今日の臨床サポート

下肢静脈怒張

著者: 高木郁代1) 日本医科大学 循環器内科・総合診療科/榊原記念クリニック

著者: 新本春夫2) 榊原記念病院

監修: 今井靖 自治医科大学 薬理学講座臨床薬理学部門・内科学講座循環器内科学部門

著者校正/監修レビュー済:2021/08/11
患者向け説明資料

概要・推奨   

  1.  下肢静脈怒張を認めたら、その原因として下肢静脈瘤および深部静脈血栓症を鑑別する。
  1.  速やかに下肢静脈エコーを行い、急性深部静脈血栓症であった場合の致死的合併症を回避することが重要である。
  1.  下肢静脈瘤であれば、患者の意向も尊重しつつ、適切な治療を適時選択する。
薬剤監修について:
オーダー内の薬剤用量は日本医科大学付属病院 薬剤部 部長 伊勢雄也 以下、林太祐、渡邉裕次、井ノ口岳洋、梅田将光による疑義照会のプロセスを実施、疑義照会の対象については著者の方による再確認を実施しております。
※薬剤中分類、用法、同効薬、診療報酬は、エルゼビアが独自に作成した薬剤情報であり、
著者により作成された情報ではありません。
尚、用法は添付文書より、同効薬は、薬剤師監修のもとで作成しております。
※薬剤情報の(適外/適内/⽤量内/⽤量外/㊜)等の表記は、エルゼビアジャパン編集部によって記載日時にレセプトチェックソフトなどで確認し作成しております。ただし、これらの記載は、実際の保険適用の査定において保険適用及び保険適用外と判断されることを保証するものではありません。また、検査薬、輸液、血液製剤、全身麻酔薬、抗癌剤等の薬剤は保険適用の記載の一部を割愛させていただいています。
(詳細はこちらを参照)
著者のCOI(Conflicts of Interest)開示:
高木郁代 : 特に申告事項無し[2021年]
新本春夫 : 未申告[2021年]
監修:今井靖 : 講演料(第一三共株式会社)[2021年]

改訂のポイント:
  1. 定期レビューを行い、『CEAP分類 2020年版』について加筆修正を行った。

病態・疫学・診察

疫学情報・病態・注意事項  
  1. 下肢静脈怒張は、静脈瘤(varicose vein = 蛇行し拡張した静脈)と病態的にはほぼ同義語である。
 
静脈怒張

a:伏在静脈瘤(左下肢)
b:側枝静脈瘤(右下肢)

出典

img1:  著者提供
 
 
 
  1. 自覚症状はある場合とない場合があり、進行の度合いも静脈の拡張~怒張からうっ滞性皮膚潰瘍まで幅広い。下肢静脈怒張は形態学的異常と、静脈の逆流などの機能的異常の両方の側面を反映している。下肢の観察は循環器診察においても重要で、静脈の怒張から心肺疾患の存在を疑うきっかけにもなる。
  1. 静脈、特に下肢静脈を考えるとき、重力の関与を考慮せずに論じることはできない。すなわち、立位であれば視診で容易に診断がつくが、臥床時などはまったく気づかれないこともある。
  1. 静脈怒張をみたら、速やかに診断し、適切な治療に踏み切ると同時に、重大な合併症(肺動脈血栓塞栓症( 深部静脈血栓症 )など)を予防することが望まれる。
問診・診察のポイント  
  1. 下肢静脈怒張は静脈のうっ滞から生じ、表在静脈の瘤様変化として観察される。

