Medical prevention and management of varicose vein disease during pregnancy

Khryshchanovich V.Ya.; Skobeleva N.Ya.

doi:https://doi.org/10.17116/rosakush20212104127

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Abstract:

Chronic venous disease of the lower limbs represents one of the most frequent medical conditions that could be observed in the general population. Pregnancy is one of the major predisposing factors for developing venous insufficiency due to an enlarged gravid uterus that obstructs pelvic venous outflow and an increase in hormone secretion, which weakens the vein wall. A clinical examination and Doppler ultrasound evaluation are used to diagnose venous insufficiency of the lower limbs during pregnancy; these clinical findings can vary from insignificant telangiectasias to severe varicose veins and skin damage. Treatment is essentially non-interventional based on: the wearing of medical compression stockings, adapted to the severity of the venous disease, sufficient elevation of the lower limbs when in the supine position, and the prescription of venous-active agents in case of «venous» symptoms. The expediency of performing sclerotherapy, as well as other elective surgical interventions during the gestation period is questionable. Elimination of primary varicose vein disease before pregnancy is the most preferable option. This article reviews and discusses modern views on the pathogenesis of varicose veins during gestation, and the current guidelines for the treatment of chronic venous insufficiency during pregnancy and the prevention of thrombotic and other complications.

Keywords:

varicose vein disease

prevention

management

pregnancy

Authors:

Khryshchanovich V.Ya.

Belarusian State Medical University

Skobeleva N.Ya.

Belarussian State Medical University;
Regional Clinical Maternity Hospital

Received:

14.12.2020

Accepted:

20.01.2021

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References:

