Davies Huw Ob, Popplewell Matthew, Singhal Rishi, Smith Neil, Bradbury Andrew W
1 University Department of Vascular Surgery, Heartlands Hospital, Birmingham, UK.
2 Department of Upper Gastro-Intestinal and Bariatric Surgery, Heartlands Hospital, Birmingham, UK.
Phlebology. 2017 May;32(4):227-233. doi: 10.1177/0268355516649333. Epub 2016 May 13.
Introduction Lower limb venous disease affects up to one half, and obesity up to one quarter, of the adult population. Many people are therefore affected by, and present to health services for the treatment of both conditions. This article reviews the available evidence of pathophysiological and clinical relationship between obesity and varicose veins, chronic venous insufficiency and ulceration and deep vein thrombosis. Methods A literature search of PubMed and Cochrane libraries was performed in accordance with PRISMA statement from 1946 to 2015, with further article identification from following cited references for articles examining the relationship between obesity and venous disease. Search terms included obesity, overweight, thrombosis, varicose veins, CEAP, chronic venous insufficiency, treatment, endovenous, endothermal, sclerotherapy, bariatric surgery and deep vein thrombosis. Results The proportion of the population suffering from lower limb venous disease and obesity is increasing. Obesity is an important risk factor for all types of lower limb venous disease, and obese patients with lower limb venous disease are more likely to be symptomatic as a result of their lower limb venous disease. The clinical diagnosis, investigation, imaging and treatment of lower limb venous disease in obese people present a number of challenges. The evidence base underpinning medical, surgical and endovenous management of lower limb venous disease in obese people is limited and such treatment may be associated with worse outcomes and increased risks when compared to patients with a normal body mass index. Conclusion Lower limb venous disease and obesity are both increasingly common. As such, phlebologists will be treating ever greater numbers of obese patients with lower limb venous disease, and clinicians in many other specialties are going to be treating a wide range of obesity-related health problems in people with or at risk of lower limb venous disease. Unfortunately, obese people have been specifically excluded from many, if not most, of the pivotal studies. As such, many basic questions remain unanswered and there is an urgent need for research in this challenging and increasingly prevalent patient group.
引言 下肢静脉疾病影响多达一半的成年人口，肥胖影响多达四分之一的成年人口。因此，许多人同时受这两种疾病影响，并前往医疗服务机构寻求治疗。本文综述了肥胖与静脉曲张、慢性静脉功能不全、溃疡以及深静脉血栓形成之间病理生理和临床关系的现有证据。方法 根据PRISMA声明，对1946年至2015年期间的PubMed和Cochrane图书馆进行文献检索，并从随后引用的参考文献中进一步识别研究肥胖与静脉疾病关系的文章。检索词包括肥胖、超重、血栓形成、静脉曲张、CEAP、慢性静脉功能不全、治疗、腔内、内热、硬化疗法、减肥手术和深静脉血栓形成。结果 患有下肢静脉疾病和肥胖的人口比例正在增加。肥胖是所有类型下肢静脉疾病的重要危险因素，患有下肢静脉疾病的肥胖患者因其下肢静脉疾病更易出现症状。肥胖人群下肢静脉疾病的临床诊断、检查、影像学检查和治疗存在诸多挑战。支持肥胖人群下肢静脉疾病药物、手术和腔内治疗的证据基础有限，与体重指数正常的患者相比，此类治疗可能与更差的结果和更高的风险相关。结论 下肢静脉疾病和肥胖都越来越常见。因此，静脉病学家将治疗越来越多患有下肢静脉疾病的肥胖患者，许多其他专科的临床医生也将治疗患有下肢静脉疾病或有下肢静脉疾病风险的人群中各种与肥胖相关的健康问题。不幸的是，许多关键研究（如果不是大多数的话）都特意将肥胖人群排除在外。因此，许多基本问题仍未得到解答，迫切需要对这个具有挑战性且日益普遍的患者群体进行研究。
