Nautilus survey on chronic venous diseases

Aim. The large diffusion of venous disease (CVD) has been confirmed by several epidemiological studies in Europe and the USA. Since general practitioners (GPs) are the first segment of the population to evaluate for CVD, the Italian Project Nautilus (concerning vascular prevention) organized a monitoring campaign in 2009 with the aim of studying CVD using the CEAP classification criteria. Methods. More than 1000 GPs were included in the survey. The study produced anamnestic and clinical data on more than 10,000 patients with CVD divided into three age segments: ≤ 30 years; 31-60 years; > 60 years. Of these results, 83% were considered valid for a statistical evaluation. Results. The prevalent population in CVD includes adult and aging subjects; four out of five are women. The number of pregnancies is the first risk or predisposing factor in the adult population, and prolonged standing is the first cause in younger subjects. Excess weight and previous thromboses, either superficial (SVT) or deep (DVT), become more significant factors with advancing age and included, respectively, 58% and 44% of the study’s subjects over the age of 60. The most severe signs of CVD (edema, venous ulcers) show a significant progression in the aging segment of the population. Edema is present in 50% of the aging population, and inflammatory endothelial activation (swollen, heavy or painful legs) also increases with aging. Symptoms related to hemorrheological activation (including itching, nocturnal cramps) progress in parallel with increasing signs. A history of previous SVT or DVT episodes is the determining factor in more severe signs (CEAP: C4-C6) in more than 50% of the studied patients in comparison with only 20% of patients without a history for SVT or DVT. Diabetes is associated with more severe signs in 50% of patients. Conclusions. The Nautilus Survey of CVD indicates determining factors associated with the beginning and progression of CVD in three different age segments. These factors may be considered as clinically significant parameters for defining the clinical evolution of CVD. The observations are useful to evaluate the best preventive and treatment options on the basis of the most recent pathophysiological considerations.