Wittens C, Davies AH, Bækgaard N, Broholm R, Cavezzi A, Chastanet S, de Wolf M, Eggen C, Giannoukas A, Gohel M, Kakkos S, Lawson J, Noppeney T, Onida S, Pittaluga P, Thomis S, Toonder I, Vuylsteke M, Esvs Guidelines Committee, Kolh P, de Borst GJ, Chakfé N, Debus S, Hinchliffe R, Koncar I, Lindholt J, de Ceniga MV, Vermassen F, Verzini F, Document Reviewers, De Maeseneer MG, Blomgren L, Hartung O, Kalodiki E, Korten E, Lugli M, Naylor R, Nicolini P, Rosales A. Editor’s choice — management of chronic venous disease: clinical practice guidelines of the European Society for vascular surgery (ESVS). Eur J Vasc Endovasc Surg. 2015;49:6:678-737. https://doi.org/10.1016/j.ejvs.2015.02.007
Diagnostics and treatment of chronic venous disease: guidelines of Russian Phlebological Association. Flebologiya. 2018;12:3:146-240. (In Russ.). https://doi.org/10.17116/flebo20187031146
Rabe E, Guex JJ, Puskas A, Scuderi A, Fernandez Quesada F; VCP Coordinators. Epidemiology of chronic venous disorders in geographically diverse populations: results from the Vein Consult Program. Int Angiol. 2012;31:2:105-115.
Beebe-Dimmer JL, Pfeifer JR, Engle JS, Schottenfeld D. The epidemiology of chronic venous insufficiency and varicose veins. Ann Epidemiol. 2005;15:3:175-184. https://doi.org/10.1016/j.annepidem.2004.05.015
Smyth RM, Aflaifel N, Bamigboye AA. 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
Barros-Junior N, Perez MDCJ, Amorim JE, Miranda F. Pregnancy and lower limb varicose veins: prevalence and risk factors. J Vasc Bras. 2010;9:2:29-35.
Saliba OAJ, Rollo HA, Saliba O, Sobreira ML. Compression stocking prevents increased venous retrograde flow time in the lower limbs of pregnant women. Phlebology. 2020;35:10:784-791. https://doi.org/10.1177/0268355520939371
Matić M, Matić A, Gajinov Z, Golušin Z, Prćić S, Jeremić B. Major risk factors for chronic venous disease development in women: is childbirth among them? Women Health. 2019;59:10:1118-1127. https://doi.org/10.1080/03630242.2019.1590492
Engelhorn CA, Cassou MF, Engelhorn AL, Salles-Cunha SX. Does the number of pregnancies affect patterns of great saphenous vein reflux in women with varicose veins? Phlebology. 2010;25:4:190-195. https://doi.org/10.1258/phleb.2009.009057
Ropacka-Lesiak M, Kasperczak J, Breborowicz GH. Risk factors for the development of venous insufficiency of the lower limbs during pregnancy — part 1. Ginekol Pol. 2012;83:12:939-942. (In Polish.).
Nüllen H, Noppeney T. Diagnosis and treatment of varicose veins. Part 1: definition, epidemiology, etiology, classification, clinical aspects, diagnostic and indications. Chirurg. 2010;81:11:1035-1044; quiz 1045. https://doi.org/10.1007/s00104-009-1865-y
Belcaro G, Dugall M, Luzzi R, Ippolito E, Cesarone MR. Postpartum varicose veins: Supplementation with pycnogenol or elastic compression — 12-month follow-up. Int J Angiol. 2017;26:1:12-19. https://doi.org/10.1055/s-0033-1363784
Bihari I, Tornoci L, Bihari P. Epidemiological study on varicose veins in Budapest. Phlebology. 2012;27:2:77-81. https://doi.org/10.1258/phleb.2011.010063
Zubilewicz R, Chmiel-Perzynska I, Derkacz M, Schabowski J. The women’s span of knowledge about chronic venous disease. Family Med Primary Care Rev. 2009;11:4:919-922.
Ivanov EV, Nizamov FKh, Mikhailova AV. Pregnancy and delivery in women with lower limb varicosity. Meditsinskaya nauka i obrazovanie Urala. 2012;3:5-7. (In Russ.).
Ismail L, Normahani P, Standfield NJ, Jaffer U. A systematic review and meta-analysis of the risk for development of varicose veins in women with a history of pregnancy. J Vasc Surg Venous Lymphat Disord. 2016;4:4:518-524. https://doi.org/10.1016/j.jvsv.2016.06.003
Horecka A, Hordyjewska A, Biernacka J, Dąbrowski W, Zubilewicz T, Malec A, Musik I, Kurzepa J. Intense remodeling of extracellular matrix within the varicose vein: the role of gelatinases and vascular endothelial growth factor. Ir J Med Sci. 2020 Jun 27. Online ahead of print. https://doi.org/10.1007/s11845-020-02289-1