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文献 

著者: H G Beebe, J J Bergan, D Bergqvist, B Eklof, I Eriksson, M P Goldman, L J Greenfield, R W Hobson, C Juhan, R L Kistner, N Labropoulos, G M Malouf, J O Menzoian, G L Moneta, K A Myers, P Neglen, A N Nicolaides, T F O'Donnell, H Partsch, M Perrin, J M Porter, S Raju, N M Rich, G Richardson, D S Sumner
雑誌名: Eur J Vasc Endovasc Surg. 1996 Nov;12(4):487-91; discussion 491-2. doi: 10.1016/s1078-5884(96)80019-0.
Abstract/Text
PMID 8980442  Eur J Vasc Endovasc Surg. 1996 Nov;12(4):487-91; discus・・・
著者: Bo Eklöf, Robert B Rutherford, John J Bergan, Patrick H Carpentier, Peter Gloviczki, Robert L Kistner, Mark H Meissner, Gregory L Moneta, Kenneth Myers, Frank T Padberg, Michel Perrin, C Vaughan Ruckley, Philip Coleridge Smith, Thomas W Wakefield, American Venous Forum International Ad Hoc Committee for Revision of the CEAP Classification
雑誌名: J Vasc Surg. 2004 Dec;40(6):1248-52. doi: 10.1016/j.jvs.2004.09.027.
Abstract/Text The CEAP classification for chronic venous disorders (CVD) was developed in 1994 by an international ad hoc committee of the American Venous Forum, endorsed by the Society for Vascular Surgery, and incorporated into "Reporting Standards in Venous Disease" in 1995. Today most published clinical papers on CVD use all or portions of CEAP. Rather than have it stand as a static classification system, an ad hoc committee of the American Venous Forum, working with an international liaison committee, has recommended a number of practical changes, detailed in this consensus report. These include refinement of several definitions used in describing CVD; refinement of the C classes of CEAP; addition of the descriptor n (no venous abnormality identified); elaboration of the date of classification and level of investigation; and as a simpler alternative to the full (advanced) CEAP classification, introduction of a basic CEAP version. It is important to stress that CEAP is a descriptive classification, whereas venous severity scoring and quality of life scores are instruments for longitudinal research to assess outcomes.

PMID 15622385  J Vasc Surg. 2004 Dec;40(6):1248-52. doi: 10.1016/j.jvs・・・
著者: Fedor Lurie, Marc Passman, Mark Meisner, Michael Dalsing, Elna Masuda, Harold Welch, Ruth L Bush, John Blebea, Patrick H Carpentier, Marianne De Maeseneer, Anthony Gasparis, Nicos Labropoulos, William A Marston, Joseph Rafetto, Fabricio Santiago, Cynthia Shortell, Jean Francois Uhl, Tomasz Urbanek, André van Rij, Bo Eklof, Peter Gloviczki, Robert Kistner, Peter Lawrence, Gregory Moneta, Frank Padberg, Michel Perrin, Thomas Wakefield
雑誌名: J Vasc Surg Venous Lymphat Disord. 2020 May;8(3):342-352. doi: 10.1016/j.jvsv.2019.12.075. Epub 2020 Feb 27.
Abstract/Text The CEAP (Clinical-Etiology-Anatomy-Pathophysiology) classification is an internationally accepted standard for describing patients with chronic venous disorders and it has been used for reporting clinical research findings in scientific journals. Developed in 1993, updated in 1996, and revised in 2004, CEAP is a classification system based on clinical manifestations of chronic venous disorders, on current understanding of the etiology, the involved anatomy, and the underlying venous pathology. As the evidence related to these aspects of venous disorders, and specifically of chronic venous diseases (CVD, C2-C6) continue to develop, the CEAP classification needs periodic analysis and revisions. In May of 2017, the American Venous Forum created a CEAP Task Force and charged it to critically analyze the current classification system and recommend revisions, where needed. Guided by four basic principles (preservation of the reproducibility of CEAP, compatibility with prior versions, evidence-based, and practical for clinical use), the Task Force has adopted the revised Delphi process and made several changes. These changes include adding Corona phlebectatica as the C4c clinical subclass, introducing the modifier "r" for recurrent varicose veins and recurrent venous ulcers, and replacing numeric descriptions of the venous segments by their common abbreviations. This report describes all these revisions and the rationale for making these changes.

