Factors affecting the intensity of nurses’ lower limbs’ varicose veins in the hospitals of North Khorasan, Iran, in 2016

  • Mehri Bozorgnezha Department of Nursing and Midwifery, School of Nursing, Iran University of Medical Sciences, Tehran, Iran
  • Samaneh Nodehi Nodehi Department of Nursing and Midwifery, School of Nursing, Iran University of Medical Sciences, Tehran, Iran
  • Mehdi Keyvan Keyvan Department of Nursing and Midwifery, School of Nursing, International Campus, Iran University of Medical Sciences, Tehran, Iran
  • Salimeh Azizi Department of Nursing, School of Nursing, North Khorasan University of Medical Sciences, Bojnurd, Iran
Keywords: Varicose veins, Demography, Occupational exposure, Life style, Quality of life


Background & Aim: Varicose vein (VV) is known as the most prevalent venous disease which has many complications. Since this is a hard healing disease which imposes a large burden on individual and society, and also has high mortality, many studies begin to assess risk factors in their population.Methods & Materials: Participants were examined by a cardiovascular specialist and their VVs were graded by CEAP criteria. The patients filled a four-part researcher-made questionnaire of demography, occupation, quality of life (QOL), and lifestyle. Data were analyzed by SPSS software.Results: We found that sex, age, pregnancy, child number, family history, standing, sitting, walking, weight, body mass index (BMI), overtime, and work experience have significant effects on VV intensity. Multiple logistic regression shows that standing (OR = 13.850), sitting (OR = 4.850), pregnancy (OR = 2.002), age (OR = 1.219), and overtime (OR = 1.029) are the most effective demographic and occupational factors. Age and sex adjusted demographic and occupational factors show that only pregnancy factor is affected. Life style factors show that physical activity (OR = 4.038), as well as weight control and nutrition (OR = 3.760) have significant effect on VV intensity. It is also found that symptoms intensity have significant relationship with VV intensity (OR = 4.048). It means that increasing VV intensity causes a 4-fold decrease of QOL.Conclusion: It is revealed that most of the effective factors on VV intensity are secondary factors which are preventable.


Brunicardi FC, Andersen DK, Billiar TR. Schwartz's principles of surgery ABSITE and board review. 9th ed. New York, NY: McGraw-Hill Education; 2010.

Goldman MP, Fronek A. Anatomy and pathophysiology of varicose veins. J Dermatol Surg Oncol 1989; 15(2): 138-45.

Rabe E, Berboth G, Pannier F. Epidemiology of chronic venous diseases. Wien Med Wochenschr 2016; 166(9-10): 260-3. [In German].

Kroeger K, Ose C, Rudofsky G, Roesener J, Hirche H. Risk factors for varicose veins. Int Angiol 2004; 23(1): 29-34.

Cojocaru AL, Marza-Dnila D. Study concerning the efficiency of the reflex massage in the treatment of varicose veins. Procedia Soc Behav Sci 2014; 117: 559-65.

Hamdan A. Management of varicose veins and venous insufficiency. JAMA 2012; 308(24): 2612-21.

Bergan JJ, Schmid-Schonbein GW, Smith PD, Nicolaides AN, Boisseau MR, Eklof B. Chronic venous disease. N Engl J Med 2006; 355(5): 488-98.

Shepherd AC, Gohel MS, Lim CS, Davies AH. A study to compare disease-specific quality of life with clinical anatomical and hemodynamic assessments in patients with varicose veins. J Vasc Surg 2011; 53(2): 374-82.

Brand FN, Dannenberg AL, Abbott RD, Kannel WB. The epidemiology of varicose veins: The Framingham Study. Am J Prev Med 1988; 4(2): 96-101.

Almeida JI, Wakefield T, Kabnick LS, Onyeachom UN, Lal BK. Use of the Clinical, Etiologic, Anatomic, and Pathophysiologic classification and Venous Clinical Severity Score to establish a treatment plan for chronic venous disorders. J Vasc Surg Venous Lymphat Disord 2015; 3(4): 456-60.

