Epidemiology, diagnosis and treatment of chronic venous disease
Project Leader Lena Blomgren
The aim of the project is to contribute to improved diagnosis and treatment for patients with chronic venous disease (CVD), such as venous ulcers and postthrombotic syndrome (PTS). Historically this group of patients has been given low priority despite the fact that CVD causes considerable suffering for the patients and high costs for society. The treatment of CVD has improved tremendously with new endovascular methods such as endovenous methods for varicose veins and stenting for PTS, but the optimal selection of patients for treatment and long term results are not fully known. Magnetic resonance imaging (MRI) is increasingly used for imaging proximal deep veins, but it´s role is not defined. Pletysmography is another interesting method for evaluating venous function. We don’t know yet why some people develop leg ulcers due to VV or PTS, thus it´s not possible to predict which patients will develop ulcers in the future. Different theories exist, such as activation of white blood cells and coagulation disorders with microthrombi.
The project takes place in a network of co-workers in hospitals and private clinics. In the project we study different aspects of CVD.
Our main hypothesis is that the majority of hard-to-heal leg ulcers can heal, and that many patients with venous claudication can be much improved, with modern vascular and endovascular treatment. Another hypothesis is that if risk factors for venous ulcer can be identified, new and recurrent ulcers can be prevented with active intervention.
The following subjects are studied:
- Reproducibility and variability of the CEAP-classification and guidelines when selecting CVD patients for treatment.
- Long term results after treatment of varicose veins with endovenous laser for venous ulcer, healing and risk factors for recurrence.
- The value of MRI and pletysmography before stenting for PTS.
- Long term results after stenting for PTS.
- Levels of markers for coagulation and activation of white blood cells in patients with different severity of CVD. Cooperation with group working with similar project with patients with arterial aneurysms (Joy Roy).
- A pilot study investigating the prevalence of vascular disease amongst patients with leg and foot ulcers in Uganda.
If we can select the right patient for varicose vein treatment or stenting for PTS, then more patients with CVD can improve their symptoms and more venous ulcers can be prevented and cured, and this in turn will improve quality of life and decrease the cost of care. If a significant number of patients in Uganda have a vascular cause for non-healing ulcers, this has implications for the planning of health care, training of surgeons, life-style interventions in the population etc.