Peripheral veins: influence of gender,body mass index,age and varicose veins on cross-sectional area

Abstract

To investigate changes in the size of the deep and superficial venous systems associated with gender, age, body mass index and varicose veins, changes to the cross-sectional area of the femoral and the long saphenous veins were analysed in the Duesseldorf=Essen civil servant study population. Between December 1989 and July 1993 a total of 9935 employees were recruited; 9261 were then evaluated for this analysis. Diameters of the long saphenous and femoral veins were determined 2-3 cm distal to the confluence in lying (after 15 min rest) and standing (after 5 min) positions. Cross-sectional areas (CSA) were calculated. A total of 63% of all people were assigned to CEAP (clinical, etiological, anatomical pathophysiological) class 0, 27% to class 1, 8.5% to class 2, while 1.5% belonged to higher CEAP classes. In people without varicose veins (CEAP class 0) the CSA of the femoral and long saphenous veins were smaller in females than in males. In people with a normal body mass index (BMI) (20-25) the mean CSA of the femoral and long saphenous veins in a standing position was similar from the third up to the sixth decade of life. The volume increase due to a standing position expressed as the absolute increase in CSA of the femoral and long saphenous veins was not age-related, either. The relative volume increase expressed as a ratio remained unchanged with age. There was a strong relationship between the CSA of both veins and increasing BMI. In a lying position, the CSA of the femoral and long saphenous veins increased only slightly with increasing CEAP classes. In a standing position, the CSA of both veins increased even in CEAP class 1 (p < 0.001). In a stepwise multivariate regression analysis, the CSA of both veins in a standing position was not age-related but associated with BMI, CEAP classes and gender. The absolute increase in CSA was influenced by all four variables, but BMI and gender were most important. In Conclusion, this study shows that aging is not necessarily associated with an increase in venous CSA of the deep and superficial venous system. BMI is the most important determinant for an increase in CSA in standing position. Varicosity of the superficial venous system is always associated with similar changes in the deep venous system.

Keywords

age body mass index CEAP classification gender varicose veins

References

Consensus Statement: the investigation of chronic venous insufficiency. Circulation 2000; 120: E126-E163.

Canonico S , Gallo C , Paolisso G et al. Prevalence of varicose veins in an Italian elderly Population. Angiology 1998; 49: 129-135.

Evans CJ , Fowkes FGR , Ruckley CV. Prevalence of varicose veins and chronic venous insufficiency in men and women in the general population. Edinburgh vein study. J Epidemiol Community Health 1999; 53: 149-153.

Fowkes FG , Evans CJ , Lee AJ. Prevalence and risk factors of chronic venous insufficiency. Angiology 2001; 52: S5-S15

Beaglehole R , Salmond CE , Prior IAM. Varicose veins in New Zealand: prevalence and severity. N Z M ed J 1976; 84: 396-399.

Abramson JH , Hopp C , Epstein LM. The epidemiology of varicose veins-a survey of Western Jerusalem. J Epidemiol Community Health 1981; 35: 213-217.

Coon WW , Willis PW , Keller JB. Venous thromboembolism and other venous disease in the Tecumseh community health study. Circulation 1973; 48: 839-846.

Clarke H , Smith SR , Vasdekis SN , Hobbs JT , Nicolaides AN. Role of venous elasticity in the development of varicose veins. Br J Surg 1989; 76: 577-580.

Almgren B , Eriksson I. Primary deep venous incompetence in limbs with varicose veins. Acta Chir Scand 1989; 155: 455-460.

10.

Van Bemmelen PS , Bedford G , Beach K , Strandness DR Jr. Status of the valves in the superficial and deep venous system in chronic venous disease. Surgery 1991; 109: 730-734.

11.

Petter O. Clinical aspects of deep venous varicose insufficiency. Phlebologie 1992; 45: 247-253.

12.

Hach W. Diagnosis and surgical methods in primary varicose veins. Langenbecks Arch Chir 1988; Suppl 2: 145-151.

13.

Engelhorn C , Engelhorn A , Salles-Cunha SX et al. Relationship between reflux and greater saphenous vein diameter. J Vasc Technol 1997; 21: 167-172.

14.

Widmer LK. Peripheral venous disorders, Basel III. Bern: Hans Huber, 1978.

15.

Porter JM , Moneta GL , an International Consensus Committee on Chronic Venous Disease . Reporting standards in venous disease: an update. J Vasc Surg 1995; 21: 635-645.

