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Original Article

A study of epidemiological factors and clinical

profile of primary varicose veins
Siddharth Mishra, Iqbal Ali, Gurjit Singh
Department of General Surgery, Dr.D. Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India

ABSTRACT Access this article online

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Introduction: Varicose veins cause a great deal of morbidity in Website:
our population today. They are part of the penalty we pay for the www.mjdrdypu.org
adoption of the erect posture. They affect 1020% of population
in the Western world but in India, it is 5%. Varicose veins do not DOI:
threaten life and are seldom disabling, but they cause a considerable
10.4103/0975-2870.192169
demand on medical care. They are the cause of morbidity and
loss of precious work hours and a significant financial burden
on the healthcare system. Aims and Objective: To study the
epidemiological factors with respect to age, sex, and occupation
the cause of morbidity and loss of precious work hours and
and clinical profile as per Clinical, Etiologic, Anatomical,
Pathophysiological classification of varicose veins. Materials and a significant financial burden on the healthcare system.
Methods: Atotal of sixty cases of were examined at a teaching It is a penalty we pay for adoption of the erect posture. It
Medical College, Hospital and Research Centre during the period affects 1020% of population in the Western world but in
from July 2013 to September 2015. Examination of patients was India, it is 5%.[3]
carried out according to the pro forma. All patients underwent
detailed clinical examination followed by color Doppler
They can be primary where the defect lies in the walls or the
ultrasound. Results: In our study, 70% patients were males and
30% patients were females. Maximum patients were in age group valves of superficial venous system/perforating veins. Secondary
of 4554years. Twenty were in CEAP C2, 15cases in CEAP C3 varicose veins are due to the obstruction in venous flow such as
and 15cases in CEAP C4 and 10cases in C5. Sixty percent patients deep vein thrombosis(DVT), pregnancy, and tumor.
had involvement of great saphenous vein(GSV), 17% patients had
short saphenous vein(SSV) while 23% patients had involvement Various predisposing factors of varicose veins have been
of both GSV and SSV. Conclusion: Not only prolonged standing
implicated such as pregnancy, prolonged standing, obesity,
but also sitting posture can cause varicose veins. Obesity and
increasing age are other risk factors. Classifying the varicose old age, chronic rise in intraabdominal pressure, and
veins has an impact on the course of the disease and preventing its athletics. Heredity also plays an important role.[4]
complications. Color Doppler is superior to clinical examination
in the evaluation of superficial and perforator veins incompetence. The aims of this study are to study the epidemiological
factors such as age, sex, area of residence, posture, and to
Keywords: Epidemiology, primary varicose veins, varicose veins

This is an open access article distributed under the terms of the

Introduction
Varicose veins are defined as dilated, tortuous, subcutaneous
veins3mm in diameter measured in the upright position
with demonstrable reflux.[1]
Creative Commons Attribution-NonCommercial-ShareAlike 3.0
License, which allows others to remix, tweak, and build upon the
work non-commercially, as long as the author is credited and the
new creations are licensed under the identical terms.
For reprints contact: reprints@medknow.com

How to cite this article: Mishra S, Ali I, Singh G. A study of

Varicose veins do not threaten life and are seldom disabling, epidemiological factors and clinical profile of primary varicose veins.
but it causes a considerable demand on medical care.[2] It is Med J DY Patil Univ 2016;9:617-21.

Address for correspondence:

Dr.Siddharth Mishra, Department of General Surgery, Dr.D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, Maharashtra,
India. Email:sid1508@gmail.com

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Mishra, et al.: Varicose veins epidemiology and clinical profile

