Chronic venous disease in overweight: what to do?

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Introduction:

WHO recognize Overweight and Obesity as a major health risk in many countries, Chronic venous disease affects one in two women and one in three men. Few studies highlighted a correlation between these two pathologies. However, simple rules to better manage these conditions should help improve the quality of life of patients.

Epidemiological data:
The prevalence of overweight and obesity is clearly increasing, especially in GCC and in Western populations, in adults and children. The prevalence of chronic venous disease (CVD) is also high.

Obesity is well recognized as a risk factor for thromboembolic venous disease and development of post-thrombotic disease. On the other hand, the exact impact of overweight on chronic venous disease and its evolution remains controversial. The Framingham study, the only longitudinal study available to us, found a higher incidence of varicose veins when there is excess weight at baseline, especially for women. Few studies concern this impact.

However, our experience as a clinician confirms the link between onset or aggravation of chronic venous disease symptoms (heavy and heavy legs, swelling of ankles and legs) and weight gain.

 

Several studies are targeted on obese pa- tients, with discordant results:

For some, a BMI> 30 kg / m² increases the risk of varicose veins by 6. Conversely, in the
French study of Carpentier, if varicose veins are more common in women of tall size, the weight comes little. J.P. Benigni et al. also found no significant correlation between BMI and chronic venous disease,

In obese patients, there are severe trophic disorders in the absence of any detectable reflux on the deep or superficial veins during the Doppler ultrasound scan. The explanation would be related to the abdominal hyperpressure and the weakness of the muscular pump of the calf, major element of the venous return.

Also, Doppler ultrasound confirms that the progression of venous disease is faster in patients who become obese or remain obese during the five years of follow-up versus those who control their obesity.

Other progression factors involved are prolong

ed standing and lack of compliance with socks or stockings or pantyhose compression.

The symptoms of venous disease are not significant in the overweight patient, but several pathologies can be associated with varicose veins, including lymphatic, cellulitis or lipodystrophic and rheumatic. The clinical examination and the Doppler ultrasound will allow the precise anatomical and func- tional assessment of the deep and superficial veins. There is no major problem for ultrasound scanning of venous networks, even in cases of severe obesity.

 

Physiopathological reminder of venous return in case of overweight:

Overweight and obesity come with a number of mechanisms hindering return circulation
– The reduction of activity and especially walking: the obese has a particular gait using more hips than calves,

– The installation of osteoarthritis andosteo-ligament disorders aggravating inactivity, especially in the ankle and knee, and of course increased in the elderly,

– The sagging of the arch, hindering the communication between the superficial plantar network and the deep plantar network,

– Muscular hypotonia, especially the calf muscles, also increased in the elderly,

– The thickening of the adipose panniculus and the stretching of the venous network which induce physiological changes with decrease of the speed of the blood flow and increase of the blood pressure. Dilatations occur in the area of weakness of the vein and at the level of the valves: hence the appearance of varicose veins,

– Cardiorespiratory insufficiency, with in particular a more abdominal than thoracic breathing, element moreover to a bad venous return.

Management of overweight and obesity in venous insufficiency:

The ideal drug treatment for obesity does not exist. Non-pharmacological measures such as diets and regular physical exercise are therefore of interest. It is necessary to eat less, limit caloric intake between 800 and

 

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