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Chronic venous disease in developing countries

Chairpersons: M. Cazaubon (France), A. Scuderi (Brazil)

A global approach to world epidemiology in chronic venous
disorders (CVD)

M. CAZAUBON (France)

Epidemiology of venous disorders in Morocco

The incidence of venous disease in Brazil based on the CEAP
classification: an epidemiological study


1. The incidence of the venous disease in developing countries is similar to that in Western countries.
2. The CEAP classification is an important method for standardizing the clinical manifestations of the venous pathology. It allows everybody, around the world, to speak the same language when referring to venous disease.
3. The varicose syndrome is much more common in women than men.
4. Age and pregnancy are important factors in the development of venous disease and its complications. This fact was clearly demonstrated in the female group over 48 years.
5. More than 50% of women in the groups ranging from 14 to 22 and from 23 to 48 years old presented a large number of incidences of visible veins without any symptoms.
6. Venous disease, besides being a physiological and public health problem, is also an important esthetic factor, especially for women.

Chronic venous disease in the obese male:
an epidemiological survey


To assess the relationship between obesity and chronic venous disease (CVD) in adult male patients, a cross-sectional study, including clinical descriptions of the disease by phlebologists and angiologists, was performed. Four hundred and ninety-four male patients (obese and nonobese) were included in the study.
The authors stated that:
1. CVD severity increases with age.
2. Twenty-five percent of patients with venous ulcer are obese.
3. Disease duration is longer in obese than in nonobese patients.
4. Popliteal reflux is more frequent in obese than in nonobese patients.
5. Paresthesia and pruritus are more severe in obese patients.
6. Pain and heaviness are more severe in obese patients.
7. Obesity effect on CVD severity is a result of age.

Epidemiology and socioeconomics

Chairpersons: F. Pace (Argentina), D. Gama (Portugal)

Leg ulcer prevalence in a defined geographical population: a repeated cross-sectional study

The same postal cross-sectional study with health care providers was performed in 1988 and repeated in 2002 in a defined geographic population of Sweden. Between 1988 and 2002, a radical change in leg ulcer management had been introduced by the creation of an organized structured care of leg ulcer patients in this district. After correction for wrong inclusions and clinical examination of a random sample of patients, the leg ulcer prevalence, previously found to be 0.31% of the general population in 1988, had decreased to 0.24% in 2002. The 23% decrease in the number of leg ulcer patients was probably related to the radical change in leg ulcer management in the district. This result is interesting, as it is usually believed that the increasing number of elderly people may lead to an increasing number of leg ulcer patients. In this study, 82% of the leg ulcer patients were over 64 years old.

Venous ulcer prevention: socioeconomic issues
C. ALLEGRA (Italy)

Varicose disease is a chronic and evolving disease. The etiology of leg ulceration is venous disease in 70% to 80% of cases, and among them, 30% are the result of the post-thrombotic syndrome. The prevalence of leg ulcers is high, reaching 0.8% to 1% of the general population, but it increases with age. Indeed, among people over 65 years old, ulcer prevalence is 3.6% of the population. The duration of venous ulcer is more than 4 months in 50% of the cases, and more than 2 years in 20%. Chronic venous disease is supposed to consume 1% to 2% of the health care budget of European countries. The prognosis for healing is largely dependent on age, so the ageing of the population in developed countries is likely to increase the prevalence of venous leg ulcers in the next 10 years. The total CVI-related direct costs (CVI diagnosis and management: hospitalizations, consultations and drug costs; loss of working days not included) was evaluated in Italy before and after the Italian healthcare reform (drug dereimbursement) in 1993-94. The total CVI-related costs were 360.4 million Euro before the reform and 384 million Euro after the reform, but the distribution of the costs has changed. The 23.6 million Euro increase in CVI management costs was due to cost redistribution from prescriptions and consultations to hospitalizations. Fewer patients were treated overall, with consequent disease worsening and increase in complications. Primary prophylaxis of venous ulcers includes clinical examination and careful family and personal history assessment. Secondary prophylaxis, including compression therapy, pharmacotherapy and two consultations a year with duplex examination, is estimated at 1.08 Euros/ patient/day. Both primary and secondary prophylaxis are cost-effective.

Prophylaxis and treatment of leg edema

Chairpersons: H. Partsch (Austria), A. Scuderi (Brazil)

Leg edema, a frequent sign in a European population
E. RABE (Germany)

Lymphedema is an important cause of chronic leg disease in the general population. Up to now, almost no epidemiological data concerning lymphedema of the legs has been available concerning prevalence and distribution in the general population. In the Bonn Vein Study, a population-based cross-sectional study in 3072 individuals randomly chosen from population registers in the city of Bonn and the surrounding rural townships, aged between 18 and 79 years, the prevalence and risk factors of chronic venous diseases were evaluated. In addition to the questionnaire and the phlebological investigations, a skin-fold test at the dorsum of the second toe was performed. The so-called Stemmer´s sign was slightly positive (Stemmer I) when the skin fold was between 0.5 and 1 cm wide. Stage II was reached when the skin fold measured more than 1 cm, and Stage III when the skin fold was extremely enlarged. In the history questionnaire 1.8% of all individuals claimed to have lymphedema; 1.1% of the male and 2.4% of the female population. In the clinical investigation 12.4% of the men and 15.2% of the women had a slightly positive Stemmer´s sign; 1.5% of the men and 2% of the women had a manifest lymphedema represented by Stemmer´s sign stages II and III. The prevalence of positive Stemmer´s sign II and III was markedly higher in the urban population, at 2.4%, compared with the rural population with 0.7%. The prevalence of the positive Stemmer´s sign increased significantly with age, and also with the clinical stages of chronic venous disease in the CEAP classification. These data show the prevalence of lympedema of the legs in the general population and the close connections between chronic venous disease and a positive Stemmer´s sign.