Kritaya Kritayakirana
Current Position
Associate Professor
Chulalongkorn University
Venous Reflux Session

Topic: Risk factors for chronic venous stasis ulcer in King Chulalongkorn Memorial Hospital


Background: The disorder of varicose veins is a common disease among the Thai population, however the published studies in Thai patients are still limited.
Objectives: The aim of this study is to investigate the risk factors, patterns of venous reflux, and venous clinical severity scores (VCSS) in Thai patients afflicted with varicose veins.
Materials and Methods: A prospective comparative case-control study was performed for patients with varicose veins in a vascular surgery clinic at a single institute between February 2018 and January 2019. The patients were enrolled, interviewed and compared with the same number of sex-matched control patients. Demographic data, information about relevant risk factors, and VCSS were collected. Duplex ultrasonography was performed on all patients.
Results: There were 59 new varicose vein patients. The majority, 46 patients (73%), were female. Twenty-four patients (40.7%) were over 60 years old. The mean body mass index (BMI) of the cohort was 25.1 kg/m2. Pain was the most common presenting symptom (49%), followed by edema of the legs (29%), and cosmetic concerns (27%). Most of the patients had had symptoms for more than one year (92%). The 95 limbs with visible varicose veins were categorized into CEAP (Clinical, Etiology, Anatomy and Pathophysiology) clinical stages: C2 69%, C3 12%, C4 12%, C5 5%, and C6 2%. The mean VCSS was 5.9. Refluxes of different types were found: at the saphenofemoral junction (SFJ) (33%), saphenopopliteal junction (SPJ) (1%), perforators reflux (3%), and the great saphenous vein (GSV) reflux 16%. The mean diameter of GSV was 6.9 ± 2.6 mm. The risk factors that were found to be significant when compared with the control group were age between 51-60 years old (odds ratio(OR) = 5.2, 95%CI = 1.21-22.2), age over 60 years old (OR = 31.1, 95%CI = 5.7-169.7), varicose veins in family history (OR = 10.1, 95%CI = 2.3-45.0), and prolonged standing posture (>50% of working hours) (OR = 3.8, 95%CI = 1.4-10.6). It should be noted that, among females, oral contraception, hormonal therapy, and number of pregnancies were not significant risk factors.
Conclusion: This study revealed that risk factors for varicose veins include increasing age, especially above 50 years old, varicose veins in family history, and prolonged standing posture. Pain, edema and cosmetic concerns comprised common presentations. The venous reflux was most commonly found in SFJ, and there was no deep vein reflux identified in any patients.
Keywords Varicose veins, Risk factors, Venous reflux