Varicose veins natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
The progression of chronic venous insufficiency over time is not well understood. The progression follows quite a variable path. Some patients might initially have varicose veins but not have any clinical symptoms; others might develop clinical symptoms(such as heaviness,eczema, etc.) without any clinically visible disease. Without treatment most patients will show worsening of the condition over time[1].
Serious complications are rare but severe varicosities can lead to major complications, due to the poor circulation through the affected limb.
Natural History
The natural history of varicose veins is not well understood. This has been a roadblock in prioritizing patients on the basis of stage of clinical disease. For different patients, the disease progresses in different manners. The progression of the varicose veins is driven by a cycle of venous hypertension, inflammation, capillary damage, and edema [2]. In a study by Lee et al[3], it was found that almost half(57%) the patients who develop some level of chronic venous disease initially would show a progression of the disease when followed over time. 98% of the patients who had both varicose veins and chronic venous insufficiency at baseline showed deterioration with time. While the progression was affected by a family history of varicose veins, age, history of DVT, being overweight; gender did not seem to play a role in determining the rate of progression. On duplex ultrasonography scanning, venous reflux especially, superficial combined with deep vein reflux was found to be associated with higher rates of disease progression.
Complications
Most varicose veins are relatively benign, but severe varicosities can lead to major complications, due to the poor circulation through the affected limb [4].
- Pain, heaviness, inability to walk or stand for long hours thus hindering work
- Skin conditions / dermatitis often occurs with chronic stasis of venous blood
- Bleeding: although uncommon, a life-threatening bleed can happen from injury to the varicose vein
- Ulcer: non-healing varicose ulcer could threaten limb amputation.
- Development of carcinoma or sarcoma in long-standing venous ulcers. There have been over 100 reported cases of malignant transformation and the rate is reported as 0.4% to 1%.[5]
- Coagulation of blood in varicose veins cause superficial venous thrombosis, deep vein thrombosis (DVT), pulmonary embolism (PE) & could precipitate stroke in the rare case of predisposed individuals (that is, patients with patent foramen ovale).
Prognosis
Even though Varicose veins are a chronic condition, the prognosis is often benign. Most of the mortality associated with varicose veins is due to venous thromboembolism. The possibility of DVT should always be considered in patients with varicose veins. In a 14 year study conducted in Taiwan during the year 2018, the incidence of DVT was found to be 5 times higher in subjects with varicose veins as compared to without[6]. This can be prevented with timely intervention.
References
- ↑ Labropoulos N, Leon L, Kwon S, Tassiopoulos A, Gonzalez-Fajardo JA, Kang SS; et al. (2005). "Study of the venous reflux progression". J Vasc Surg. 41 (2): 291–5. doi:10.1016/j.jvs.2004.11.014. PMID 15768012.
- ↑ Bergan JJ, Schmid-Schönbein GW, Smith PD, Nicolaides AN, Boisseau MR, Eklof B (2006). "Chronic venous disease". N Engl J Med. 355 (5): 488–98. doi:10.1056/NEJMra055289. PMID 16885552.
- ↑ Lee AJ, Robertson LA, Boghossian SM, Allan PL, Ruckley CV, Fowkes FG; et al. (2015). "Progression of varicose veins and chronic venous insufficiency in the general population in the Edinburgh Vein Study". J Vasc Surg Venous Lymphat Disord. 3 (1): 18–26. doi:10.1016/j.jvsv.2014.09.008. PMID 26993676.
- ↑ https://www.clinicbarcelona.org/en/assistance/diseases/varicose-veins/evolution-of-the-disease#:~:text=Although%20varicose%20veins%20and%20venous,discomfort%2C%20complications%2C%20and%20progression.
- ↑ Goldman M. Sclerotherapy, Treatment of Varicose and Telangiectatic Leg Veins. Hardcover Text, 2nd Ed, 1995
- ↑ Chang SL, Huang YL, Lee MC, Hu S, Hsiao YC, Chang SW; et al. (2018). "Association of Varicose Veins With Incident Venous Thromboembolism and Peripheral Artery Disease". JAMA. 319 (8): 807–817. doi:10.1001/jama.2018.0246. PMC 5838574. PMID 29486040.