The risk of complications with varicose veins | CEAР scale | Trophic ulcers and no panic.
26 jul 2021
Risk of complications of varicose veins. CEAR scale. Trophic ulcers and no panic.
Frequent questions from patients at a phlebologist's appointment: "Will I have a trophic ulcer?" ".
Answering questions honestly based on evidence-based medicine. We explain where are the risks and where are the urban myths.
For convenience, let's talk about CEAP classification, because the first stage of varicose veins is considered to be the vascular networks (C1), the second stage is visible varicose veins (C2), the third stage is edema (C3), and the fourth stage is the first trophic changes (C4). At the last stage - varicose ulcers.
Varicose disease does not progress at lightning speed. Severe forms (C3 and above) take time to develop. We often hear from patients about grandparents who lived with varicose veins into their 90s without major problems. The other side of the coin: decompensation of the disease, especially in the elderly. We see this every day.
Analysis of modern publications indicates that the risk of transition from uncomplicated stage C2 (visible varicose veins that do not bother the patient) to decompensated forms is 3.5 to 7% per year.
This means that in the next 10 years, with the most positive prognosis, in every 3rd patient, varicose veins will go into a severe stage (total risk of 35%), and in the worst case scenario, cumulative the risk of disease progression will be 70%.
Here are the two most extensive studies: the Edinburgh Vein Study, conducted in the UK, where progression of venous insufficiency occurred in every second patient (47.4%) over a 13.5-year follow-up, and Bonn Vein Study II, in which every third patient (31.8%) experienced severe clinical manifestations of varicose veins within six years.
Some patients have an aggressive course and progression even at a young age. This issue is being studied and a significant role is given to the genetically determined activity of enzymes that destroy the protein in the connective tissue (metal proteinase), resulting in an increased risk of trophic ulcers.
At the same time, this risk does not exceed 1-2% per year at stage C4. An ulcer is more likely to occur in a person who has been ill for over 20 years. Our main task is to convey knowledge to the patient, explain the real risks.
In most patients with uncomplicated varicose veins, endovenous treatment is not urgent, but this should not be shelved. The problem will not be solved by itself, and in 5-10 years some patients will come already in the stage of decompensation.
Apply for a consultation at the AngioLife Vascular Center for the diagnosis and possible treatment of varicose veins. We offer only what is vital.