Division of Vascular Surgery, Department of Surgery, University of Maryland, Baltimore, Md; Vascular Service, Veterans Affairs Medical Center, Baltimore, Md.
Division of Vascular Surgery, Department of Surgery, University of Maryland, Baltimore, Md.
J Vasc Surg Venous Lymphat Disord. 2020 Mar;8(2):224-230. doi: 10.1016/j.jvsv.2019.10.017.
Health care workers spend extended times standing and walking short distances and are at risk for development of chronic venous insufficiency (CVI). We conducted a hospital-wide venous screening program designed to measure the prevalence of and risk factors for clinical manifestations of CVI and ultrasound evidence of venous reflux or obstruction in health care workers. We also determined their risk for deep venous thrombosis (DVT).
Free venous screening and education were offered to all hospital employees; the program started in April 2016, and results are presented from the first year. Demographics, medical history, and use of compression stockings were recorded. A physical examination determined the clinical class of the Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) classification for clinical disease, and an ultrasound test evaluated for reflux or obstruction in the common femoral vein, popliteal vein, and saphenofemoral junction. The Caprini score was recorded to evaluate risk of DVT. Descriptive statistics were reported, and logistic regression was used for multivariate analysis of risk factors.
We enrolled 636 participants (1272 legs); 93.0% were women. The median age was 42 years (interquartile range, 31-52 years), mean body mass index was 29.2 ± 6.6 kg/m, and most participants were white (49.1%) or African American (39.5%); 18% reported having hypertension, 7.1% had diabetes, and 6.1% were current smokers. The majority reported occasional leg pain (72.7%) and evening leg swelling (42.3%). Only 2.7% used daily compression stockings. Clinical evidence of CVI was present in at least one leg in 69.1% (C1, 49.0%; C2, 17.7%; C3, 1.9%; C4, 0.2%; C5, 0.2%). Venous reflux was present in at least one leg in 82.1%; obstruction was rare (0.2%). Reflux in either the superficial (saphenofemoral junction) or the deep (femoral or popliteal) venous system was present in the majority (71.0%) of patients with CVI (clinical class ≥C1). Reflux and white race were risk factors for clinical disease; clinical disease, age, female sex, and white race were risk factors for reflux. On the basis of the Caprini score, 14.1% of participants were in the highest risk category for DVT when experiencing a high-risk situation (including 2.2% with history of DVT).
Prevalence of clinical CVI and venous reflux is high among health care workers despite a low frequency of cardiovascular comorbidities. Increased awareness about CVI and DVT and preventive strategies for venous disease must be instituted in this high-risk cohort.
医护人员长时间站立和短距离行走，因此存在发展慢性静脉功能不全（CVI）的风险。我们开展了一项全院范围的静脉筛查计划，旨在测量医护人员 CVI 的临床表现和静脉反流或阻塞的超声证据的流行程度和相关风险因素，并确定他们发生深静脉血栓（DVT）的风险。
为所有医院员工提供免费的静脉筛查和教育；该计划于 2016 年 4 月开始，现将第一年的结果呈现出来。记录人口统计学、病史和使用压缩袜的情况。体格检查确定了临床疾病的临床、病因、解剖和病理生理学（CEAP）分类的临床疾病分级，超声检查评估股总静脉、腘静脉和隐股静脉连接处的反流或阻塞情况。记录卡皮拉尼评分以评估 DVT 的风险。报告描述性统计数据，并使用逻辑回归进行多因素分析风险因素。
我们共纳入 636 名参与者（1272 条腿）；93.0%为女性。中位年龄为 42 岁（四分位间距 31-52 岁），平均体重指数为 29.2±6.6kg/m，大多数参与者为白人（49.1%）或非裔美国人（39.5%）；18%报告有高血压，7.1%有糖尿病，6.1%为当前吸烟者。大多数参与者报告偶尔腿部疼痛（72.7%）和晚上腿部肿胀（42.3%）。只有 2.7%的人每天穿压缩袜。至少一条腿有 CVI 的临床证据的占 69.1%（C1，49.0%；C2，17.7%；C3，1.9%；C4，0.2%；C5，0.2%）。至少一条腿有静脉反流的占 82.1%；阻塞很少见（0.2%）。有 CVI（临床分级≥C1）的患者中，大多数（71.0%）在浅静脉（隐股静脉连接处）或深静脉（股静脉或腘静脉）系统中存在反流。反流和白色人种是临床疾病的风险因素；临床疾病、年龄、女性和白色人种是反流的风险因素。根据卡皮拉尼评分，当经历高危情况时（包括 2.2%有 DVT 病史的患者），14.1%的参与者处于 DVT 的最高风险类别。必须在这个高危人群中提高对 CVI 和 DVT 的认识，并制定静脉疾病的预防策略。
