Venous Disease: Epidemiology, Management and Delivery of Care - Tapa dura

Varicose veins are a very common problem. The precise aetiology of primary varicose veins remains unclear. It seems likely from the available evidence that inherited structural weakness combined with haemodynamic or microcirculatory abnormalities eventually lead to reduced vein wall elasticity, dilatation and the formation of varicosities. Increasing age, female gender, parity and occupation may all promote the development of varicose veins in susceptible individuals. Further clinical and experimental studies are necessary if the relative contribution of each of these factors is to be fully elucidated. References 1. Editorial. The treatment of varicose veins. Lancet 1975;ii:311. 2. Prerovsky I. Diseases of the veins. World Health Organisation, internal communication, MHO-PA 10964. 3. Weddell JM. Varicose veins: pilot study. Br J Surg 1969;23:179-186. 4. Hobsley M. Pathways in surgical management. 2nd ed. London: Edward Arnold, 1986. 5. Browse NL, Burnand KG, Lea Thomas M. Diseases of the veins. London: Edward Arnold, 1988. 6. Logan WPD, Brooke EM. The survey of sickness. Studies on medical and population subjects no. 12. London: General Register Office, 1957. 7. The committee on the Danish national morbidity survey. The sickness survey of Denmark. Copenhagen, 1960. 8. US Department of Health. Education and welfare: national health survey 1935-1936. Washington, DC, 1938. 9. The Department of National Health and Welfare and the Dominion Bureau of Statistics. Illness and health care in Canada. Canadian Sickness Survey 1950-1951. Ottawa, 1960.

Venous Disease highlights the increasing recognition of venous disease in terms of morbidity, impaired quality of life and health care costs. The epidemiology, pathogenesis, classification and health care costs of varicose veins and venous leg ulcers are analysed. Diagnostic tests of venous imaging and venous function are reviewed and related to clinical status. The full range of clinical management is covered, encompassing drug therapy, compression, sclerotherapy and surgery, including the new field of endoscopic subfascial perforator surgery. Issues in the delivery of care are addressed including the selection of patients for venous surgery, one-stop clinics, day care and the contributions of hospitals, community services and the private sector. Finally, improvement of outcomes for patients with varicose veins and chronic leg ulcers is also examined.