Eklof B, Rutherford RB, Bergan JJ, Carpentier PH, Gloviczki P, Kistner RL, et al. Revision of the CEAP classification for chronic venous disorders: Consensus statement. J Vasc Surg 2004; 40(6): 1248-52.

Klem TM, Sybrandy JE, Wittens CH, Essink Bot ML. Reliability and validity of the Dutch translated Aberdeen Varicose Vein Questionnaire. Eur J Vasc Endovasc Surg 2009; 37(2): 232-8.13. Vasquez MA, Munschauer CE. Venous Clinical Severity Score and quality-of-life assessment tools: Application to vein practice. Phlebology 2008; 23(6): 259-75.

Lali M, Abedi A, Kajbaf MB. Construction and validation of the Lifestyle Questionnaire (LSQ). Psychological Research 2012; 15(1): 64-80. [In Persian].

Rabe E, Guex JJ, Puskas A, Scuderi A, Fernandez QF. Epidemiology of chronic venous disorders in geographically diverse populations: Results from the Vein Consult Program. Int Angiol 2012; 31(2): 105-15.

Burleva EP, Burleva NA. Russian observational programme SPEKTR: analysis of age-specific structure of patients with chronic venous diseases. Angiol Sosud Khir 2013; 19(2): 67-72. [In Russian].

Chiesa R, Marone EM, Limoni C, Volonte M, Schaefer E, Petrini O. Demographic factors and their relationship with the presence of CVI signs in Italy: The 24-cities cohort study. Eur J Vasc Endovasc Surg 2005; 30(6): 674-80.

Serra R, Gallelli L, Perri P, De Francesco EM, Rigiracciolo DC, Mastroroberto P, et al. Estrogen receptors and chronic venous disease. Eur J Vasc Endovasc Surg 2016; 52(1): 114-8.

Asbeutah AM, Al-Azemi M, Al-Sarhan S, Almajran A, Asfar SK. Changes in the diameter and valve closure time of leg veins in primigravida women during pregnancy. J Vasc Surg Venous Lymphat Disord 2015; 3(2): 147-53.

Asbeutah AM, Al-Enezi M, Al-Sharifi NM, Almajran A, Cameron JD, McGrath BP, et al. Changes in the diameter and valve closure time of leg veins across the menstrual cycle. J Ultrasound Med 2014; 33(5): 803-9.

Zahariev T, Anastassov V, Girov K, Goranova E, Grozdinski L, Kniajev V, et al. Prevalence of primary chronic venous disease: The Bulgarian experience. Int Angiol 2009; 28(4): 303-10.

Beebe-Dimmer JL, Pfeifer JR, Engle JS, Schottenfeld D. The epidemiology of chronic venous insufficiency and varicose veins. Ann Epidemiol 2005; 15(3): 175-84.23. Ismail L, Normahani P, Standfield NJ, Jaffer U. A systematic review and meta-analysis of the risk for development of varicose veins in women with a history of pregnancy. J Vasc Surg Venous Lymphat Disord 2016; 4(4): 518-24.

Lenkovic M, Cabrijan L, Gruber F, Batinac T, Manestar-Blazic T, Stanic ZZ, et al. Effect of progesterone and pregnancy on the development of varicose veins. Acta Dermatovenerol Croat 2009; 17(4): 263-7.

Laurikka JO, Sisto T, Tarkka MR, Auvinen O, Hakama M. Risk indicators for varicose veins in forty- to sixty-year-olds in the Tampere varicose vein study. World J Surg 2002; 26(6): 648-51.

Ciardullo AV, Panico S, Bellati C, Rubba P, Rinaldi S, Iannuzzi A, et al. High endogenous estradiol is associated with increased venous distensibility and clinical evidence of varicose veins in menopausal women. J Vasc Surg 2000; 32(3): 544-9.