Copyright © 2020 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.
PMID 32113854  J Vasc Surg Venous Lymphat Disord. 2020 May;8(3):342-35・・・
著者: F N Brand, A L Dannenberg, R D Abbott, W B Kannel
雑誌名: Am J Prev Med. 1988 Mar-Apr;4(2):96-101.
Abstract/Text The epidemiology of varicose veins was examined in 3,822 adults in the Framingham Study. Findings indicate that the incidence of varicose veins is higher among women than men, with no clear age differences. Compared to women without varicose veins, women with varicose veins were more often obese (p less than .01), had lower levels of physical activity (p less than .001) and higher systolic blood pressure (p less than .001), and were older at menopause (p less than .001). Women who reported spending eight or more hours in an average day in sedentary activities (sitting or standing) also had a significantly higher incidence of varicose veins than those who spent four or fewer hours a day in such activities (p less than .05). For men, varicose veins coexisted with lower levels of physical activity (p less than .05) and higher smoking rates (p less than .05). While men and women with varicose veins had a higher incidence of atherosclerotic cardiovascular disease than those without varicose veins, only the excess risk of coronary heart disease in women was statistically significant (p less than .05). However, this finding was not significant after controlling for body mass and systolic blood pressure. These results suggest that increased physical activity and weight control may help prevent varicose veins among adults at high risk, and reduce the overall risk of atherosclerotic cardiovascular disease as well.

PMID 3395496  Am J Prev Med. 1988 Mar-Apr;4(2):96-101.
著者: M J Callam
雑誌名: Br J Surg. 1994 Feb;81(2):167-73.
Abstract/Text Assessment and treatment of varicose veins comprises a significant part of the surgical workload. In the UK, National Health Service waiting lists suggest that there is still considerable unmet need. This review analyses all published data on the epidemiology of varicose veins, paying particular regard to the differing epidemiological terminology, populations sampled, assessment methods and varicose vein definitions, which account for much of the variation in literature reports. Half of the adult population have minor stigmata of venous disease (women 50-55 per cent; men 40-50 per cent) but fewer than half of these will have visible varicose veins (women 20-25 per cent; men 10-15 per cent). The data suggest that female sex, increased age, pregnancy, geographical site and race are risk factors for varicose veins; there is no hard evidence that family history or occupation are factors. Obesity does not appear to carry any excess risk. Accurate prevalence data allow provision of appropriate resources or at least aid rational debate if demand is greater than the resources available.

PMID 8156326  Br J Surg. 1994 Feb;81(2):167-73.
著者: C J Evans, F G Fowkes, C V Ruckley, A J Lee
雑誌名: J Epidemiol Community Health. 1999 Mar;53(3):149-53.
Abstract/Text STUDY OBJECTIVE: To determine the prevalence of varicose veins and chronic venous insufficiency (CVI) in the general population.
DESIGN: Cross sectional survey.
SETTING: City of Edinburgh.
PARTICIPANTS: Men and women aged 18-64 years selected randomly from age-sex registers of 12 general practices.
MAIN RESULTS: In 1566 subjects examined, the age adjusted prevalence of trunk varices was 40% in men and 32% in women (p < or = 0.01). This sex difference was mostly a result of higher prevalence of mild trunk varices in men. More than 80% of all subjects had mild hyphenweb and reticular varices. The age adjusted prevalence of CVI was 9% in men and 7% in women (p < or = 0.05). The prevalence of all categories of varices and of CVI increased with age (p < or = 0.001). No relation was found with social class.
CONCLUSIONS: Approximately one third of men and women aged 18-64 years had trunk varices. In contrast with the findings in most previous studies, mainly conducted in the 1960s and 1970s, chronic venous insufficiency and mild varicose veins were more common in men than women. No evidence of bias in the study was found to account for this sex difference. Changes in lifestyle or other factors might be contributing to an alteration in the epidemiology of venous disease.

