title: Progression of varicose veins and chronic venous insufficiency in the general population in the Edinburgh Vein Study.
abstract: OBJECTIVE
  The natural history in the general population of chronic venous disease in the legs is not well understood. This has limited our ability to predict which patients will deteriorate and to assign clinical priorities. The aims of this study were to describe the progression of trunk varicose veins and chronic venous insufficiency (CVI) in the general population, to identify important lifestyle and clinical prognostic factors, and to determine the relationship between venous reflux and progression.
  
  
  METHODS
  The Edinburgh Vein Study is a population-based cohort study in which randomly selected adults aged 18 to 64 years had an examination at baseline. This included a questionnaire on lifestyle and clinical factors, standardized assessment and classification of venous disease in the legs, and duplex scan to detect venous reflux in eight segments of each leg. A follow-up examination 13 years later included a reclassification of venous disease to ascertain progression in the development or increase in severity of varicose veins and CVI.
  
  
  RESULTS
  Among 1566 adults seen at baseline, 880 had a follow-up examination, of whom 334 had trunk varicose veins or CVI at baseline and composed the study sample. The mean (standard deviation) duration of follow-up was 13.4 (0.4) years. Progression was found in 193 (57.8%), equivalent to 4.3% (95% confidence interval [CI], 3.7-4.9) annually. In 270 subjects with only varicose veins at baseline, 86 (31.9%) developed CVI, with the rate increasing consistently with age (P = .04). Almost all subjects (98%) with both varicose veins and CVI at baseline deteriorated. Progression of chronic venous disease did not differ by gender or leg, but a family history of varicose veins and history of deep venous thrombosis increased risk (odds ratio [OR], 1.85 [95% CI, 1.14-1.30] and 4.10 [95% CI, 1.07-15.71], respectively). Overweight was associated with increased risk of CVI in those with varicose veins (OR, 1.85; 95% CI, 1.10-3.12). Reflux in the superficial system increased the likelihood of progression, especially in combination with deep reflux (OR, 2.57; 95% CI, 1.55-4.25) and when located in the small saphenous vein (OR, 4.73; 95% CI, 1.37-16.39).
  
  
  CONCLUSIONS
  Nearly half of the general population with chronic venous disease deteriorated during 13 years, and almost one third with varicose veins developed skin changes of CVI, increasing their risk of ulceration. Age, family history of varicose veins, history of deep venous thrombosis, overweight, and superficial reflux, especially in the small saphenous vein and with deep reflux, might influence the risk of progression.
authors.affiliation: Medical Statistics Team, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom.
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Lee
authors.affiliation: Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Lindsay A
authors.initials: LA
authors.lastname: Robertson
authors.affiliation: Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Sheila M
authors.initials: SM
authors.lastname: Boghossian
authors.affiliation: Radiology Department, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, United Kingdom.
authors.forename: Paul L
authors.initials: PL
authors.lastname: Allan
authors.affiliation: Division of Health Sciences: Clinical Surgery, University of Edinburgh, Edinburgh, United Kingdom.
authors.forename: C Vaughan
authors.initials: CV
authors.lastname: Ruckley
authors.affiliation: Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom. Electronic address: gerry.fowkes@ed.ac.uk.
authors.forename: F Gerald R
authors.initials: FG
authors.lastname: Fowkes
authors.affiliation: Public Health Department, NHS Lothian, Edinburgh, United Kingdom.
authors.forename: Christine J
authors.initials: CJ
authors.lastname: Evans
mesh_terms: D000328:Adult; D015331:Cohort Studies; D018450:Disease Progression; D006801:Humans; D008875:Middle Aged; D016017:Odds Ratio; D011152:Popliteal Vein; D012501:Saphenous Vein; D014648:Varicose Veins / Q000453:epidemiology / Q000503:physiopathology; D014689:Venous Insufficiency / Q000453:epidemiology / Q000503:physiopathology; D055815:Young Adult