Correlation of obesity & comorbid conditions with chronic venous insufficiency: Results of a single-centre study

 Indian J Med Res. 2018 May;147(5):471-476. doi: 10.4103/ijmr.IJMR_1844_16.Sandeep Mahapatra 1, Pinjala Ramakrishna 1, Bhumika Gupta 1, Arumalla Anusha 1, Muneer Ahmad Para 1

PMID: 30082571

 

PMCID: PMC6094506

DOI: 10.4103/ijmr.IJMR_1844_16

Free PMC article

Abstract

Background & objectives: Chronic venous insufficiency (CVI) is a common clinical problem among obese patients. This study was conducted to evaluate the impact of body mass index (BMI) and associated morbidities such as diabetes, hypertension and hypothyroidism on venous disease clinical scores as per Clinical, Etiological, Anatomical, Pathological (CEAP) classification. Methods: In this study, adult patients with BMI more than 30 kg/m2 with signs of CVI were evaluated clinically and by using Duplex ultrasonography of venous system. The patients with C0, C1, C2, C3 and C4, C5, C6 clinical scores in CEAP classification were grouped as lower and higher clinical scores of CVI, respectively. 

Results: Of the 200 enrolled patients, 147 (73.5%) were males and were associated with higher grades of clinical scores (P=0.051). Superficial venous system was involved in 96 per cent patients and 91 per cent patients had reflux in the sapheno-femoral junction. A negative association was observed between hypertension and male gender (P=0.001). Higher BMI was associated with higher clinical scoring (P=0.053). BMI >40 kg/m2 was associated with primary aetiology (P=0.007) of CVI. There was no correlation between superficial, deep or perforator incompetence with BMI (P=0.506). Duplex-confirmed significant reflux was observed in patients with higher BMI (P=0.006). Age and BMI were positively correlated with clinical score (r=0.176; P=0.013 & r=0.140; P=0.049), respectively. 

Interpretation & conclusions: Our findings indicated that elderly male patients with high BMI seemed to be at a higher risk of advanced clinical grades of CVI. The impact of comorbid conditions such as diabetes, hypertension and hypothyroidism on CVI could not reach at significance in the present study.

Stockings and venous disease

 Stockings and venous disease

Stocking as a part of compression therapy is the common prescription given to the patients attending the vascular (venous) clinics. Stockings are usually pressure graded. The maximum pressure is at the bottom level (ankle) and as we go up, the pressures decrease. These pressure graded compression garments are expected to improve venous flows and reduce venous stasis and ambulatory venous pressures. The venous symptoms are linked with ambulatory venous pressures (AVP). The higher (>80mmHg) AVPs are associated with non-healing venous ulcers.

Modern compression socks were invented by Conrad Jobst, a dashing German engineer who lived in Toledo, Ohio.  He suffered from varicose veins. The compression socks, which he invented around 1950, were his flagship achievement. They are tightest near the ankle, but still pretty tight up top. They work by countering hydrostatic pressure in the wearer’s legs. After Conrad's death in 1957, his wife, Carolyn Jobst, successfully grew the business. Under her leadership, JOBST^® expanded its product lines to include Ready-to-Wear vascular garments, consumer support stockings, plastic and reconstructive surgery garments, and anti-embolism stockings. Sales extended to virtually every continent as the JOBST reputation for quality grew.