Severe chronic venous insufficiency

Magnitude of the problem and consequences

Susan Tsai, Anna Dubovoy, Reid Wainess, Gilbert R. Upchurch, Thomas W. Wakefield, Peter K. Henke

Research output: Contribution to journalArticle

Abstract

The aim of this study was to characterize patients requiring hospitalization for severe chronic venous insufficiency (CVI) at the local and national levels and to analyze factors related to primary amputation. An administrative database (Nationwide Inpatient Sample, 1988-2000) and a single institution (1992-2000) were reviewed using the International Classification of Diseases, 9th ed., Clinical Modification, codes for CVI, excluding phlegmasia and concomitant peripheral vascular occlusive disease codes. Demographics, clinical course, and outcomes were assessed. Descriptive, univariate, and multivariate statistical analyses were used; p <0.05 was considered significant. Nationally, CVI occurred with a mean incidence of 92/100,000 admissions, of which 55% were women, having a mean age of 65 years and a median length of stay of 7 days. Mean hospital charges were $13,900 and did not change significantly over time. Acute deep vein thrombosis affected 1.3%, amputation was performed in 1.2%, and in-hospital mortality was 1.6% The local cohort included 67 patients with a mean age of 51 years; a majority were men (60%), and 85% were C6 (of Clinical-Etiologic-Anatomic-Pathophysiology [CEAP]). Patients averaged 23 clinic visits and a median of one hospitalization for CVI care over a 44-month follow-up. Twelve patients (18%) underwent a CVI-related amputation (one transmetatarsal amputation, nine below-knee amputations, and two above-knee amputations). They had fourfold more CVI-related hospitalizations, greater preoperative chronic narcotic use than nonamputee patients (85% vs. 58%), but less ongoing wound care needs (25% vs. 89%) (all p values <0.05). However, no significant difference in long-term mortality, number of clinic visits, duration of symptoms, antibiotic courses, or prior venous-related surgeries was found. In those with amputation, ambulatory status was maintained in 75% at 15-month follow-up. The physiological and economic costs of severe CVI are significant and have not decreased over more than a decade. Amputation for CVI-related nonhealing wounds has a reasonable outcome. Future therapy must focus on prevention of CVI sequelae.

Original languageEnglish (US)
Pages (from-to)705-711
Number of pages7
JournalAnnals of Vascular Surgery
Volume19
Issue number5
DOIs
StatePublished - Sep 2005
Externally publishedYes

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Venous Insufficiency
Amputation
Hospitalization
Ambulatory Care
Knee
Hospital Charges
Peripheral Vascular Diseases
Narcotics
Wounds and Injuries
International Classification of Diseases
Hospital Mortality
Venous Thrombosis
Statistical Factor Analysis
Inpatients
Length of Stay
Multivariate Analysis
Economics
Demography
Databases
Anti-Bacterial Agents

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Tsai, S., Dubovoy, A., Wainess, R., Upchurch, G. R., Wakefield, T. W., & Henke, P. K. (2005). Severe chronic venous insufficiency: Magnitude of the problem and consequences. Annals of Vascular Surgery, 19(5), 705-711. https://doi.org/10.1007/s10016-005-5425-8

Severe chronic venous insufficiency : Magnitude of the problem and consequences. / Tsai, Susan; Dubovoy, Anna; Wainess, Reid; Upchurch, Gilbert R.; Wakefield, Thomas W.; Henke, Peter K.

In: Annals of Vascular Surgery, Vol. 19, No. 5, 09.2005, p. 705-711.

Research output: Contribution to journalArticle

Tsai, S, Dubovoy, A, Wainess, R, Upchurch, GR, Wakefield, TW & Henke, PK 2005, 'Severe chronic venous insufficiency: Magnitude of the problem and consequences', Annals of Vascular Surgery, vol. 19, no. 5, pp. 705-711. https://doi.org/10.1007/s10016-005-5425-8
Tsai, Susan ; Dubovoy, Anna ; Wainess, Reid ; Upchurch, Gilbert R. ; Wakefield, Thomas W. ; Henke, Peter K. / Severe chronic venous insufficiency : Magnitude of the problem and consequences. In: Annals of Vascular Surgery. 2005 ; Vol. 19, No. 5. pp. 705-711.
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