Cordts PR, Gawley TS. Anatomic and physiologic changes in lower extremity venous hemodynamics associated with pregnancy. J Vasc Surg. 1996;24:5:763-767. https://doi.org/10.1016/s0741-5214(96)70010-1
Mozheiko LF, Tikhonovich EV, Perepelitsa SI. Aspects of pregnancy and labor in patients suffering from chronic venous insufficiency. Reproduktivnoye zdorov’e. Vostochnaya Evropa. 2016;6:4:519-525. (In Russ.).
Stryuk RI, Berns SA, Filippova MP, Brytkova YaV, Borisov IV, Barkova EL, Gomova TA, Kozina EA, Nagirnyak OA. Cardiovascular disease and associated comorbid conditions as determinants of adverse perinatal outcomes in pregnancy — an analysis of the results of the register of pregnant BEREG. Terapevticheskii arkhiv. 2018;90:1:9-16. (In Russ.).
Lurie F, Passman M, Meisner M, Dalsing M, Masuda E, Welch H, Bush RL, Blebea J, Carpentier PH, De Maeseneer M, Gasparis A, Labropoulos N, Marston WA, Rafetto J, Santiago F, Shortell C, Uhl JF, Urbanek T, van Rij A, Eklof B, Gloviczki P, Kistner R, Lawrence P, Moneta G, Padberg F, Perrin M, Wakefield T. The 2020 Update of the CEAP Classification System and Reporting Standards. J Vasc Surg Venous Lymphat Disord. 2020;8:3:342-352. https://doi.org/10.1016/j.jvsv.2019.12.075
Petrov VV, Novikov KV, Abashin VG. About use of phlebotonic drugs at conduction of pregnant women with varicose illness of veins of the bottom extremities. Obzory po klinicheskoi farmakologii i lekarstvennoi terapii. 2011;9:1:83-84. (In Russ.).
O’Connor DJ, Scher LA, Gargiulo NJ III, Jang J, Suggs WD, Lipsitz EC. Incidence and characteristics of venous thromboembolic disease during pregnancy and the postnatal period: a contemporary series. Ann Vasc Surg. 2011;25:1:9-14. https://doi.org/10.1016/j.avsg.2010.04.003
James AH, Jamison MG, Brancazio LR, Myers ER. Venous thromboembolism during pregnancy and the postpartum period: Incidence, risk factors, and mortality. Am J Obstet Gynecol. 2006;194:5:1311-1315. https://doi.org/10.1016/j.ajog.2005.11.008
Lussana F, Coppens M, Cattaneo M, Middeldorp S. Pregnancy-related venous thromboembolism: risk and the effect of thromboprophylaxis. Thromb Res. 2012;129:6:673-680. https://doi.org/10.1016/j.thromres.2012.01.017
Nguessan KL, Mian DB, Aissi GA, Oussou C, Boni S. Spontaneous rupture of uterine varices in third trimester pregnancy: an unexpected cause of hemoperitoneum. A case report and literature review. Clin Exp Obstet Gynecol. 2013;40:1:175-177.
Bremme K, Lundgren Hinnerdal S, Hallström Sjöquist S, Chaireti R. Risk factors and obstetric outcomes in pregnancies complicated by pelvic vein thrombosis, and in the subsequent pregnancy. Thromb Res. 2018;168:145-147. https://doi.org/10.1016/j.thromres.2018.06.023
Gavrilov SG, Vasiliev A, Moskalenko Y, Mishakina N. Diagnostic value of pelvic venography in female patients with pelvic varicose veins and vulvar varicosities. Int Angiol. 2020;39:6:452-460. https://doi.org/10.23736/S0392-9590.20.04402-8
Vuylsteke ME, Thomis S, Guillaume G, Modliszewski ML, Weides N, Staelens I. Epidemiological study on chronic venous disease in Belgium and Luxembourg: prevalence, risk factors, and symptomatology. Eur J Vasc Endovasc Surg. 2015;49:4:432-439. https://doi.org/10.1016/j.ejvs.2014.12.031
Darvall KA, Bate GR, Adam DJ, Bradbury AW. Generic health-related quality of life is significantly worse in varicose vein patients with lower limb symptoms independent of CEAP clinical grade. Eur J Vasc Endovasc Surg. 2012;44:3:341-344. https://doi.org/10.1016/j.ejvs.2012.06.022
National Clinical Guideline Centre (UK). Varicose veins in the legs: the diagnosis and management of varicose veins. London: National Institute for Health and Care Excellence (UK); 2013; Jul.
