Aspects on Chronic Venous Disease of the Lower Limb

Sammanfattning: Controversies exist regarding both what is required for a proper diagnosis of chronic venous disease (CVD), and what treatment to offer patients. An objective evaluation is mandatory to individualize treatment. This thesis deals with the evaluation of patients with CVD with specific emphasis on CEAP classification (C; clinical, E; etiological, A; anatomical, P; pathophysiological), symptoms and signs and functional evaluation of the disease. Also, the effect of overweight on prevalence of skin changes/ulcer and the effect of new treatment alternatives such as medical therapy with micronized purified flavonoid fraction (MPFF) and surgical therapy with Restore® operation in saphenous vein incompetence were analyzed. The effect of orthostatism and treatment with MPFF was further analyzed by determining white blood cell and endothelial cell activity by measuring cell bound and soluble adhesion molecule and cytokines. The anatomical distribution and venous function was evaluated with duplex ultrasound (reflux time and peak reverse flow velocity) and foot volumetry and the findings were correlated to the clinical severity and symptoms. CEAP classification and BMI measurements in 272 patients (401 legs) revealed that overweight is an independent risk factor for increased prevalence and the total peak reverse flow velocity score is significantly higher in patients with skin changes/ulcer. Axial deep venous reflux increased the prevalence of skin changes/ulcer whereas axial superficial venous reflux did not. Global venous function measured with foot volumetry in 101 patients with CVD correlated with the clinical class of CEAP classification while total reflux time measured with duplex ultrasound did not. There was no correlation between symptoms and clinical class. MPFF did not enhance venous function although symptomatic improvement was noted regarding night cramps and reduced reflux time in patients with venous edema compared to the control croup. MPFF treatment increased the expression of CD11b adhesion molecules on circulating granulocytes. Orthostatism for 30 minutes in 10 patients with healed venous ulcer did not cause significant activation of white blood cells or endothelial cells. MPFF treatment increased the expression of CD11b adhesion molecules on circulating granulocytes. Restoring of the valve competence with endovascular treatment in 13 patients with reflux in the proximal saphenous vein did enhance venous function although the function tended to deteriorate when the vein diameter increased during the follow up time.