Somers P, Knaapen M. The histopathology of varicose vein disease. Angiology 2006; 57(5): 546-55.

Berard A, Kahn SR, Abenhaim L. Is hormone replacement therapy protective for venous ulcer of the lower limbs? Pharmacoepidemiol Drug Saf 2001; 10(3): 245-51.

Bromen K, Pannier-Fischer F, Stang A, Rabe E, Bock E, Jockel KH. Should sex specific differences in venous diseases be explained by pregnancies and hormone intake? Gesundheitswesen 2004; 66(3): 170-4. [In German].

Krasinski Z, Sajdak S, Staniszewski R, Dzieciuchowicz L, Szpurek D, Krasinska B, et al. Pregnancy as a risk factor in development of varicose veins in women. Ginekol Pol 2006; 77(6): 441-9.

Bihari I, Tornoci L, Bihari P. Epidemiological study on varicose veins in Budapest. Phlebology 2012; 27(2): 77-81.

Jukkola TM, Makivaara LA, Luukkaala T, Hakama M, Laurikka J. The effects of parity, oral contraceptive use and hormone replacement therapy on the incidence of varicose veins. J Obstet Gynaecol 2006; 26(5): 448-51.33. Callam MJ. Epidemiology of varicose veins. Br J Surg 1994; 81(2): 167-73.

Evans CJ, Fowkes FG, Ruckley CV, Lee AJ. Prevalence of varicose veins and chronic venous insufficiency in men and women in the general population: Edinburgh Vein Study. J Epidemiol Community Health 1999; 53(3): 149-53.

Bradbury A, Evans C, Allan P, Lee A, Ruckley CV, Fowkes FG. What are the symptoms of varicose veins? Edinburgh vein study cross sectional population survey. BMJ 1999; 318(7180): 353-6.

Maffei FH, Magaldi C, Pinho SZ, Lastoria S, Pinho W, Yoshida WB, et al. Varicose veins and chronic venous insufficiency in Brazil: Prevalence among 1755 inhabitants of a country town. Int J Epidemiol 1986; 15(2): 210-7.

Sharif NH, Chan YH, Haghdoost AA, Soleimani MA, Beheshti Z, Bahrami N. Varicose veins of the legs among nurses: Occupational and demographic characteristics. Int J Nurs Pract 2015; 21(3): 313-20.

Sisto T, Reunanen A, Laurikka J, Impivaara O, Heliovaara M, Knekt P, et al. Prevalence and risk factors of varicose veins in lower extremities: Mini-Finland health survey. Eur J Surg 1995; 161(6): 405-14.

Carpentier PH, Maricq HR, Biro C, Poncot-Makinen CO, Franco A. Prevalence, risk factors, and clinical patterns of chronic venous disorders of lower limbs: A population-based study in France. J Vasc Surg 2004; 40(4): 650-9.

Robertson L, Evans C, Fowkes FG. Epidemiology of chronic venous disease. Phlebology 2008; 23(3): 103-11.

Robertson L, Lee AJ, Evans CJ, Boghossian S, Allan PL, Ruckley CV, et al. Incidence of chronic venous disease in the Edinburgh Vein Study. J Vasc Surg Venous Lymphat Disord 2013; 1(1): 59-67.

Danielsson G, Eklof B, Grandinetti A, Kistner RL. The influence of obesity on chronic venous disease. Vasc Endovascular Surg 2002; 36(4): 271-6.43. Musil D, Kaletova M, Herman J. Age, body mass index and severity of primary chronic venous disease. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2011; 155(4): 367-71.

Dimakakos E, Syrigos K, Scliros E, Karaitianos I. Prevalence, risk and aggravating factors of chronic venous disease: an epidemiological survey of the general population of Greece. Phlebology 2013; 28(4): 184-90.