PMID 10396491  J Epidemiol Community Health. 1999 Mar;53(3):149-53.
著者: T Zahariev, V Anastassov, K Girov, E Goranova, L Grozdinski, V Kniajev, M Stankev
雑誌名: Int Angiol. 2009 Aug;28(4):303-10.
Abstract/Text AIM: The aim of this study was to evaluate the prevalence of and risk factors for chronic venous disease (CVD) in the Bulgarian adult population seeking medical help from general practitioners.
METHODS: The design was a cross-sectional descriptive survey. Each general practitioner (GP) enrolled 50 consecutive patients aged 18 and over attending for a routine consultation. A subsample of these patients was reappraised by a group of specialists to confirm the GPs diagnosis.
RESULTS: A total of 576 GPs selected 26 785 subjects to participate in the survey. In the GP survey, 11 724 subjects (44%) were found to be suffering from CVD. Specialist reappraisal of a subset of 373 subjects confirmed the initial diagnosis in 91.2% of cases. CVD was more prevalent in females (51%) than in males (32%) (P<0.0001) and prevalence increased with age and body mass index.
CONCLUSIONS: Heavy legs, pain in the legs, and a sensation of swelling were the most frequently reported symptoms. Varicose veins and telangiectasias were the most common signs in both males and females, but with a higher frequency of varicose veins in males and telangiectasias in females. Increasing age, pregnancy, and a positive family history were found to be risk factors for CVD.

PMID 19648874  Int Angiol. 2009 Aug;28(4):303-10.
著者: Roberto Chiesa, Enrico Maria Marone, Costanzo Limoni, Marina Volontè, Orlando Petrini
雑誌名: J Vasc Surg. 2007 Aug;46(2):322-30. doi: 10.1016/j.jvs.2007.04.030. Epub 2007 Jun 27.
Abstract/Text BACKGROUND: The aim of this study was to investigate the frequency of chronic venous disorders (CVD) in different demographic groups in Italy and to provide correlations between patterns of valve incompetence and clinical feature of disease severity.
METHODS: Advertisements in television and newspapers in 53 Italian cities were used to solicit 16,251 subjects (13,826 women, mean age 50.4 years; 2,425 men, mean age 59.1 years). They underwent a clinical examination of the lower limbs, including presence and severity of visible signs (CEAP classification), and assessment of functional disease by color-coded duplex ultrasound imaging.
RESULTS: Varicose veins and telangiectases were the most common objective signs in both men and women. Older people were more severely affected. Telangiectases were more frequent in women, and men had a higher incidence of trunk varices, trophic changes, and venous reflux. Frequency of both visible and functional venous disease increased with family history and body mass index. Presence of reflux correlated positively with increasing CEAP grade of visible disease (Pfor trend < .0001 for all superficial venous segments). A large number of subjects, especially women, complained of subjective symptoms in the legs, and the presence of symptoms correlated almost always positively with both worsening of visible findings (P for trend < .001) and presence of hemodynamic change in both genders.
CONCLUSIONS: The frequency of reflux increased with the severity of visible signs of disease as described by the CEAP classification. In men, the occurrence of subjective symptoms was mostly correlated with functional disorders.

PMID 17600668  J Vasc Surg. 2007 Aug;46(2):322-30. doi: 10.1016/j.jvs.・・・
著者: K A Rigby, S J Palfreyman, C Beverley, J A Michaels
雑誌名: Cochrane Database Syst Rev. 2004 Oct 18;(4):CD004980. doi: 10.1002/14651858.CD004980. Epub 2004 Oct 18.
Abstract/Text BACKGROUND: Varicose veins are a relatively common condition and account for around 54,000 in-patient hospital episodes per year. The two most common interventions for varicose veins are surgery and sclerotherapy. However, there is little comparative data regarding their effectiveness.
OBJECTIVES: To identify whether the use of surgery or sclerotherapy should be recommended for the management of primary varicose veins.
SEARCH STRATEGY: Thirteen electronic bibliographic databases were searched covering biomedical, science, social science, health economic and grey literature (including current research). In addition, the reference lists of relevant articles were checked and various health services research-related resources were consulted via the internet. These included health economics and HTA organisations, guideline producing agencies, generic research and trials registers, and specialist sites.
SELECTION CRITERIA: All studies that were described as randomised controlled trials comparing surgery with sclerotherapy for the treatment of primary varicose veins were identified.
DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted and summarised data from the eligible studies using a data extraction sheet for consistency. All studies were cross-checked independently by the reviewers.
MAIN RESULTS: A total of 2306 references were found from our searches, 61 of which were identified as potential trials comparing surgery and sclerotherapy. However, only nine randomised trials, described in a total of 14 separate papers, fulfilled the inclusion criteria. Fifty trials were excluded and one trial is ongoing and is due for completion in 2004. The trials used a variety of outcome measures and classification systems which made direct comparison between trials difficult. However, the trend was for sclerotherapy to be evaluated as significantly better than surgery at one year; after one year (sclerotherapy resulted in worse outcomes) the benefits with sclerotherapy were less, and by three to five years surgery had better outcomes. The data on cost-effectiveness was not adequately reported.
REVIEWERS' CONCLUSIONS: There was insufficient evidence to preferentially recommend the use of sclerotherapy or surgery. There needs to be more research that specifically examines both costs and outcomes for surgery and sclerotherapy.

