Enfermedad venosa crónica. Conceptos actuales y avances terapéuticos

  1. Rial Horcajo, R.
  2. Serrano Hernando, F.J.
  3. Moñux Ducajú, G.
  4. Reina Gutiérrez, T.
  5. Martín Conejero, A.
Journal:
Medicine: Programa de Formación Médica Continuada Acreditado

ISSN: 0304-5412

Year of publication: 2017

Issue Title: Enfermedades cardiológicas (VII) Enfermedades vasculares

Series: 12

Issue: 41

Pages: 2448-2457

Type: Article

DOI: 10.1016/J.MED.2017.09.013 DIALNET GOOGLE SCHOLAR

More publications in: Medicine: Programa de Formación Médica Continuada Acreditado

Abstract

Abstract Chronic venous disease (CVD) is the most prevalent vascular disorder and consumes a great amount of economic and health resources, particularly in its final outcome of venous ulcer. Basic genetic molecular research has enabled more precise knowledge of the condition's aetiopathogeny and pathophysiology and is applied practically towards prevention and treatment. A correct initial diagnosis, both clinical and haemodynamic, with Doppler ultrasound, will enable the implementation of appropriate medical treatment to improve symptoms and delay or prevent progression to advanced stages of the disease. Venous hypertension (VHT) is the fundamental pathophysiological event in CVD. Correcting VHT with postural measures and compression therapy and venoactive drugs to act on its consequences are the basic pillars of medical treatment and are generally applied. Surgical treatment of varices is of proven benefit compared to conservative treatment in patients who are candidates for it. Surgical techniques have seen huge advances over the past decade and the classical paradigm of phlebo-extraction has been changed for endoluminal treatments. Sclerotherapy plays an essential role for aesthetic situations, for the elderly and frail or for patients at high surgical risk.

Funding information

Actualización de la guía para el diagnóstico no invasivo de la insuficiencia ven osa (I) Documento de consenso del capítulo de diagnóstico vascular de la Sociedad Española de Angiología y Cirugía Vascular