16.

Jeanneret C , Labs KH , Schwanden M , Bollinger A , Hoffmann U , Jager K. Physiological reflux and venous diameter change in the proximal lower limb veins during a standardised Valsalva manoeuvre. Eur J Vasc Endovasc Surg 1999; 17: 398-403.

17.

Jeanneret C , Labs KH , Schwanden M , Gehring A , Jäger KA : Venenquerschnittsfläche: messen oder berechnen. [Venous cross-sectional area: measured or calculated?] Ultraschall in Med 2000; 21: 16-19

18.

Hertzberg BS , Kliewer MA , DeLong DM et al. Sonographicassessment of vein diameters in leg. AJR 1997; 168: 1253-1257.

19.

Haenen JH , van Langen H , Janssen MCH et al. Venous duplex scanning of the leg: range, variability and reproducibility. Clini Sci 1999; 96: 271-277.

20.

Tullis MJ , Meisner MH , Bergelin RO , Caps MT , Manzo RA , DE Strandness . The relationship of venous diameter to reflux, cephalad thrombus and cephalad reflux following deep venous thrombosis. Thrombosis and Haemost 1997; 77: 462-465.

21.

Callam MJ. Epidemiology of varicose veins. Br J Surg 1994; 81: 167-173.

22.

Fronek A , Criqui MH , Denenberg J , Langer RD. Common femoral vein dimensions and hemodynamics including Valsalva response as a function of sex, age and ethnicity in a population study. J Vasc Surg 2001; 33: 1050-1056.

23.

Brand FN , Dannenberg AL , Abbott RD , Kannel WB. The epidemiology of varicose veins: the Framingham study. Am J Prev M ed 1988; 4: 96-101.

24.

Seidel JC , Bakx KC , Deurenberg P , van den Hoogen HJM , Hautvast JGAJ , Stijnen T. Overweight and chronic illness-a retrospective cohort study, with a follow-up of 6-17 years, in men and women of initially 20-50 years of age. J Chron Dis 1986; 39: 585-593.

25.

Kurz X , Kahne SR , Abenhaim L et al. Chronic venous disorders of the leg: epidemiology, outcomes, diagnosis and management. Int Angiol 1999; 18: 83-102.

26.

Laurikka JO , Sisto T , Tarkka MR , Auvinen O , Hakam M. Risk indicators for varicose veins in forty-to sixty-year-olds in the Tampere varicose veins study. W orld J Surg 2002; 26: 648-651.

27.

Monahan KD , Dinenno FA , Seals DR , Halliwill JR. Smaller age-associated reductions in leg venous compliance in endurance exercise-trained men. Am J Physiol Heart Circ Physiol 2001; 281: 1267-1273.

28.

Smit AAJ , Halliwil JR , Low PA , Wieling W. Pathophysiological basis of orthostatic hypotension in autonomic failure. J Physiol 1999; 519: 1-10.

29.

Burke D , Sundlöf G , Wallin BG. Postural effects on muscle nerve sympathetic activity in man. J physiol 1977; 272: 399-414.

30.

Rothe CF. Reflex control of the veins in cardiovascular function. Physiologist 1979; 22: 28-35.

31.

Clarke H , Vasdekis SN , Hobbs JT , Nicolaides AN. Venous wall function in the pathogenesis of varicose veins. Surg 1992; 111: 402-408.

32.

Kisch D , Dienes HP , Küchle R et al.

Changes in the extracellular matrix of the vein wall-the cause of primary varicosis?

Vasa 2000; 29: 173-177.

33.

Goodall S , Crowther M , Bell PR , Thompson MM. The association between venous structural alterations and biomechanical weakness in patients with abdominal aortic aneurysms. J Vasc Surg 2002; 35: 937-942.

34.

Stranzenberg W , Hach W. Diagnosis of secondary popliteal and femoral venous insufficiency in truncal varicose veins. Vasa 1990; 19: 30-34.

35.

Perrin M , Bayon JM , Hiltbrand B , Nicolini P. Deep venous insufficiency and recurrent varicose veins after surgery of superficial venous insufficiency. J Mal Vasc 1997; 22: 343-347.

36.

Sakurai T , Matsushita M , Nishikimi N , Nimura Y. Hemodynamic assessment of femoropopliteal venous reflux in patients with primary varicose veins. J Vasc Surg 1997; 26: 260-264.