Clinical study of asymptomatic deep vein thrombosis in patients with varicose veins of lower extremities

Authors

  • Basavarajappa M. Department of General Surgery, SS institute of Medical Sciences and Research Centre, Davangere, Karnataka, India
  • Anantharaju G. S. Department of General Surgery, SS institute of Medical Sciences and Research Centre, Davangere, Karnataka, India
  • Deepak G. Department of General Surgery, SS institute of Medical Sciences and Research Centre, Davangere, Karnataka, India

DOI:

https://doi.org/10.18203/2349-2902.isj20194218

Keywords:

Varicose veins, Deep vein thrombosis, CEAP classification

Abstract

Background: The main aim is to study the association between asymptomatic deep vein thrombosis (DVT) in patients with varicose veins in different gender and age groups. Secondly, to study the risk of developing DVT in patients having superficial venous thrombophlebitis (SVT) with varicose veins and finally to study the clinical correlation of clinical, etiological, anatomical and pathological (CEAP) classification with DVT in patients with varicose veins.

Methods: Patients presenting to department of General surgery at SS Institute of Medical Science 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 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.

Conclusions: There is a strong association between varicose veins and asymptomatic DVT .The presence of SVT 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.

Author Biography

Basavarajappa M., Department of General Surgery, SS institute of Medical Sciences and Research Centre, Davangere, Karnataka, India

Associate professor

Departement of General Surgery

References

Bergan JJ. Lymphedema: introduction and clinical evaluation. In: Handbook of Venous Disorders, Guidelines of American Venous Forum. 4th ed. Chapman-Hall Medical; 1996;33:569-79.

Foldi M. Insufficiency of lymph flow. Lymphangiol. Stuttgart: Schattauer; 1983: 195-210.

Beebe-Dimmer JL, Pfeifer JR, Engle JS, Schottenfeld D. The epidemiology of chronic venous insufficiency and varicose veins. Ann Epidemiol. 2005;15:175-84.

National Clinical Guideline Centre. Varicose veins in the legs: The diagnosis and management of varicose veins. Available at: http://www.nice.org.uk/guidance/cg168/evidence/ varicose-veins-in-the-legs-full-guideline-191485261. Accessed on 15 November 2018.

Robertson L, Evans C, Fowkes FG. Epidemiology of chronic venous disease. Phlebol. 2008;23:103-11.

Piazza G. Varicose veins. Circulation. 2014;130(7):582-7.

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):250-6.

Riva N, Donadini MP, AgenoW. Epidemiology and pathophysiology of venous thromboembolism: similarities with atherothrombosis and the role of inflammation. Thromb Haemost. 2015;113(6):1176-83.

Lee AJ, MacGregor AS, Hau CM, Price JF, Rumley A, Lowe GD. The role of haematological factors in diabetic peripheral arterial disease: the Edinburgh artery study. Br J Haematol. 1999;105(3):648-54.

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;33(10):1968-72.

Sharif S, Eventov M, Kearon C, Parpia S, Li M, Jiang R, et al. Comparison of the age-adjusted and clinical probability-adjusted D-dimer to exclude pulmonary embolism in the emergency department. Am J Emerg Med. 2019;37(5):845-50.

Delluc A, Le Mao R, Tromeur C, Chambry N, Rault-Nagel H, Bressollette L, et al. Incidence of upper-extremity deep vein thrombosis in western France: a community-based study. Haematologica. 2019;104(1):29-31.

Kearon C. Natural history of venous thromboembolism. Circulation. 2003;107:22-30.

Galanaud JP, Kahn SR. Post-thrombotic syndrome: a 2014 update. Curr Opin Cardiol. 2014;29:514-9.

Kahn SR, Shrier I, Julian JA, Ducruet T, Arsenault L, Miron MJ, et al. Determinants and time course of the postthrombotic syndrome after acute deep venous thrombosis. Ann Intern Med. 2008;149(10):698-707.

Sogaard KK, Schmidt M, Pedersen L, Horvath-Puho E, Sørensen HT. 30-year mortality after venous thromboembolism: a population-based cohort study. Circulation. 2014;130:829-36.

LK Widmer, HB Stahelin, Nissen C, SilvaVenen A. Arterienkrankheiten, koronare Herzkrankheit bei Berufstätigen: Prospektiv epidemiologische Untersuchung. Basler Studie I-III, Switzerland: Bern; Stuttgart: H. Huber; 1981.

Leu HJ, Leu AJ. Phlebitidesa survey. VASA. 1994;23:289-98.

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. J Clin Epidemiol. 2003;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. Int J Surg. 2008;20:1-4.

Muller-Buhl 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):360-5.

Engbers MJ, Karasu A, Blom JW, Cushman M, Rosendaal FR, van Vlieg HA. Clinical features of venous insufficiency and the risk of venous thrombosis in older people. Br J Haematol. 2015;171(3):417-23.

Chang SL, Huang YL, Lee MC, Hu S, Hsiao YC, Chang SW, et al. Association of varicose veins with incident venous thromboembolism and peripheral artery disease. JAMA. 2018;319(8):807-17.

Hafner CD, Cranley JJ, Krause RJ, Strasser ES. A method of managing superficial thrombophlebitis. Surg. 1964;55(2):201-6.

Skillman JJ, Kent KC, Porter DH, Kim D. Simultaneous occurrence of superficial and deep thrombophlebitis in the lower extremity. J Vascul Surg. 1990;11(6):818-24.

Bounameaux H, Reber-Wasem MA. Superficial thrombophlebitis and deep vein thrombosis: a controversial association. Arch Intern Med. 1997;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;24:745-9.

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;18:70-3.

Shirasugi N, Horiguchi S, Shirato H, Kawakami T, Ono H, Yabuki S, et al. Prevalence of isolated asymptomatic deep vein thrombosis in varicose vein patients with superficial thrombophlebitis: a single center experience in Japan. Ann Vasc Dis. 2016;9(1):2-7.

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Published

2019-09-26

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Original Research Articles