study the clinical profile according to the CEAP classification
of varicose veins.
Materials and Methods
A prospective observational study with a sample size of sixty
patients was undertaken at a Teaching Medical College and
Hospital and Research Center. The period of study was July
2013September 2015. Patients with features of varicose
veins and its complications were included in the study
while patients with secondary varicose veins due to DVT,
pregnancy, and venous flow obstruction were excluded
from the study. Clinical history of all the patients was taken.
Clinical examinations and color Doppler were performed.
The collected data were analyzed using Chisquare test and
IBM Corp. Released 2013. IBM SPSS Statistics for Windows,
Version 22.0. (IBM Corp., Armonk, NY).
Results
In our study, 70% of patients were males, and 30% of
patients were females [Figure1].
Age of the patients ranged from 19 to 70years. Maximum
patients were in age group of 45 to 54years(21.67%)[Figure2].
The numbers of patients were maximum in the body
mass index(BMI) range 18.625kg/m 2 . However,
the majority of the patients 31 were overweight and
obese[Figure3].
In our study, 44patients(73%) had a history of prolonged
standing out of with 17 had history of mainly standing,
6 had history of standing and walking, 12 had history of
standing and sitting, 9 had history of standing, walking,
and sitting.
Sixteen patients had history of sitting posture out of which
9 had history of mainly sitting and 7 had history of sitting
and walking [Figure 4].
Fiftyfour patients had unilateral lower limb varicose veins
while six patients had bilateral lower limb [Figure5].
Out of 60patients, 38patients had the involvement of only
great saphenous vein(GSV), while only short saphenous
vein(SSV) was involved in 8patients. Both GSV and SSV
were present in 14patients[Figure6].
Among the patients examined, 33% of patients belonged to
C2 class, and 17% of patients belonged to C5 class[Figure7].
Out of 60patients examined, 47patients had incompetent
saphenofemoral junctions(SFJs) on clinical examination
while 13patients had competent SFJ[Figure8].
On color Doppler study, 55patients had incompetent SFJ
while only 5patients had competent SFJ.
On clinical examination[Figure9]:
Eleven patients had incompetent midthigh perforators
on clinical examination while 49patients had competent
midthigh perforators
Thirtythree patients had incompetent knee perforators
on clinical examination while 27patients had competent
knee perforators
Thirtyone patients had incompetent midcalf
perforators on clinical examination while 29patients
had competent
Twentynine patients had incompetent ankle perforators
on clinical examination while 31patients had competent.
On color Doppler study[Figure10]:
Twentytwo patients had incompetent midthigh

Male Female 10
9
Males
8 Females
7
No. of patiemts

30% 6
5
4
3
2
70% 1
0
15-19 20-24 25-34 35-44 45-54 55-64 65-74 75+
Age range

Figure 1: Gender distribution Figure 2: Age distribution

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Mishra, et al.: Varicose veins epidemiology and clinical profile

25 18
BMI Range 16 No. of patients

20 14

12

15 10

10 6

5 2

0
Mainly Standing & Standing & Standing, Mainly Sitting &
0 Standing Walking Sitting Walking & Sitting Walking
16 - 18.5 18.6 - 25 26 - 30 >30 Stitting

Figure 3: Bar diagram showing levels body mass index among patients Figure 4: Bar diagram showing number of patients according to their
posture

GSV SSV GSV, SSV

23%
Unilateral

Bilateral

13%
64%

Figure 5: Pie diagram showing the incidence of the limb affected

Figure 6: Pie diagram showing distribution as per the involved venous
system
20
No. of patients
18
60 Competent
16 Incompetent
14 50

12
40
10

8 30

6
20
4

2 10
0
C2 C3 C4 C5 0
Clinical Examination Color Doppler
Figure 7: Bar diagram showing the distribution of patients according
to clinical classification
Figure 8: Bar diagram showing comparison between competent and
incompetent saphenofemoral junction on clinical tests and color Doppler
perforators while only 38patients had competent
midthigh perforators while only 19patients had competent below knee
Fortyone patients had incompetent knee perforators perforators