Schardt C, Adams MB, Owens T, Keitz S, Fontelo P. Utilization of the PICO framework to improve searching PubMed for clinical questions. BMC Med Inform Decis Mak. 2007;7:1:16. PMid:17573961. https://doi.org/10.1186/1472-6947-7-16
Sahoo MR, Misra L, Deshpande S, Mohanty SK, Mohanty SK. Subfascial endoscopic perforator surgery: A safe and novel minimal invasive procedure in treating varicose veins in 2nd trimester of pregnancy for below knee perforator incompetence. J Minim Access Surg. 2018;14:3:208-212. https://doi.org/10.4103/jmas.JMAS_107_17
Tsukanov YuT, Kropmayer KP, Tsukanov AYu, Beznoshchenko GB. Chronic venous diseases of the lower extremities and small pelvis in pregnant women and blood flow in the maternal-fetoplacental system. Flebologiya. 2012;1:20-27. (In Russ.).
Segiet OA, Brzozowa M, Piecuch A, Dudek D, Reichman-Warmusz E, Wojnicz R. Biomolecular mechanisms in varicose veins development. Ann Vasc Surg. 2015;29:2:377-384. https://doi.org/10.1016/j.avsg.2014.10.009
Asbeutah AM, Al-Azemi M, Al-Sarhan S, Almajran A, Asfar SK. Changes in the diameter and valve closure time of leg veins in primigravida women during pregnancy. J Vasc Surg Venous Lymphat Disord. 2015;3:2:147-153. https://doi.org/10.1016/j.jvsv.2014.09.005
Panicker VV, Riyaz N, Balachandran PK. A clinical study of cutaneous changes in pregnancy. J Epidemiol Glob Health. 2017;7:1:63-70. https://doi.org/10.1016/j.jegh.2016.10.002
Tyler KH. Physiological skin changes during pregnancy. Clin Obstet Gynecol. 2015;58:1:119-124. https://doi.org/10.1097/GRF.0000000000000077
Ponnapula P, Boberg JS. Lower extremity changes experienced during pregnancy. J Foot Ankle Surg. 2010;49:5:452-458. https://doi.org/10.1053/j.jfas.2010.06.018
Furuta N, Kondoh E, Yamada S, Kawasaki K, Ueda A, Mogami H, Konishi I. Vaginal delivery in the presence of huge vulvar varicosities: a case report with MRI evaluation. Eur J Obstet Gynecol Reprod Biol. 2013;167:2:127-131. https://doi.org/10.1016/j.ejogrb.2012.11.024
Pratilas GC, Dinas K. Severe vulvovaginal varicosities in pregnancy. N Engl J Med. 2018;378:22:2123. https://doi.org/10.1056/NEJMicm1715053
Taylor J, Hicks CW, Heller JA. The hemodynamic effects of pregnancy on the lower extremity venous system. J Vasc Surg Venous Lymphat Disord. 2018;6:2:246-255. https://doi.org/10.1016/j.jvsv.2017.08.001
Galambosi PJ, Gissler M, Kaaja RJ, Ulander VM. Incidence and risk factors of venous thromboembolism during postpartum period: a population-based cohort study. Acta Obstet Gynecol Scand. 2017;96:7:852-861. https://doi.org/10.1111/aogs.13137
Hosny M, Maged AM, Reda A, Abdelmeged A, Hassan H, Kamal M. Obstetric venous thromboembolism: a one-year prospective study in a tertiary hospital in Egypt. J Matern Fetal Neonatal Med. 2020;16:1-6. https://doi.org/10.1080/14767058.2020.1793316
Yasafova NN, Momot KA, Bublikov DS, Levkina AK. Risk factors for acute venous thrombosis in women of reproductive age. Akusherstvo i ginekologiya Sankt-Peterburga. 2018;3-4:14-19. (In Russ.).
Timokhina EV, Zenin VI. The course of pregnancy, labour and the postpartum period after surgical treatment for lower extremity vein thrombophlebitis. Voprosy ginekologii. akusherstva i perinatologii. 2015;14:3:28-32. (In Russ.).
Labropoulos N. How does chronic venous disease progress from the first symptoms to the advanced stages? A Review. Adv Ther. 2019;36(suppl 1):13-19. https://doi.org/10.1007/s12325-019-0885-3
Heller JA, Evans NS. Varicose veins. Vasc Med. 2015;20:1:88-90. https://doi.org/10.1177/1358863X14566224
Pavlov OG. Combined parents’ somatic pathology and their daughters’ reproductive function. Vestnik novykh meditsinskikh tekhnologii. 2011;18:3:248-250. (In Russ.).
Styazhkina SN, Chernenkova ML, Vinokhodova EM, Voronchikhina EYu, Tronina KA. Currency of the problem dysplasia of connective tissue in gynecology and obstetrics. Uspekhi sovremennogo estestvoznaniya. 2014;9:21-23. (In Russ.).
