Natural History of Varicose Veins of the Legs

Abstract

Objective To assess the natural history of saphenous and non-saphenous varicose veins using the results of the Bonn Vein Studies and data published in literature.

Methods We used the data of the Bonn Vein Studies (BVS) 1 and 2 to assess if preexisting non-saphenous varicose veins (NSVV) in persons who had no saphenous varicose veins (SVV) at baseline have an impact on the incidence of SVV during the follow-up of 6.6 years and vice versa. SVV where defined as tortuous or not-tortuous refluxing saphenous veins. The statistical evaluation was performed using SAS version 9.4 (SAS Institute, Cary, North Carolina). In addition, we performed a review of publications concerning the natural history of varicose veins (VV) using PubMed.

Results In the BVS the overall incidence of SVV within the follow-up time of 6.6 years was 8.0 % (n = 133 of 1661; 95 % CI: 6.8–9.4). 7.2 % (n = 107 of 1492) without VV in BVS 1 and 19.8 % (n = 26) of patients with preexisting NSVV developed SVV. The relative risk for the development of SVV in patients with preexisting NSVV was 2.44 (95% CI: 1.64–3.64) adjusted for age and sex. The overall incidence of NSVV was markedly higher with 13.3 % (n = 226 of 1661; 95 % CI: 11.8–15.1). During follow-up 148 patients (9.9 %) without VV in BVS 1 developed NSVV. 48.5 % (n = 78) of patients with preexisting SVV developed NSVV during follow-up. The relative risk for the development of NSVV in patients with preexisting SVV was 4.10 (95% CI: 3.26–5.16), adjusted for age and sex.

In published studies the development of VV is preceded by venous reflux. Initial VV may develop at any segment and the results from literature suggest that the location of VV and reflux at the time of the investigation depends on age. In younger individuals more distal location are reported with an ascending progression in the majority but also descending progression is possible.

Conclusions Based on the results of the Bonn Vein Studies 1 and 2 we could demonstrate, that preexisting SVV increase the risk of developing NSVV and preexisting NSVV increase the risk of developing SVV in a similar way. Venous reflux may initially occur in any segment of the venous system and may progress in antegrade and/or retrograde fashion. In younger adults initial VV seem to be localized more often in distal parts of the legs with an antegrade progression over time.

Zusammenfassung

Ziel Beurteilung der Entwicklung der Stammvenen und der Nicht-Saphena-Venen mithilfe der Ergebnisse der Bonner Venenstudien und in der Literatur veröffentlichter Daten.

Methoden Wir verwendeten Daten der Bonner Venenstudien (BVS) 1 und 2 zur Untersuchung, ob vorbestehende Nicht-Saphena-Varizen (NSVV) bei Probanden, die initial keine Saphena-Stammvarikose aufwiesen, im Follow-up von 6,6 Jahren einen Einfluss auf die Inzidenz von Saphena-Varizen (SVV) haben und umgekehrt. Eine refluxive Stammvene mit oder ohne Schlängelung wurde als Stammvarikose bzw. Saphena-Varikose definiert. Die statistische Auswertung erfolgte mit der Software SAS-Version 9.4 (SAS-Institute, Cary, North Carolina). Darüber hinaus führten wir eine Literaturrecherche zum natürlichen Verlauf von Krampfadern (VV) mit PubMed durch.

Ergebnisse In der BVS betrug die Gesamtinzidenz von SVV innerhalb der Nachbeobachtungszeit von 6,6 Jahren 8,0% (n=133 von 1661; 95%-KI 6,8–9,4). 7,2% (n=107 von 1492) ohne VV bei BVS 1 und 19,8% (n=26) der Patienten mit vorbestehender NSVV entwickelten eine SVV. Das relative Risiko für die Entwicklung einer SVV bei Patienten mit vorbestehender NSVV betrug 2,44 (95%-KI 1,64–3,64), adjustiert nach Alter und Geschlecht. Die Gesamtinzidenz von NSVV war mit 13,3% deutlich höher (n=226 von 1661; 95%-KI 11,8–15,1). Während der Nachbeobachtung entwickelten 148 Patienten (9,9%) ohne VV in BVS 1 NSVV. 48,5% (n=78) der Patienten mit vorbestehender SVV entwickelten während der Nachbeobachtung NSVV. Das relative Risiko für die Entwicklung von NSVV bei Patienten mit vorbestehender SVV betrug 4,10 (95%-KI 3,26–5,16), angepasst an Alter und Geschlecht.

In veröffentlichten Studien geht der Entwicklung einer VV ein venöser Reflux voraus. Die anfängliche VV kann sich in jedem Segment entwickeln, und die Ergebnisse aus der Literatur legen nahe, dass die Lokalisation von VV und Reflux zum Zeitpunkt der Untersuchung vom Alter abhängt. Bei jüngeren Personen wird über eine distalere Lokalisation mit einer aufsteigenden Progression in der Mehrzahl berichtet, aber auch eine absteigende Progression ist möglich.

Schlussfolgerungen Basierend auf den Ergebnissen der Bonner Venenstudien 1 und 2 konnten wir zeigen, dass vorbestehende SVV das Risiko für die Entwicklung von NSVV erhöhen und vorbestehende NSVV das Risiko für die Entwicklung von SVV in ähnlicher Weise erhöhen. Venöser Reflux kann anfänglich in jedem Abschnitt des Venensystems auftreten und kann antegrad und/oder retrograd fortschreiten. Bei jüngeren Erwachsenen scheinen anfängliche VV häufiger in distalen Teilen der Beine lokalisiert zu sein, mit einer antegraden Progression im Laufe der Zeit.

Schlüsselwörter

Varizen - Progression - natürlicher Verlauf - Reflux - Saphena-Insuffizienz

Keywords

varicose veins - progression - natural history - reflux - saphenous varicose veins

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