Chronic venous disease (CVD), also known as chronic venous insufficiency in its advanced
stages, is marked by dysfunction in the peripheral venous system of the lower
extremities, often due to venous flow obstruction or reflux. Affecting approximately
25-45% of women and 10-40% of men, CVD significantly increases public health
expenditures. While the exact mechanisms remain unclear, evidence suggests that CVD is
multifactorial, involving heightened inflammation, valvular incompetence, and calf muscle
dysfunction, all contributing to impaired venous return and elevated venous pressure.
Common symptoms include varicose veins, lower limb edema, leg discomfort, and heaviness.
CVD is progressive and can advance from superficial vessel involvement, known as
telangiectasia, to deep venous ulcers. Risk factors such as family history, prolonged
standing, smoking, and obesity can contribute to its onset and progression. Conservative
management focuses on lifestyle changes like exercise, weight control, limb elevation,
and compression. Pharmacologic or surgical intervention may be necessary in advanced
cases. Left untreated, CVD can severely impact patients' quality of life, hindering daily
and work activities.
However, data on CVD prevalence in Brazil is limited, largely based on a single study by
Maffei et al. in 1986, which found a 47.6% prevalence of varicose veins and a 3.6%
prevalence of advanced CVD in 1,755 adults in Botucatu, São Paulo. To better serve
Brazilian patients, further data on CVD prevalence, treatment, and risk factors is
essential, aiding healthcare providers in optimizing patient care.
This study aims to characterize the clinical and epidemiological profile of Brazilian CVD
patients through a multicenter, prospective observational study. Conducted across 10
centers nationwide, the study will recruit at least 65 patients per center over 12 weeks.
Quality of life will be assessed using the Aberdeen Varicose Vein Questionnaire (AVVQ),
with lower scores indicating better quality of life. The Venous Clinical Severity Score
(VCSS) will gauge CVD severity, with higher scores indicating greater disease severity.
VCSS correlates with the CEAP classification system and ultrasound findings.
CVD diagnoses will be categorized using the CEAP classification:
C0: No signs of venous disease C1: Telangiectasia/reticular veins C2: Varicose veins (≥3
mm diameter) C3: Edema C4: Skin/subcutaneous changes due to CVD, subdivided into C4a
(pigmentation/eczema), C4b (lipodermatosclerosis/Atrophie Blanche), and C4c (corona
phlebectatica) C5: Healed venous ulcer C6: Active venous ulcer C6r: Recurrent active
venous ulcer During exams, patients will undergo physical evaluation for CVD signs,
followed by duplex ultrasound of superficial and perforating veins. These will be
conducted in both standing and supine positions by qualified vascular specialists,
alongside personal medical history, demographics, occupation, physical stress, and
varicose vein symptoms.
The study will measure factors including:
Presence and location of saphenous vein insufficiency, reflux, and vein caliber Presence
of perforating veins and reflux characteristics Presence of deep vein thrombosis and
related complications The study also covers therapeutic procedures such as sclerotherapy,
endovenous ablation, and surgical vein removal. Compression stockings and pharmacological
treatments (e.g., diosmin + hesperidin, calcium dobesilate, troxerutin) will be
documented, including usage frequency and duration.
Data on cardiovascular diseases, comorbidities (e.g., hypertension, diabetes,
dyslipidemia), occupation, and family history of CVD will also be collected, providing
comprehensive insights into the risk and impact of CVD on the Brazilian population.