'Real' - Epidemiology of varicose veins and chronic venous diseases: The San Valentino vascular screening project

The aim of this indipendent study was to evaluate prevalence and incidence venous diseases and the role of concomitant/risk factors for varicose veins (VV) or chronic venous insufficiency (CVI). The study was based in San Valentino in Central Italy and was a 'real' whole-population study. The study included 30000 subjects in 8 villages/towns evaluated with clinical assessment and duplex scanning. The total prevalence of VV was 7%; for CVI prevalence was 0.86 with 0.48% of ulcers. Incidence (new cases per year) was 0.22% for VV and 0.18% for CVI; 34% of patients with venous disease had never been seen or evaluated. The distribution of VV and CVI in comparison with duplex-detected incompetence (DI) indicates that 12% of subjects had only VV (no DI), 2% had DI but no VV, 7.5% had DI associated with VV, 2% 'apparent' CVI without DI, 3% DI only (without CVI) and 1.6% both CVI and DI. VV associated to DI are rapidly progressive and CVI associated with DI often progresses to ulcerations (22% in 6 years). VV without significant DI (3%) and venous dilatations without DI tend to remain at the same stage without progression for a long period of time. New cases per year appear to have a greater increase in the working population (particularly CVI) possibly as a consequence of trauma during the working period. In older age (>80) the incidence of CVI tends to decrease. Ulcers increase in number with age. Only 22% of ulcers can be defined as venous (venous hypertension, increased ambulatory venous pressure, shorter refilling time, obstruction and DI). Medical advice for VV or CVI is requested in 164 subjects out of 1000 in the population. In 39/1000 there is a problem but no medical advice is requested and in only 61/1000 the venous problem is real. In VV in 78% of limbs there is only reflux, in 8% only obstruction and in 14% both. In CVI 58% of limbs have reflux, 23% obstruction and 19% both. In conclusion VV and CVI are more common with increasing age. The increase with age is linear. There was no important difference between males and females. These results are the basis for future 'real', whole population studies to evaluate VV and CVI.