Efficacy of compression and phlebotropic therapy varicose veins in pregnant women
https://doi.org/10.21518/akh2022-007
Abstract
Introduction. Pregnancy is the leading cause of varicose veins(VVs) in women. Therapeutic measures during pregnancy include the wearing of compression hosiery and the phlebotropic therapy.
Purpose. To evaluate the clinical effectiveness of graduated elastic compression and phlebotropic therapy in pregnant women with VVs.
Materials and methods. A total of 88 pregnant women were included, 30 of whom used compression stockings (group 1), 28 women received phlebotonics together with compression (group 2) and 30 were controls. VVs severity was determined using the Venous Clinical Severity Score (VCSS). Quality of life (QoL) was calculated using the Chronic Venous Insufficiency Questionnaire (CIVIQ-20). The calf circumference was measured with a measuring tape in an orthostatic position.
Results and discussion. At the end of the study there was a decrease in VCSS (p < 0.001 and p < 0.008) in both treatment groups, whereas the control group showed an increase in VCSS severity (p < 0.001). At the end of follow-up the QOL score in the treatment groups showed a tendency to improve while the control group showed a decrease in QOL. A bilateral decrease in tibial circumference (p < 0.001) was seen in groups 1 and 2 and the adjuvant phlebotropic treatment was found to be superior in controlling the oedema.
Conclusions. The combined use of elastic compression and phlebotonics is more effective in eliminating venous oedema in pregnant women with VVs.
About the Authors
V. Ya. KhryshchanovichBelarus
Vladimir Ya. Khryshchanovich, Dr. Sci. (Med.), Professor, Professor of the Department of General Surgery,
83, Dzerzhinsky Ave., Minsk, 220116
N. A. Rogovoy
Belarus
Nicolay A. Rogovoy, Cand. Sci. (Med.), Associate Professor of the Department of General Surgery,
83, Dzerzhinsky Ave., Minsk, 220116
N. Ya. Skobeleva
Belarus
Natalia Ya. Skobeleva, Postgraduate Student, Department of Obstetrics and Gynecology, 83, Dzerzhinsky Ave., Minsk, 220116;
Obstetrician-Gynecologist, Head of the Obstetric Department of Pregnancy Pathology, 16, Frantsisk Skorina St., Minsk, 220114
O. V. Krasko
Belarus
Olga V. Krasko, Cand. Sci. (Tech.), Associate Professor, Lead Researcher at the Bioinformatics Laboratory,
6, Surganova St., Minsk, 220012
References
1. Rabe E., Guex J.J., Puskas A., Scuderi A., Fernandez Quesada F. Epidemiology of chronic venous disorders in geographically diverse populations: results from the Vein Consult Program. Int Angiol. 2012;31(2):105–115. Available at: https://pubmed.ncbi.nlm.nih.gov/22466974/.
2. Barros-Junior N., Perez M.D.C.J., Amorim J.E., Miranda F. Pregnancy and lower limb varicose veins: prevalence and risk factors. J Vasc Bras. 2010;9(2):29–35. https://doi.org/10.1590/S1677-54492010000200004.
3. Robertson L.A., Evans C.J., Lee A.J., Allan P.L., Ruckley C.V., Fowkes F.G.R. Incidence and risk factors for venous reflux in the general population: Edinburgh Vein Study. Eur J Vasc Endovasc Surg. 2014;48(2):208–214. https://doi.org/10.1016/j.ejvs.2014.05.017.
4. Fukaya E., Flores A.M., Lindholm D., Gustafsson S., Zanetti D., Ingelsson E. et al. Clinical and genetic determinants of varicose veins. Circulation. 2018;138(25):2869–2880. https://doi.org/10.1161/CIRCULATIONAHA.118.035584.
5. Smyth R.M., Aflaifel N., Bamigboye A.A. Interventions for varicose veins and leg oedema in pregnancy. Cochrane Database Syst Rev. 2015;2015(10):CD001066. https://doi.org/10.1002/14651858.CD001066.pub3.