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Mishra, et al.: Varicose veins epidemiology and clinical profile
35 Incompetent
30
25
20
15
10
5
0
Mid-thigh Knee perforators Mid-calf Ankle perforators
perforators perforators
Figure 9: Bar diagram showing locations of various incompetent
perforators on clinical tests
Thirtyeight patients had incompetent midcalf
perforators while only 22patients had competent
midcalf perforators
Thirtyseven patients had incompetent ankle
perforators while only 23patients had competent ankle
perforators.
Discussion
This study was done to seek a better knowledge about the
epidemiology of the varicose veins in the local population
which visited this hospital. No similar study has been
reported in India. The study also aims to spread awareness
about the lifestyle which leads to the development of
varicose veins and to take measure to avoid them.
Varicose veins are more common in the Western countries as
compared to India[5] which results in considerable morbidity
and costs to the health services.
In our study, 70% of patients were males and 30% patients
were females. The study of Lee etal., Edinburgh Vein
Study shown the prevalence of 40% in men and 32% in
women.[6] Our findings are in accordance with the study
of Vashist etal. which showed 64% of males and 36% of
females.[7]
The marked female preponderance of varicose veins in
the Jerusalem sample may be related to the fact that the
prevalence of overweight(BMI 28g/cm2 or more) in the
study population was 14times as high among women as
among men. In the USA, the corresponding sex ratio is 1.1
if overweight is defined as 10% or more above standard
weight and 17 if it is defined as 20% or more above standard
weight.[4]
620 Medical Journal of Dr. D.Y. Patil University | September-October 2016 | Vol 9 | Issue 5
45 Incompetent
40
35
30
25
20
15
10
5
0
Mid-thigh Knee perforators Mid-calf Ankle perforators
perforators perforators
Figure 10: Bar diagram showing locations of various incompetent
perforators on color Doppler
Age of the patients ranged from 19 to 70years. Maximum
patients were in age group of 4554years(21.67%). The
finding is in accordance with Edinburgh Vein Study.[6]
Our study showed that majority of patients 51.67% were
either overweight or obese while 40% had normal BMI
and 8.33% were underweight. Our findings correlate with
the findings of Krger etal. which showed that increase in
BMI was one of the most important determinants of the
development of varicose veins.[8] A study by Seluk Kapsz
etal. showed that obesity and lack of exercise are one of the
contributory factors in the development of varicose veins.[9]
Seventythree percent patients had a history of prolonged
standing. Prolonged standing is defined as standing for 60%
of work day.
When work posture was added to the analysis of variance,
using data for gainfully employed people aged 2064, this
variable was found to have a significant specific effect in
each sex, somewhat stronger among women. The inclusion
of work posture in the analysis of variance produced little
change in the specific effects of the other variables.[4]
Our results support the notion that prolonged standing
can contribute to the development of varicose veins. This
is a widely accepted belief for which little reliable and
convincing evidence exists.[4,10] However, we also conclude
that not only the prolonged standing but also sitting posture
also causes varicose veins.
In our study, 62% of patients resided in an urban area while
38% of patients lived in the rural area.
In our study, 54patients had unilateral lower limb varicose
veins while 6patients had bilateral.
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Mishra, et al.: Varicose veins epidemiology and clinical profile
In a study by Staniszewska etal.,[11] majority of patients
had unilateral lower limb varicose veins which correlate
with our study.
In our study, 60% of patients had involvement of GSV, 17%
patients had SSV while 23% patients had involvement of
both GSV and SSV.
In our study, 20 were in CEAP C2, 15cases in CEAP C3 and
15cases in CEAP C4 and 10cases in C5.
In the study of de Andrade etal ., [12] it was observed
that severity was related to the number of incompetent
perforating veins in each limb and to association of
superficial veins, especially with SSV incompetency. The
absence of reflux in perforating veins alone was predominant
in patients with C2, which correlates with our study.
In a study by Staniszewska etal.,[11] the majority of patients
had varicosities in C2 class.
However, only the clinical classification(C) holds the
importance. The CEAP classification can only be used to
describe patients and not to evaluate the results of treatment.
It provides adequate information in communications
between practitioners in different fields and is also helpful
in the thorough patient counseling.
In our study, SFJ incompetency in 78% of patients was
detected by BrodieTrendelenburgs test. Color Doppler
identified 92% of patients with SFJ incompetency. Sensitivity
was 93.07%. Specificity was 100% which closely correlates
with the study of Vashist etal. in which 72% patients were
detected to have SFJ incompetence on clinical tests while
80% of patients were found to have SFJ incompetence on
color Doppler.[7] Their sensitivity was 90%, and specificity
was 100%.
In our study, 104 perforators were detected by clinical tests
while 138 perforators were detected by color Doppler. In
the study by Vashist etal., 104 perforators were detected
by clinical tests while 100 perforators were detected by
color Doppler.[7]
Conclusion
Our study finds that not only prolonged standing but
also sitting posture can cause varicose veins. Obesity
Medical Journal of Dr. D.Y. Patil University | September-October 2016 | Vol 9 | Issue 5 621
and increasing age are other risk factors. Classifying the
varicose veins has an impact on the course of the disease and
preventing its complications. We also conclude that color
Doppler is superior to clinical examination in the evaluation
of superficial and perforator veins incompetence.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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