Beznoshchenko GB, Kravchenko EN, Tsukanov YuT, Kropmaer KP, Tsygankova OYu. Varicose veins in pregnant women: Specific features of a gestational period, phlebohemodynamics of the small pelvis and lower limbs. Rossiiskii vestnik akushera-ginekologa. 2016;3:4-8. (In Russ.). https://doi.org/10.17116/rosakush20161634-8
Verma SB. Varicosities of vulva (vulvar varices): a seldom seen entity in dermatologic practice. Int J Dermatol. 2012;51:1:123-124. https://doi.org/10.1111/j.1365-4632.2010.04498.x
Atkins E, Mughal NA, Place F, Coughlin PA. Varicose veins in primary care. BMJ. 2020;370:m2509. https://doi.org/10.1136/bmj.m2509
Hall H, Lauche R, Adams J, Steel A, Broom A, Sibbritt D. Healthcare utilisation of pregnant women who experience sciatica, leg cramps and/or varicose veins: A cross-sectional survey of 1835 pregnant women. Women Birth. 2016;29:1:35-40. https://doi.org/10.1016/j.wombi.2015.07.184
Bolz M, Körber S, Reimer T, Buchmann J, Schober HC, Briese V. The treatment of illnesses arising in pregnancy. Dtsch Arztebl Int. 2017;114:37:616-626. https://doi.org/10.3238/arztebl.2017.0616
Nicolaides A, Kakkos S, Baekgaard N, Comerota A, de Maeseneer M, Eklof B, Giannoukas AD, Lugli M, Maleti O, Myers K, Nelzén O, Partsch H, Perrin M. Management of chronic venous disorders of the lower limbs. Guidelines According to Scientific Evidence. Part I. Int Angiol. 2018;37:181-254. https://doi.org/10.23736/S0392-9590.18.03999-8
Marsden G, Perry M, Kelley K, Davies AH; Guideline Development Group. Diagnosis and management of varicose veins in the legs: summary of NICE guidance. BMJ. 2013;347:f4279. https://doi.org/10.1136/bmj.f4279
Koval SD, Medved’ VI, Benyuk VA, Kurochka VV. Optimization of gestational varicose illness treatment. Reproduktivnoe zdorov’e. Vostochnaya Evropa. 2015;3:39:8-12. (In Russ.).
Novikov BN. Varicose vein disease and pregnancy. RMZh. 2011;19:1:18-21. (In Russ.).
Martinez-Zapata MJ, Vernooij RW, Uriona Tuma SM, Stein AT, Moreno RM, Vargas E, Capellà D, Bonfill Cosp X. Phlebotonics for venous insufficiency. Cochrane Database Syst Rev. 2016;4:4:CD003229. https://doi.org/10.1002/14651858.CD003229.pub3
Porembskaya OYa, Kosenko IM. Pharmacotherapy of chronic venous disease — how to choose appropriate venoactive drug? Flebologiya. 2018;3:123-132. (In Russ.). https://doi.org/10.17116/flebo2018123123
Jain BK, Choudhary D. Surgical intervention for varicose veins during pregnancy: Is it sensible? J Minim Access Surg. 2019;15:3:277-278. https://doi.org/10.4103/jmas.JMAS_197_18
Nicolaides A, Kakkos S, Eklof B, Perrin M, Nelzen O, Neglen P, Partsch H, Rybak Z. Management of chronic venous disorders of the lower limbs — guidelines according to scientific evidence. Int Angiol. 2014;33:2:87-208.
Rabe E, Breu FX, Cavezzi A, Coleridge Smith P, Frullini A, Gillet JL, Guex JJ, Hamel-Desnos C, Kern P, Partsch B, Ramelet AA, Tessari L, Pannier F; Guideline Group. European guidelines for sclerotherapy in chronic venous disorders. Phlebology. 2014;29:6:338-354. https://doi.org/10.1177/0268355513483280
Reich-Schupke S, Leiste A, Moritz R, Altmeyer P, Stücker M. Sclerotherapy in an undetected pregnancy — a catastrophe? Vasa. 2012;41:4:243-247. https://doi.org/10.1024/0301-1526/a000199
Kalodiki E, Stvrtinova V, Allegra C, Andreozzi G, Antignani P-L, Avram R, Brkljacic B, Cadariou F, Dzsinich C, Fareed J, Gaspar L, Geroulakos G, Jawien A, Kozak M, Lattimer CR, Minar E, Partsch H, Passariello F, Patel M, Pécsvárady Z, Poredos P, Roztocil K, Scuderi A, Sparovec M, Szostek M, Skorski M. Superficial vein thrombosis: a consensus statement. Int Angiol. 2012;31:3:203-216.
Khryshchanovich VYa, Klimchuk IP. Retrospective analysis of deep vein thrombosis incidence in patients with superficial vein thrombosis of the lower extremities. Khirurgiya. Vostochnaya Evropa. 2014;1:66-74. (In Russ.).