Approach to venous diseases in the elderly

Abstract

Incidence and severity of both deep vein thrombosis and chronic venous insufficiency are increased with age. Today, however, the significance of these diseases in the elderly patient population are still poorly comprehended. Although most patients have a history of previous treatment, chronic venous insufficiency is usually encountered in the advanced clinical stage. As a result, there is an increase in mobility restrictions, the need for assistance in daily activities and the risk of falls in elderly patients. The quality of life is negatively affected in patients. Age, immobilization and obesity are the main risk factors for the development of chronic venous insufficiency in the elderly. Patients present with complaints such as pain, edema, burning, bloating, weight sensation, restless leg syndrome, night cramps, varicosities, color change and open wound in the legs. In diagnostic procedures, color Doppler ultrasonography examination is used together with patient's staging as well as history and physical examination. Classification of "Clinical-Etiology-Anatomy-Pathology (CEAP)" is used in defining venous insufficiency patients. Among the leading differential diagnoses are congestive heart failure, renal failure, liver dysfunction, antihypertensive, non-steroidal anti-inflammatory and some antidiabetic medications and lymphedema and deep vein thrombosis. Patients underwent early diagnosis and long-term regular follow-up after appropriate therapeutic interventions reduce the risk of developing advanced complicated clinical conditions. The main components of treatment include patient education, mobilization, leg elevation, prevention of obesity, use of venous compression stockings, use of venoactive agents, and catheter-based/surgical interventions. Endovenous radiofrequency or laser ablation techniques and endovenous chemical ablation techniques in superficial venous insufficiency are preferential interventional modalities due to low morbidity risks in older age group of chronic superficial venous insufficiency patients. Foam sclerotherapy for superficial truncal varicosities can also be considered as an alternative for older age groups. In any treatment decision to be taken, the risk-benefit ratio, the patient's clinical status, the available treatment options as well as the patient-specific risks and the patient's expectation and decision should be the main determinant. It is important to remember that what is more important than the age of the patient is the patient's own physical condition and that the quality of life is improved.