Diagnostic et traitement des varices des membres inférieurs - KCE

6 Varicose Veins KCE Reports 164
1.2 CLINICAL BACKGROUND: VARICOSE VEINS
1.2.1 Definition
The condition of varicose veins has been defined as permanently dilated subcutaneous
veins equal to or more than 3 mm in diameter in the upright position 5 . Patients with
varicose veins of the lower limbs typically present with abnormal sensation (itching,
aching, tingling), leg pain, fatigue and heaviness, swelling and restless leg syndrome with
prolonged standing 6, 7 . These symptoms are associated with clinical signs, such as dilated
tortuous veins (veins are twisted, swollen, and visible under the skin) and oedema.
Complications are leg ulcers, thrombophlebitis and other pathological skin changes (e.g.
dermatitis) 7, 8 .
1.2.2 Prevalence
Estimates for prevalence vary based upon population, selection criteria, disease
definition and imaging techniques. Prevalence increases with age and the following
figures have been reported by different studies 9 :
• In a population-based study (Bonn Vein Study 10 ) classification levels were
59.0% for C1, 14.3% for C2, 13.5% for C3, 2.9% for C4 and 0.7% for C5-C6;
• Estimates in the adult population from UK ranged from 20% to 40% 11 .
• Occurrence in Europe and the USA is estimated to be 25% to 30% in adult
women and approximately 15% in adult men 11 .
• The age stratified prevalence of trunk varices measured in the Edinburgh Vein
study was 11.5% in the 18-24 age group increasing to 55.7% in the 55-64 age
range 12 13 .
1.2.3 Aetiology and risk factors
The aetiology of varicose veins remains elusive 14 but is likely to be multifactorial.
Varicose veins might result from abnormal elastic properties of the venous wall 7 . Valve
damage is the most common aetiology of primary varicose veins, leading to increased
pressure and distension of the veins 15 .
Risk factors include high intravenous pressure (due to standing for long periods),
sedentary lifestyle, pregnancy, gender, and family history, although genetic factors have
not been proven 16, 17 . Obesity itself is not a risk factor; however obese people with
varicose veins have a higher complication rate 17 . Smoking in men has been shown to be
also a risk factor 18 . Previous deep vein thrombosis is the most frequent cause of
secondary varicose veins 7, 14 .
1.2.4 Disease severity: CEAP Classification
Disease severity is commonly classified using the CEAP classification (Table 1): Clinical,
Etiologic, Anatomic and Pathophysiologic classifications 19 20 .
Table 1: CEAP classification (adapted from Kundu et al. 2010 19 Clinical
)
Description
Classification
C0 No visible or palpable signs of venous disease
C1 Telangiectases or reticular veins
C2 Varicose veins: distinguished from reticular veins by a diameter of 3mm or more
C3 Oedema
C4 Changes in skin and subcutaneous tissue secondary to venous disease
C4a Pigmentation or eczema
C4b Lipodermatosclerosis or atrophie blanche
C5 Healed venous ulcer
C6
Etiologic
classification
Active venous ulcer