II – Epidemiology

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Varicose Veins

Chairperson: M. Perrin
Moderator: J. Barrett

Epidemiology of varicose veins
E. Rabe

E. Rabe commented on the epidemiological results of Bonn Vein Study part I and remarked on the absence of epidemiological studies with long follow-up. This was one of the reasons for designing the second part of this study. The Bonn Vein Study part II includes the same population and procedures as in the previous phase, with a follow-up of 6.6 years. The objectives of this study were to analyze the incidence of venous disorders in the general population, progression of chronic venous disease and risk factors related to CEAP classification.
Chronic venous disease, like varicose veins and venous insufficiency, is one of the most frequent diseases in the Western population due to demographic changes, increase in body weight, and increase in sedentary life. Age and a family history of venous disease increase the incidence of new varicose veins. The main risk factors for CVI are age and obesity. The prevalence of this pathology may increase in the future.

Servier Vein Consult Project
Chairpersons: E. Rabe, J-J. Guex
With the participation of V. Bogachev, J-J. Guex, D. Milic, A. Puskas, E. Rabe

The VEIN CONSULT Program is being carried out under the auspices of the International Union of Phlebology (UIP), supported by an unrestricted grant from the Servier Research Group.
The program is an international educational survey to highlight the need for early detection and management of this chronic disease specifically amongst primary care doctors. Chronic venous disease is an extremely common condition that has a significant impact on both the individuals affected and health care systems. It is estimated that 30-35% of the general population are categorized as C0s and C1 of the CEAP classification system. This includes people with venous symptoms but no visible or palpable signs of venous disease (C0s) and those with telangiectasias or reticular veins (C1). Despite being an expensive disease to manage which results in poor quality of life for its sufferers, few people recognize that early diagnosis and early patient monitoring can prevent complications of chronic venous disease.

The VEIN CONSULT Program’s main objectives are the following:

• To assess the prevalence of chronic venous disease and provide a picture of the typical adult patient and the management of their disease, in different geographical areas
• To evaluate how GPs and venous specialists manage patients with chronic venous disease and to understand better at which stage of the disease specialists take over from GPs in the management process
• To improve GPs’ and venous specialists’ education about the need for early detection and management of chronic venous disease, with the goal of improving management of this chronic disease
• To assess the impact of chronic venous disease on the quality of life of patients, health care resources, and the economy

What is the VEIN CONSULT Program? The program is an observational, multicenter, descriptive survey of chronic venous disease. In Step 1, doctors in the primary care setting will complete a case report form assessing their patient’s history, listing any chronic venous disease risk factors, screening for chronic venous disease symptoms, and performing a routine leg examination. If the patient shows signs of having any chronic venous disease symptoms and the GP considers him or her to be eligible to participate in Step 2 of the program, the patient will be asked to complete a CIVIQ questionnaire. The GP will then recommend a follow-up consultation with a venous specialist. Step 2 is the follow-up consultation with a venous specialist, who will complete a questionnaire to assess whether treatment is required.

Many countries will take part in the VEIN CONSULT research. The Program will run in participating countries in Europe and Latin America during 2009. A second batch of countries will then join the program in 2010. Many patients and doctors will be involved, as 3000 selected GPs will participate in Step 1 of the Program, screening approximately 70 000 patients. Around 400 selected specialists will follow up with Step 2, potentially seeing 7000 patients.

The VEIN CONSULT Program is unique in that it uses the same questionnaire worldwide and the same classification ( the “universal” CEAP classification) for description of patients. It will give a snapshot of the management of patients with chronic venous disease and reflects the reality in each country that performs the program. Finally , the VEIN CONSULT Program will be useful in:

• Establishing the prevalence of chronic venous disease
• Comparing the VCP epidemiological data with these of previous surveys
• Performing comparative analyses between countries and with previous surveys in the same country
• Evaluating resource requirements thanks to the assessment of the impact of chronic venous disease on patients’ quality of life and costs
• Building a simplified screening questionnaire for earlier detection and management of chronic venous disease
• Preventing progression of chronic venous disease by intervention on environmental / behavioral factors