The presentation and clinical severity grading in management of chronic venous disease at Kenyatta national hospital.

Abstract

Chronic venous disease (CVD) describes a range of disorders usually of the lower limbs characterized by venous hypertension. Mild and moderate forms manifest as telangiectasia, reticular veins or varicose veins while severe forms present with skin changes or venous ulcers. These disorders are fairly common in the adult population. Symptoms of CVD vary and so do reasons for patients to report to health institutions. Lack of uniformity in diagnosis and classification ofCVD has contributed to variability in reporting. CEAP (clinical, etiological, anatomical and pathophysiological) classification offers an effective and reproducible method of grading the disease. Epidemiological studies put prevalence rates for CVD at 10 to 35 percent. African studies in the 1970's showed low prevalence rates of between 0.12% and 7.7%. At Kenyatta National Hospital, a study on varicose veins by Cheruiyot (1995) showed an average of 28 patients treated annually. There has been an. apparent rise in numbers of patients with venous disease seen at KNH. Management of CVD has moved from the domain of general surgeons to the cardiovascular surgeons. Despite this being a common problem, little has been reported from this hospital and the region. In the current study, we looked at the pattern of presentation and management of chronic venous disease at Kenyatta National Hospital. This is a prospective descriptive hospital based study. Permission was obtained from the hospital's Ethics and Research committee. All patients with clinical features of CVD seen in the hospital, who met the inclusion criteria and gave consent during the study period, were enrolled. The patients were interviewed and examined by the researcher together with his assistant(s). Follow up examinations were carried out on the patients. Questionnaires were used to collect data which was then analyzed using SPSS computer program. During the period January to August 2008 one hundred and forty patients were recruited into the study. Sixty four had bilateral disease giving a total of 204 legs. Over eighty percent were from Nairobi and the neighbouring provinces (Central, Eastern). Eighty percent lived in urban centers and 20% were from rural areas. Fifty three percent were between 30 and 50 years. Females were 75 in number and males were 65( 1.15: 1.00). Our patients had a mean weight of 74 kg, a mean height of 167cm and a mean BMI of 26.8. Females had a relatively high BMI (28kg/m2) compared to males (25kg/m2). The commonest presenting complaint