The Epidemilogy of Chronic Venous Ulcer: Some Unanswered Questions

Abstract

Objective:

To highlight gaps in knowledge concerning the epidemiology of chronic venous insufficiency and to indicate what future studies are required.

Methods:

Existing classifications are compared. Limitations of epidemiological studies are defined. Data from published series and from the Edinburgh Vein Study are presented.

Synthesis:

The Basle 1978 classification of chronic venous insufficiency (CVI) is a purely clinical classification in which the earliest grade is corona phlebectatica. The Porter 1988 classification of CVI attempted to correlate clinical grades with sites of venous incompe-tence. However, a consistent relationship does not exist. The CEAP classification separates the clinical grades (which do not include corona phlebectasia) from the anatomical segments. The CEAP clinical classification covers a range of venous manifestations but is not consistent. There is a need for further consideration of classifications. Published selected series of patients show that the frequency of incompetence in both deep and superficial systems increases in proportion to the severity of the clinical manifestations of venous disease. To understand the significance of these data we need to know the patterns of venous incompetence in the general population. Data from 1566 subjects between the ages of 18 and 64 years in the Edinburgh Vein Study, a randomly selected cross-section of members of the Edinburgh population, showed that the prevalence of CVI was age-related and was present in 9.2% of men and 6.6% of women. Men had a significantly higher frequency of reflux in the deep system than women. In order to direct therapeutic interventions where they are most appropriate we need to know which patients with the early stages of varicose veins progress to CVI and which patients with early CVI progress to the serious skin complications.

Conclusions:

Key information concerning the natural history of venous disease and its evolution in relation to haemodynamic abnormalities awaits the findings of longitudinal-cohort epidemiological studies which include the duplex scanning of large populations.