Scientific basics

Chronic venous diseases are among the most common disease patterns of the population. Despite its prevalence, research has been neglected in Germany for many years. This is even more incomprehensible as chronic venous diseases result in major costs due to their incidence, and for this reason, they are relevant in a socioeconomic way.

In order to better be able to classify the variety of manifestations of chronic venous diseases and to facilitate the diagnosis, diverse classifications have been implemented such as the internationally recognized CEAP classification. The CEAP classification was developed by an international committee of the American venous forum in 1994 and was adopted by the vascular surgery association within the “Reporting Standards in Venous Diseases” and complemented in 2004.

CEAP classification

Today, the classification of varicose veins and chronic insufficiency is scientifically correctly performed according to the CEAP classification. Every letter has its own meaning in the CEAP classification. C stands for clinical, E for etiologic, A for anatomic, and P for the pathophysiological aspects of a venous disease. Due to its complexity, the use of this classification in clinical practice has unfortunately been very limited. We, the Kompetenznetz Chronische Venenkrankheiten obligatory use this classification being the best possible option at the moment for all trials to guarantee an international comparability of our results for the benefit of patients. We are looking forward to providing further information (please refer to our contact form).

Sources: 1. Porter et al., Reporting standards in venous disease: an update. International Consensus Committee on Chronic Venous Disease. J Vasc Surg 1995;21(4): 635-645/2. Kistner et al., Diagnosis of chronic venous disease of the lower extremities: the CEAP classification. Mayo Clin Proc 1996; 71(4): 338-345 / 3. Eklöf et al., American Venous Forum international ad hoc committee for revision of the CEAP classification. Revision of the CEAP classification for chronic venous disorders:consensus statetment. J Vasc Surg 2004; 40(6): 1248-1252

Classification as per the etiologic aspects

Generally, varicose veins are classified according to their cause or formation: The primary varicose veins being characterized by a deficiency of venous wall and venous valve of epifascial veins and the secondary varicose veins as the most common consequence of a deep leg vein thrombosis with persistent vein lumen stenosis and/or destruction of the venous valves. In both cases, the amount of blood is redistributed from the deep to the superficial venous system, resulting in a visible venectasia, the varicose veins. The primary varicose veins are definitely the most common form.

Epidemiology of varicose veins

The prevalence of venous diseases is increased in particular in Western nations. Internationally, diverse studies representing the population have been performed. The recently performed Bonner Venenstudie (Bonner vein study) is one of the largest epidemiological studies to compile the incidence and severity of chronic venous diseases. Varicose veins without the indication for CVI are shown for 24% of men and 15.8% of women. An advanced CVI has been registered for 3.6%. Total prevalence was between the age of 19 and 79 for the average population for the healed ulcer at 0.6% and in case of a florid ulcer at 0.1%. Prevalence highly depended on age. Varicose veins are, therefore, a typical widespread disease.

Source: Rabe et al., Bonner Venenstudie der Deutschen Gesellschaft für Phlebologie – Epidemiologische Untersuchung zur Frage der Häufigkeit und Ausprägung von chronischen Venenkrankheiten in der städtischen und ländlichen Wohnbevölkerung. Phlebologie 2003; 32:1-4

Genetics of chronic venous diseases/heredity

Experts have already been discussing the importance of genetics as a predisposing factor for a long time. However, it was only in 2010 that it was possible for the first time to obtain evidence of a clear genetic component in regard to the pathogenesis of varicose veins by scientifically calculating heredity by means of many family trees of the test persons having developed the disease. Heredity was determined with 17.3% for the intensity of varicose veins requiring treatment, and, therefore, it can be compared to the heredity of cardiovascular risk factors such as arterial hypertonia (systolic blood pressure 15.0%) which is also a disease of multifactorial genesis.

Source: Fiebig et al., Heritability of chronic venous disease. Human Genetics 2010; 127:669-674

Further risk factors:

Varicose veins are clearly a disease of multifactorial genesis. The modern way of living and the consequences from sitting for long periods and remaining in a standing position as well as overweight can all foster the occurrence of varicose veins. On the other hand, people who suffer from varicose veins are routinely physically active and of a normal weight. Therefore, for this reason, a genetic component has already been suspected for a long time. However, there are also other risk factors beyond genetics that contribute to the occurrence of varicose veins: Old age and being female. The relation between these two risk factors and the genetic component was calculated by means of the Kullbach-Leibler divergence. The result shows a significantly higher proportion of genetics than the product of high age and female gender. In addition to these important risk factors, other factors also play a role, including increased BMI, increased number of pregnancies, sitting for long periods and walking as well as physical activity. They all damage the veins.

Sources: 1. Rabe et al., Bonner Venenstudie der Deutschen Gesellschaft für Phlebologie – Epidemiologische Untersuchung zur Frage der Häufigkeit und Ausprägung von chronischen Venenkrankheiten in der städtischen und ländlichen Wohnbevölkerung. Phlebologie 2003; 32:1-4 / 2. Fiebig et al., Heritability of chronic venous disease. Human Genetics 2010; 127:669-674