PMID 15495134  Cochrane Database Syst Rev. 2004 Oct 18;(4):CD004980. d・・・
著者: Patrick H Carpentier, Hildegard R Maricq, Christine Biro, Claire O Ponçot-Makinen, Alain Franco
雑誌名: J Vasc Surg. 2004 Oct;40(4):650-9. doi: 10.1016/j.jvs.2004.07.025.
Abstract/Text OBJECTIVES: The goals of this study were to document the prevalence of varicose veins, skin trophic changes, and venous symptoms in a sample of the general population of France, to document their main risk factors, and to assess relationships between them.
METHODS: This cross-sectional epidemiologic study was carried out in the general population of 4 locations in France: Tarentaise, Grenoble, Nyons, and Toulon. Random samples of 2000 subjects per location were interviewed by telephone, and a sub-sample of subjects completed medical interviews and underwent physical examination, and the presence of varicose veins, trophic changes, and venous symptoms was recorded.
RESULTS: Prevalence of varicose veins, skin trophic changes, and venous symptoms was not statistically different in the 4 locations. In contrast, sex-related differences were found: varicose veins were found in 50.5% of women versus 30.1% of men ( P < .001); trophic skin changes were found in 2.8% of women versus 5.4% of men ( P = NS), and venous symptoms were found in 51.3% of women 51.3% versus 20.4% of men ( P < .001). Main risk factors for varicose veins were age and family history in both sexes, and pregnancy in women. Female sex was a significant factor only for non-saphenous varicose veins. Varicose veins, age, and pitting edema were the most significant risk factors for trophic skin changes. The risk factors for venous symptoms were female sex, varicose veins, and prolonged sitting or standing. A negative relationship with age was found in women.
CONCLUSION: Our results show a high prevalence of chronic venous disorders of the lower limbs in the general population of France, with no significant geographic variations. They also provide interesting insights regarding the association of varicose veins, skin trophic changes, and venous symptoms.