6. Saliba Júnior O.A., Rollo H.A., Saliba O., Sobreira M.L. Graduated compression stockings effects on chronic venous disease signs and symptoms during pregnancy. Phlebology. 2020;35:46–55. https://doi.org/10.1177/0268355519846740.
7. Kane E.V., Calderwood C., Dobbie R., Morris C., Roman E., Greer I.A. A population-based study of venous thrombosis in pregnancy in Scotland 1980–2005. Eur J Obst Gyne Repro Biol. 2013;169(2):223–229. https://doi.org/10.1016/j.ejogrb.2013.03.024.
8. Ivanov E.V., Nizamov F.H., Mihajlova A.V. The course of pregnancy and childbirth in women with varicose veins of the lower extremities. Meditsinskaya Nauka i Obrazovanie Urala. 2012;3(71):5–7. (In Russ.) Available at: https://elibrary.ru/item.asp?id=22584368.
9. Allegra C., Antignani P.L., Will K., Allaert F. Acceptance, compliance and effects of compression stockings on venous functional symptoms and quality oflife of Italian pregnant women. Int Angiol. 2014;33(4):357–364. Available at: https://pubmed.ncbi.nlm.nih.gov/25056167/.
10. Cornu-Thenard A., Boivin P. Chronic venous disease during pregnancy. Phlebolymphology. 2014;21(3):138–145. Available at: https://www.phlebolymphology.org/chronic-venous-disease-during-pregnancy/.
11. Tiwari A., Walsh S.R., Davies A.H., Tang T.Y. A need for evidence to guide treatment recommendation for women with chronic venous disease during childbearing years. Phlebology. 2020;35(8):548–549. https://doi.org/10.1177/0268355520916395.
12. Allaert F.A. Combination of Ruscus aculeatus extract, hesperidin methyl chalcone and ascorbic acid: a comprehensive review of their pharmacological and clinical effects and of the pathophysiology of chronic venous disease. Int Angiol. 2016;35(2):111–116. Available at: https://pubmed.ncbi.nlm.nih.gov/26928296/.
13. Nicolaides A., Kakkos S., Baekgaard N., Comerota A., de Maeseneer M. et al. Management of chronic venous disorders of the lower limbs. Guidelines According to Scientific Evidence. Part I. Int Angiol. 2018;37(3):181–254. https://doi.org/10.23736/S0392-9590.18.03999-8.
14. Ochalek K., Pacyga K., Curyło M., Frydrych-Szymonik A., Szygula Z. Risk factors related to lower limb edema, compression, and physical activity during pregnancy: a retrospective study. Lymphat Res Biol. 2017;15(2):166–171. https://doi.org/10.1089/lrb.2016.0038.
15. Eklof B., Rutherford R.B., Bergan J.J., Carpentier P.H., Gloviczki P., Kistner R.L. et al. Revision of the CEAP classification for chronic venous disorders: consensus statement. J Vasc Surg. 2004;40(6):1248–1252. https://doi.org/10.1016/j.jvs.2004.09.027.
16. ACOG Committee Opinion No. 650. Physical activity and exercise during pregnancy and the postpartum period. Obstet Gynecol. 2015;126(6):e135–142. https://doi.org/10.1097/AOG.0000000000001214.
17. Tsakiridis I., Bakaloudi D.R., Oikonomidou A.C., Dagklis T., Chourdakis M. Exercise during pregnancy: a comparative review of guidelines. J Perinat Med. 2020;48(6):519–525. https://doi.org/10.1515/jpm-2019-0419.
18. Rodríguez-Blanque R., Aguilar-Cordero M.J., Marín-Jiménez A.E., Menor-Rodríguez M.J., Montiel-Troya M., Sánchez-García J.C. Water exercise and quality oflife in pregnancy: a randomised clinical trial. Int J Environ Res Public Health. 2020;17(4):1288. https://doi.org/10.3390/ijerph17041288.
19. Passman M.A., McLafferty R.B., Lentz M.F., Nagre S.B., Iafrati M.D., Bohannon W.T. et al. Validation of Venous Clinical Severity Score (VCSS) with other venous severity assessment tools from the American Venous Forum, National Venous Screening Program. J Vasc Surg. 2011;54(6 Suppl):2S–9S. https://doi.org/10.1016/j.jvs.2011.05.117.