Bibliographic References

  • Eklöf B, Perrin M, Delis KT, Rutherford RB, Gloviczki P. Updated terminology of chronic venous disorders: the VEIN TERM transatlantic interdisciplinary consensus document. J Vasc Surg. 2009;49:498e501.
  • Escudero Rodríguez JR, Fernández Quesada F, Bellmunt Montoya S. Prevalence and clinical characteristics of chronic venous disease in patients seen in primarycare in Spain: results of the international study Vein Consult Program. Cir Esp. 2014;92(8):539-46.
  • Brand FN, Dannenberg AL, Abbott RD, Kannel WB. The epidemiology of varicose veins: the Framingham Study. Am J Prev Med. 1988;4(2):96-101.
  • Rabe E, Pannier-Fischer F, Bromen K, Schuldt K, Stang A, Poncar CH. Bonn vein study by the German Society of Phlebology. Epidemiological study to investigate the prevalence and severity of chronic venous disorders in the urban and rural residential populations. Phlebologie, 2003;32:1-14.
  • Onida S, Davies AH. Predicted burden of venous disease. Phlebology. 2016;31(1)Suppl:74-9.
  • Lévy E, Lévy P. Management of venous leg ulcer by French physicians, diversity and related costs: a prospective medicoeconomic observational study. J Mal Vasc. 2001;26(1):39-44.
  • O’Donnell TF Jr, Passman MA, Marston WA, Ennis WJ, Dalsing M, Kistner RL; Society for Vascular Surgery; American Venous Forum. Management of venous leg ulcers: clinical practice guidelines of the Society for Vascular Surgery ® and the American Venous Forum. J Vasc Surg. 2014;60(2)Suppl:3S-59S.
  • Catarinella FS, Nieman FH, Wittens CH. An overview of the most commonly used venous quality of life and clinical outcome measurements. J Vasc Surg Venous Lymphat Disord. 2015;3(3): 333-40.
  • Nicolaides A, Kakkos S, Eklof B, Perrin M, Nelzen O, Neglen P. Management of chronic venous disorders of the lower limbs : guidelines according to scientific evidence. Int Angiol. 2014;33(2): 87-208.
  • Wittens C, Davies AH, Bækgaard N, Broholm R, Cavezzi A, Chastanet S; European Society for Vascular Surgery. Editor’s Choice : Management of Chronic Venous Disease: Clinical Practice Guidelines of theEuropean Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2015;49(6):678-737.
  • Miquel C, Rial R, Ballesteros MD, García Madrid C. Guía de práctica clínica en enfermedad venosa crónica del capítulo de flebología y linfología de la Sociedad Española de Angiología y Cirugía Vascular. Angiología. 2016;68:55-62.
  • Fiebig A, Krusche P, Wolf A, Krawczak M, Timm B, Nikolaus S. Heritability of chronic venous disease. Hum Genet. 2010; 127(6):669-74.
  • Kun L, Ying L, Lei W, Jianhua Z, Yongbo X, Tao W. Dysregulated apoptosis of the venous wall in chronic venous disease and portalhypertension. Phlebology. 2016;31(10):729-36.
  • Ellinghaus E, Ellinghaus D, Krusche P, Greiner A, Schreiber C, Nikolaus S. Genome : wide association analysis for chronic venous disease identifies EFEMP1 and KCNH8 as susceptibility loci. Sci Rep. 2017;7:45652.
  • Pocock ES, Alsaigh T, Mazor R, Schmid-Schönbein GW. Cellular and molecularbasis of venous insufficiency. Vasc Cell. 2014;6(1):24.
  • Zamboni P, Gemmati D. Clinical implications of gene polymorphisms in venousleg ulcer: a model in tissue injury and reparative process. Thromb Haemost. 2007;98(1):131-7.
  • Kuo CJ, Liang SS, Hsi E, Chiou SH, Lin SD. Quantitative proteomics analysis ofvaricose veins: identification of a set of differentially expressed proteins related to ATP generation and utilization. Kao-hsiung J Med Sci. 2013;29(11):594-605.
  • Bonfield M, Cramp F, Pollock J. Deep vein thrombosis resolution, recurrence and postthrombotic syndrome: a prospective observational study protocol. BMC Hematol. 2016;16:24.
  • Bergan JJ, Schmid-Schonbein GW, Smith PD, NicolaidesAN, Boisseau MR, Eklof B. Chronic venous disease. N Engl J Med. 2006;355(5):488-98.
  • Leu AJ, Leu HJ, Franzeck UK, Bollinger A. Microvascularchanges in chronic venous insuficiency : a review. Cardiovasc Surg. 1995;3(3):237-45.
  • Wilkinson LS, Bunker C, Edwards JC, Scurr JH, Smith PD. Leukocytes: their role in the etiopathogenesis of skin damage in venous disease. J Vasc Surg. 1993;17(4):669-75.
  • Beebe-Dimmer JL, Pfeifer JR, Engle JS, Schottenfeld D. The epidemiology of chronic venous insufficiency and varicose veins. Ann Epidemiol. 2005;15:175e84
  • Eberhardt RT, Raffetto JD. Chronic venous insufficiency. Circu-lation. 2014;130(4):333-46.
  • Eklöf B, Rutherford RB, Bergan JJ, Carpentier PH, Gloviczki P, Kistner RL; American Venous Forum International Ad Hoc Committee for Revisionof the CEAP Classification. Revision of the CEAP classification for chronicvenous disorders: consensus state-ment. J Vasc Surg. 2004;40(6):1248-52.
  • Rutherford RB, Padberg FT Jr, Comerota AJ, Kistner RL, Meissner MH, Moneta GL. Venous severity scoring: An adjunct to venous outcome assessment. J Vasc Surg. 2000;31(6):1307-12.
  • Villalta S, Bagatella P, Piccioli A, Lensing A, Prins M, Prandoni P. Assessment and validity and reproducibility of aclinical scale for the post-thrombotic syndrome. Haemostasis. 1994:158a.
  • Perrin MR, Guex JJ, Ruckley CV, de Palma RG, Royle JP, Eklöf B. Recurrent varices after surgery (REVAS), a consensus document. REVAS group. Cardiovasc Surg. 2000;8:233e45.
  • Launois R, Reboul-Marty J, Henry B. Construction and validation of a qualityof life questionnaire in chronic lower limb venous insufficiency (CIVIQ). QualLife Res. 1996;5(6):539-54.
  • White JV, Ryjewski C. Chronic venous insufficiency. Perspect Vasc Surg Endovasc Ther. 2005;17(4):319-27.
  • Fontcuberta J, Samsó JJ, SeninME, Vila R, Escribano JM. Actualización de la guía para el diagnóstico no invasivo de la insuficiencia ven osa (I). Documento de consenso del capítulo de diagnóstico vascular de la Sociedad Española de Angiología y Cirugía Vascular. Angiología. 2015;67:125-32.
  • Fontcuberta J, Samsó JJ, Senin ME, Vila R, Escribano JM. Actualización de la Guía para el diagnóstico no invasivo de la insuficiencia venosa (II). Documento de consenso del capítulo de diagnóstico vascular de la Sociedad Española de Angiología y Cirugía Vascular. Angiología. 2015; 67(3):216-24.
  • Araujo DN, Ribeiro CT, Maciel AC, Bruno SS, Fregonezi GA, Dias FA. Physical exercise for the treatment of non-ulcerated chronic venous insufficiency. Cochrane Database Syst Rev. 2016;12: CD010637.
  • Raju S, Hollis K, Neglen P. Use of compression stockings in chronic venous disease: patient compliance and efficacy. Ann Vasc Surg. 2007;21(6):790-5.
  • O’Meara S, Cullum N, Nelson EA, Dumville JC. Compression for venous leg ulcers. Cochrane Database Syst Rev. 2012;11: CD000265.
  • Marinelo J, Alós J, Escudero JR. Guías de calidad asistencial en la terapéutica de compresión en la patología venosa y linfática. Recomendaciones basadas en la evidencia clínica. Angiología. 2003;55:123-80.
  • Martínez-Zapata MJ, Vernooij RW, Uriona Tuma SM, Stein AT, Moreno RM, Vargas E. Phlebotonics for venous insufficiency. Cochrane Database Syst Rev. 2016;4:CD003229.
  • Rabe E, Breu FX, Cavezzi A, Coleridge Smith P, Frullini A; Guideline Group. European guidelines for sclerotherapy in chro-nic venous disorders. Phlebology. 2014;29(6):338-54.
  • Nesbitt C, Bedenis R, Bhattacharya V, Stansby G. Endovenous ablation(radiofrequency and laser) and foam sclerotherapy versus open surgery for greatsaphenous vein varices. Cochrane Database Syst Rev. 2014;(7):CD005624.
  • Bellmunt-Montoya S, Escribano JM, Dilme J, Martínez-Zapata MJ. CHIVA methodfor the treatment of chronic venous insufficiency. Cochrane Database Syst Rev.2015;(6):CD009648.
  • Zhan HT, Bush RL. A review of the current management and treatment options forsuperficial venous insufficiency. World J Surg. 2014;38(10):2580-8.