PMID 15472591  J Vasc Surg. 2004 Oct;40(4):650-9. doi: 10.1016/j.jvs.2・・・
著者: M R Cesarone, G Belcaro, A N Nicolaides, G Geroulakos, M Griffin, L Incandela, Sanctis M T De, M Sabetai, G Geroulakos, G Agus, P Bavera, E Ippolito, G Leng, Renzo A Di, M Cazaubon, S Vasdekis, D Christopoulos, M Veller
雑誌名: Angiology. 2002 Mar-Apr;53(2):119-30.
Abstract/Text The aim of this study was to evaluate the prevalence and incidence of venous diseases and the role of concomitant/risk factors for varicose veins (VV) or chronic venous insufficiency (CVI). The study was based in San Valentino in Central Italy and was a real whole-population study. The study included 30,000 subjects in eight villages/towns evaluated with clinical assessment and duplex scanning. The global prevalence of VV was 7%; for CVI, the prevalence was 0.86% with 0.48% of ulcers. Incidence (new cases per year) was 0.22% for VV and 0.18% for CVI; 34% of patients with venous disease had never been seen or evaluated. The distribution of VV and CVI in comparison with duplex-detected incompetence (DI) indicates that 12% of subjects had only VV (no DI), 2% had DI but no VV, 7.5% had DI associated with VV, 2% apparent CVI without DI, 3% DI only (without CVI), and 1.6% both CVI and DI. VV associated with DI are rapidly progressive and CVI associated with DI often progresses to ulceration (22% in 6 years). VV without significant DI (3%) and venous dilatation without DI tend to remain at the same stage without progression for a lengthy time. New cases per year appear to have a greater increase in the working population (particularly CVI) possibly as a consequence of trauma during the working period. In older age (>80 years), the incidence of CVI tends to decrease. Ulcers increase in number with age. Only 22% of ulcers can be defined as venous (due to venous hypertension, increased ambulatory venous pressure, shorter refilling time, obstruction and DI). Medical advice for VV or CVI is requested in 164 subjects of 1,000 in the population. In 39 of 1,000, there is a problem but no medical advice is requested and in only 61 of 1,000, the venous problem is real. In VV in 78% of limbs, there is only reflux, in 8% only obstruction, and in 14% both. In CVI, 58% of limbs have reflux, 23% obstruction, and 19% both. In conclusion, VV and CVI are more common with increasing age. The increase with age is linear. There was no important difference between males and females. These results are the basis for future real, whole population studies to evaluate VV and CVI.

PMID 11952101  Angiology. 2002 Mar-Apr;53(2):119-30.
著者: Amanda J Lee, Christine J Evans, Paul L Allan, C Vaughan Ruckley, F Gerald R Fowkes
雑誌名: J Clin Epidemiol. 2003 Feb;56(2):171-9.
Abstract/Text The objective of this study was to determine the inter-relationships between a range of lifestyle factors and risk of varicose veins to identify which factors may be implicated in the etiology. An age-stratified random sample of 1566 subjects (699 men and 867 women) aged 18 to 64 years was selected from 12 general practices throughout Edinburgh. A detailed self-administered questionnaire was completed, and a comprehensive physical examination determined the presence and severity of varicose veins. The slightly higher age-adjusted prevalence of varicose veins in men than in women (39.7% versus 32.2%) was not explained by adjustment for an extensive range of lifestyle risk factors (male odds ratio [OR] 2.11, 95% confidence interval [CI] 1.51-2.96). In both sexes, increasing height showed a significant relationship with varicose veins (male OR 1.50, 95% CI 1.18-1.93 and female OR 1.26, 95% CI 1.01-1.58). Among women, body mass index was associated with an increased risk of varicose veins (OR 1.26, 95% CI 1.02-1.54). The current study casts doubt as to whether varicose veins occur predominantly in women. In addition, no consistent relationship with any lifestyle factor was shown. Self-reported evidence suggested a familial susceptibility, thereby warranting future genetic studies.

PMID 12654412  J Clin Epidemiol. 2003 Feb;56(2):171-9.
著者: N L Browse
雑誌名: World J Surg. 1986 Dec;10(6):938-43. doi: 10.1007/BF01658644.
Abstract/Text
PMID 3798942  World J Surg. 1986 Dec;10(6):938-43. doi: 10.1007/BF016・・・
著者: N L Browse, K G Burnand
雑誌名: Lancet. 1982 Jul 31;2(8292):243-5. doi: 10.1016/s0140-6736(82)90325-7.
Abstract/Text
PMID 6124673  Lancet. 1982 Jul 31;2(8292):243-5. doi: 10.1016/s0140-6・・・
著者: C J Evans, F G Fowkes, C A Hajivassiliou, D R Harper, C V Ruckley
雑誌名: Int Angiol. 1994 Sep;13(3):263-70.
Abstract/Text Disease of the venous system is a major problem affecting western societies, resulting in considerable morbidity in the population and cost to the health service. In many countries "varicose veins are probably the commonest disorder presenting to general surgeons" and an average of 30% of district nursing time is estimated to be spent caring for patients with venous ulcers. For the patient with varicose veins or leg ulceration, there is often persistent discomfort and disability extending over long periods of time. Despite this, little epidemiological research has been carried out on venous disease, perhaps partly because of society's perception that venous disease is not a major problem and it is not normally a cause death. More recently however, efforts have been made to conduct structured epidemiological studies to identify risk factors and to clarify the geographical variations suggested in the past by anecdotal evidence. This article reviews recent epidemiological studies, discusses the prevalence of varicose veins and presents evidence for and against the differing theories of causation.

