thrombosis to deep vein thrombosis. J Vasc Surg. 1996;24: 745-749.
- Jorgensen JO, Hanel KC, Morgan AM, Hunt JM. The incidence of deep vein thrombosis in the patient with superficial thrombophlebitis of the lower limbs. J Vasc Surg. 1993;18:70-73.
- Shirasugi N, Horiguchi S, Shirato H, Kawakami T, Ono H, Yabuki S, Jojima K, Niimi M. Prevalence of isolated asymptomatic deep vein thrombosis in varicose vein patients with superficial thrombophlebitis: A single center experience in Japan. Annals of vascular diseases. 2015:oa-15.
Corresponding Author
Dr Vijay Kumar S
Department of Surgery, R L Jalappa Hospital, Tamaka Kolar, Karnataka