title: Epidemiology and aetiology of C4-6 disease.
abstract: Although our understanding of chronic venous insufficiency (CVI) has improved, many important questions remain unanswered. Ensuring that patients are appropriately referred for specialist assessment and then receive evidence-based, cost-effective treatment continues to be challenging. The lifetime of risk of chronic venous ulceration (CVU) is around 1% with approximately 10% ulcers being open at any one time. The incidence skin changes disease is about 10 times greater (10%). However, many of the studies upon which these estimates are based are old and/or methodologically flawed. There is reason to believe that the incidence, prevalence and characteristics of CVI/CVU may have changed considerably over the last 10-20 years and that future change is likely. Further cross-sectional and longitudinal epidemiological studies are required to establish the size and nature of the health-care need going forward in developed and increasingly developing countries. CVI culminating CVU is primarily the result of sustained ambulatory venous hypertension, which in turn arises from superficial and/or deep venous reflux with or without deep vein obstruction. However, there are many other elements to this complex condition, for example, microvascular dysfunction; calf muscle pump efficiency; dermal inflammation; disordered fibroblast function and matrix production; failure of epithelialization; congenital and acquired thrombophilia; malnutrition, obesity and diet; and bacterial colonization. None of the currently available treatment modalities is entirely satisfactory and novel therapies based upon a clearer understanding of the disease at the psychological, genetic, mechanical, microvascular and microscopic level are required.
authors.affiliation: College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK. andrew.bradbury@btinternet.com
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Bradbury
mesh_terms: D005347:Fibroblasts / Q000473:pathology; D006801:Humans; D006973:Hypertension; D015994:Incidence; D007249:Inflammation / Q000150:complications / Q000235:genetics; D008833:Microcirculation; D018482:Muscle, Skeletal / Q000473:pathology; D019851:Thrombophilia / Q000150:complications / Q000235:genetics; D014648:Varicose Veins / Q000453:epidemiology / Q000209:etiology* / Q000235:genetics; D014652:Vascular Diseases / Q000453:epidemiology / Q000209:etiology* / Q000235:genetics; D014689:Venous Insufficiency / Q000453:epidemiology / Q000209:etiology* / Q000235:genetics