PMID 7822904  Int Angiol. 1994 Sep;13(3):263-70.
著者: F G Fowkes, A J Lee, C J Evans, P L Allan, A W Bradbury, C V Ruckley
雑誌名: Int J Epidemiol. 2001 Aug;30(4):846-52.
Abstract/Text BACKGROUND: Varicose veins occur commonly in the general population but the aetiology is not well established. Varicosities are associated frequently with reflux of blood in the leg veins due to valvular incompetence. Our aim was to determine in the general population which lifestyle factors were related to reflux and thus implicated in the aetiology of varicose veins.
METHODS: In the Edinburgh Vein Study, 1566 men and women aged 18-64 years were sampled randomly from the general population in the city of Edinburgh, Scotland, and had duplex scans to measure reflux in eight venous segments in each leg. A self-administered questionnaire enquired about occupation, mobility at work, smoking, obstetric history, dietary fibre intake and bowel habit. A bowel record form was completed subsequently.
RESULTS: In women, venous reflux was associated with decreased sitting at work (odds ratio [OR] = 0.76, 95% CI : 0.61-0.94), previous pregnancy (OR = 1.20, 95% CI : 0.93-1.54), and a lower prior use of oral contraceptives (OR = 0.84, 95% CI : 0.66-1.06). Mean body mass index was greater in women with superficial reflux compared to those with no reflux: 26.2 kg/m(2) (95% CI : 25.5-27.0) versus 25.2 kg/m(2) (95% CI : 24.8-25.6). On age adjustment, sitting at work remained related to reflux (OR = 0.78, 95% CI : 0.63-0.98) and prior use of oral contraceptives to superficial reflux (OR = 0.71, 95% CI : 0.50-1.01). In age-adjusted analyses in men, height was related to reflux, (OR = 1.13, 95% CI : 1.02-1.26) and straining at stool was related to superficial reflux (OR = 1.94, 95% CI : 1.12-3.35). No associations were found in either sex between reflux and social class, lifetime cigarette consumption, dietary fibre intake and intestinal transit time.
CONCLUSIONS: This population study did not identify strong and consistent lifestyle risk factors for venous reflux although previous pregnancy, lower use of oral contraceptives, obesity and mobility at work in women and height and straining at stool in men may be implicated.

PMID 11511615  Int J Epidemiol. 2001 Aug;30(4):846-52.
著者: Arcangelo Iannuzzi, Salvatore Panico, Anna V Ciardullo, Cristina Bellati, Vincenzo Cioffi, Gabriella Iannuzzo, Egidio Celentano, Franco Berrino, Paolo Rubba
雑誌名: J Vasc Surg. 2002 Nov;36(5):965-8.
Abstract/Text OBJECTIVE: The purpose of this study was to examine the association between body mass index (BMI), venous capacitance, and clinical evidence of varicose veins after adjustment for sex hormones in postmenopausal women.
METHODS: This study group of the DIANA (DIet and ANdrogens) project (a randomized controlled trial on the effect of some dietary changes on sex hormone pattern in women with elevated androgenic hormone levels in Italy) was comprised of 104 healthy volunteer postmenopausal women, aged 48 to 65 years. The main outcome measures were physical examination to determine the presence and severity of varicose veins and plethysmographic measurement of lower limb venous capacitance and outflow.
RESULTS: Women in the upper quartile of BMI (>30 kg/m(2)) showed a positive association with clinical evidence of varicose veins (odds ration, 5.8; 95% CI, 1.2 to 28.2) after adjustment for age, estradiol, testosterone, and sex hormone binding globulin. No association was found between BMI and plethysmographic measurements of venous parameters.
CONCLUSION: Obesity is associated with clinical evidence of varicose veins independently from the influence of sex hormones in postmenopausal women and is not associated with venous capacitance. Increased body weight increases the risk of varicose veins.

