A multicenter review of epidemiology and management of varicose veins for national guidance. (June 2016) - Joseph, Nitin
Abstract: Background: Varicose vein is a common surgical problems in India. This study was done to assess the clinico-epidemiological profile, risk factors and management practices in varicose veins. Materials and methods: Medical records of 170 varicose vein cases admitted in tertiary care hospitals in Mangalore between May 2011 to April 2014 were reviewed retrospectively. Results: Majority of cases 53(31.2%) were of the age group 41–50 years. Majority were males 127(74.7%) and majority were unskilled workers 101(59.4%). Superficial veins were involved in 123(72.4%) cases. Perforator followed by great saphenous vein were most frequently involved. Veins on the left side were more involved than on the right. Common symptoms at the time of presentation was ulceration 98(57.6%) followed by pain in the legs 96(56.5%). Ulceration was seen significantly more among females (p = 0.027) and among house wives (p = 0.004). Complications like eczema 46(27.1%), non-healing ulcers 21(12.3%) and deep vein thrombosis 10(5.9%) were reported among cases. Eczema was present significantly more among elderly patients aged above 60 years (p = 0.019). Risk factors like prolonged standing was observed in 86(50.6%) cases. This history was significantly seen among males (p = 0.001) and among those involved in unskilled occupations (p < 0.001). Recurrence of varicose vein was reported in 23(13.5%) cases. It was associated with patients of the age group 21–30 years (p = 0.021). Doppler ultrasound was the most common 120(70.6%) investigation done. Micronized purified flavonoid fraction was used in management in 15(8.8%) cases. Conservative management methods like limb elevation 50(29.4%) and compression stocking 36(21.2%) was advised to patients. Saphenous vein stripping was the most common surgical procedure 40(23.5%) performed. Conclusion: The high risk groups identified in this study need to be made aware of risk of developing varicose veins. Use of compression stocking at work place added with newer procedure in management could help in betterment in their quality of life. Highlights: Perforator veins were most commonly involved indicating risk of future complications. Most common symptom at the time of presentation of varicose veins was ulceration. Recurrence of varicose vein was reported in 13.5% cases. High risk groups for common risk factors, symptoms and complications in varicose veins were identified. Saphenous vein stripping was the most common surgical procedure performed.