20. Launois R. A quality oflife tool kit in chronic venous disorders. Phlebolymphology. 2014;21(3):152–160. Available at: https://www.phlebolymphology.org/a-quality-of-life-tool-kit-in-chronic-venous-disorders/.
21. Coleridge-Smith P., Labropoulos N., Partsch H., Myers K., Nicolaides A., Cavezzi A. Duplex ultrasound investigation of the veins in chronic venous disease of the lower limbs--UIP consensus document. Part I. Basic principles. Eur J Vasc Endovasc Surg. 2006;31(1):83–92. https://doi.org/10.1016/j.ejvs.2005.07.019.
22. Urbanek T. The clinical efficacy of Ruscus Aesculatus extract: is there enough evidence to update the pharmacotherapy guidelines for chronic venous disease? Phlebological Review. 2017;25:75–80. https://doi.org/10.5114/pr.2017.70594.
23. Saliba-Júnior O.A., Rollo H.A., Saliba O., Sobreira M.L. Positive perception and efficacy of compression stockings for prevention oflower limb edema in pregnant women. J Vasc Bras. 2022;21:e20210101. https://doi.org/10.1590/1677-5449.210101.
24. Yanagisawa N., Koshiyama M., Watanabe Y., Sato S., Sakamoto S.I. A quantitative method to measure skin thickness inleg edema in pregnant women using B-Scan portable ultrasonography: a comparison between obese and non-obese women. Med Sci Monit. 2019;(25):1–9. https://doi.org/10.12659/MSM.911799.
25. Khryshchanovich V.Y., Rogovoy N.A., Skobeleva N.YA., Kras’ko O.V. Efficacy of graded elastic compression for varicose veins in pregnant women. Akusherstvo i Ginekologiya (Russian Federation). 2022;(7):50–59. (In Russ.) https://doi.org/10.18565/aig.2022.7.50-59.
26. Horev N.G., Beller A.V. Compression hosiery in the treatment of varicose veins of the lower extremities. Phlebology. 2012;6(3):57–61. (In Russ.) Available at: https://www.mediasphera.ru/issues/flebologiya/2012/3/031997-69762012311.
27. Adamczyk A., Krug M., Schnabl S., Häfner H.M. Compression therapy during pregnancy: bane or boon? Phlebologie. 2013;42(6):301–307. https://doi.org/10.12687/phleb2165-6-2013.
28. Thaler E., Huch R., Huch A., Zimmermann R. Compression stockings prophylaxis of emergent varicose veins in pregnancy: a prospective randomised controlled study. Swiss Med Wkly. 2001;131(45–46):659–662. https://doi.org/10.4414/smw.2001.09805.
29. Testa S., Passamonti S.M., Paoletti O., Bucciarelli P., Ronca E., Riccardi A. et al. The “Pregnancy Health-care Program” for the prevention of venous thromboembolism in pregnancy. Intern Emerg Med. 2015;10(2):129–134. https://doi.org/10.1007/s11739-014-1111-6.
30. Karsanji D.J., Bates S.M., Skeith L. The risk and prevention of venous thromboembolism in the pregnant traveller. J Travel Med. 2020;27(2):taz091. https://doi.org/10.1093/jtm/taz091.
31. Vandy F., Wakefield T.W. Varicose veins: evaluating modern treatments, with emphasis on powered phlebectomy for branch varicosities. Interv Cardiol. 2012;4(5):527–536. https://doi.org/10.2217/ica.12.48.
32. Lohr J.M., Bush R.L. Venous disease in women: epidemiology, manifestations, and treatment. J Vasc Surg. 2013;57(4 Supl.):37S-45S. https://doi.org/10.1016/j.jvs.2012.10.121.
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For citations:
Khryshchanovich V.Ya., Rogovoy N.A., Skobeleva N.Ya., Krasko O.V. Efficacy of compression and phlebotropic therapy varicose veins in pregnant women. Ambulatornaya khirurgiya = Ambulatory Surgery (Russia). 2023;20(1):94-104. (In Russ.) https://doi.org/10.21518/akh2022-007

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