PMID 12422106  J Vasc Surg. 2002 Nov;36(5):965-8.
著者: N S Sadick
雑誌名: J Dermatol Surg Oncol. 1992 Oct;18(10):883-6.
Abstract/Text Presented is an epidemiologic study on predisposing factors in telangiectatic and varicose leg veins on 500 female patients. Genetic predisposition, hyperestrogenemic states, standing vocations, and obesity were found to be the major predisposing factors. Recognition of these factors may help to prevent further progression of proliferative venous disease after sclerotherapy in susceptible individuals.

PMID 1430543  J Dermatol Surg Oncol. 1992 Oct;18(10):883-6.
著者: Peter Gloviczki, Anthony J Comerota, Michael C Dalsing, Bo G Eklof, David L Gillespie, Monika L Gloviczki, Joann M Lohr, Robert B McLafferty, Mark H Meissner, M Hassan Murad, Frank T Padberg, Peter J Pappas, Marc A Passman, Joseph D Raffetto, Michael A Vasquez, Thomas W Wakefield, Society for Vascular Surgery, American Venous Forum
雑誌名: J Vasc Surg. 2011 May;53(5 Suppl):2S-48S. doi: 10.1016/j.jvs.2011.01.079.
Abstract/Text The Society for Vascular Surgery (SVS) and the American Venous Forum (AVF) have developed clinical practice guidelines for the care of patients with varicose veins of the lower limbs and pelvis. The document also includes recommendations on the management of superficial and perforating vein incompetence in patients with associated, more advanced chronic venous diseases (CVDs), including edema, skin changes, or venous ulcers. Recommendations of the Venous Guideline Committee are based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system as strong (GRADE 1) if the benefits clearly outweigh the risks, burden, and costs. The suggestions are weak (GRADE 2) if the benefits are closely balanced with risks and burden. The level of available evidence to support the evaluation or treatment can be of high (A), medium (B), or low or very low (C) quality. The key recommendations of these guidelines are: We recommend that in patients with varicose veins or more severe CVD, a complete history and detailed physical examination are complemented by duplex ultrasound scanning of the deep and superficial veins (GRADE 1A). We recommend that the CEAP classification is used for patients with CVD (GRADE 1A) and that the revised Venous Clinical Severity Score is used to assess treatment outcome (GRADE 1B). We suggest compression therapy for patients with symptomatic varicose veins (GRADE 2C) but recommend against compression therapy as the primary treatment if the patient is a candidate for saphenous vein ablation (GRADE 1B). We recommend compression therapy as the primary treatment to aid healing of venous ulceration (GRADE 1B). To decrease the recurrence of venous ulcers, we recommend ablation of the incompetent superficial veins in addition to compression therapy (GRADE 1A). For treatment of the incompetent great saphenous vein (GSV), we recommend endovenous thermal ablation (radiofrequency or laser) rather than high ligation and inversion stripping of the saphenous vein to the level of the knee (GRADE 1B). We recommend phlebectomy or sclerotherapy to treat varicose tributaries (GRADE 1B) and suggest foam sclerotherapy as an option for the treatment of the incompetent saphenous vein (GRADE 2C). We recommend against selective treatment of perforating vein incompetence in patients with simple varicose veins (CEAP class C(2); GRADE 1B), but we suggest treatment of pathologic perforating veins (outward flow duration ≥500 ms, vein diameter ≥3.5 mm) located underneath healed or active ulcers (CEAP class C(5)-C(6); GRADE 2B). We suggest treatment of pelvic congestion syndrome and pelvic varices with coil embolization, plugs, or transcatheter sclerotherapy, used alone or together (GRADE 2B).

Copyright © 2011 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
PMID 21536172  J Vasc Surg. 2011 May;53(5 Suppl):2S-48S. doi: 10.1016/・・・

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