Lee AJ, Evans CJ, Allan PL, Ruckley CV, Fowkes FG. Lifestyle factors and the risk of varicose veins: Edinburgh Vein Study. J Clin Epidemiol 2003; 56(2): 171-9.

Hirai M, Naiki K, Nakayama R. Prevalence and risk factors of varicose veins in Japanese women. Angiology 1990; 41(3): 228-32.

Kakande I. Varicose veins in Africans as seen at Kenyatta National Hospital, Nairobi. East Afr Med J 1981; 58(9): 667-76.

Komsuoglu B, Goldeli O, Kulan K, Cetinarslan B, Komsuoglu SS. Prevalence and risk factors of varicose veins in an elderly population. Gerontology 1994; 40(1): 25-31.

Diken AI, Yalcinkaya A, Aksoy E, Yilmaz S, Ozsen K, Sarak T, et al. Prevalence, presentation and occupational risk factors of chronic venous disease in nurses. Phlebology 2016; 31(2): 111-7.

Bonet-Porqueras R, Moline-Pallares A, Olona-Cabases M, Gil-Mateu E, Bonet-Notario P, Les-Morell E, et al. The night shift: a risk factor for health and quality of life in nursing staff. Enferm Clin 2009; 19(2): 76-82. [In Spanish].

Ebrahimi H, Amanpour F, Bolbol HN. Prevalence and risk factors of varicose veins among female hairdressers: a cross sectional study in north-east of Iran. J Res Health Sci 2015; 15(2): 119-23.

Scott TE, LaMorte WW, Gorin DR, Menzoian JO. Risk factors for chronic venous insufficiency: a dual case-control study. J Vasc Surg 1995; 22(5): 622-8.

Ahti TM, Makivaara LA, Luukkaala T, Hakama M, Laurikka JO. Effect of family history on the risk of varicose veins isaffected by differential misclassification. J Clin Epidemiol 2010; 63(6): 686-90.

Abramson JH, Hopp C, Epstein LM. The epidemiology of varicose veins. A survey in western Jerusalem. J Epidemiol Community Health 1981; 35(3): 213-7.

Tuchsen F, Hannerz H, Burr H, Krause N. Prolonged standing at work and hospitalisation due to varicose veins: A 12 year prospective study of the Danish population. Occup Environ Med 2005; 62(12): 847-50.

Ziegler S, Eckhardt G, Stoger R, Machula J, Rudiger HW. High prevalence of chronic venous disease in hospital employees. Wien Klin Wochenschr 2003; 115(15-16): 575-9.

Tabatabaeifar S, Frost P, Andersen JH, Jensen LD, Thomsen JF, Svendsen SW. Varicose veins in the lower extremities in relation to occupational mechanical exposures: A longitudinal study. Occup Environ Med 2015; 72(5): 330-7.

Jawien A. The influence of environmental factors in chronic venous insufficiency. Angiology 2003; 54(Suppl 1): S19-S31.

Novo S, Avellone G, Pinto A, Davi G, Deredita G, Riolo F, et al. Prevalence of primitive varicose veins of the lower limbs in a randomized population sample of Western Sicily. Int Angiol 1988; 7(2): 176-81.

Cleave TL. Varicose veins nature's error or man's?: Some implications of the Darwinian Theory. The Lancet 1959; 274(7095): 172-5.

Burkitt DP. Varicose veins, deep vein thrombosis, and haemorrhoids: Epidemiology and suggested aetiology. Br Med J 1972; 2(5813): 556-61.

Lee AJ, Evans CJ, Hau CM, Fowkes FG. Fiber intake, constipation, and risk of varicose veins in the general population: Edinburgh Vein Study. J Clin Epidemiol2001; 54(4): 423-9.

Kravtsov PF, Katorkin SA, Volkovoy VV, Sizonenko YV. The influence of the training of the muscular component of the musculo-venous pump in the lower extremities on the clinical course of varicose vein disease. Vopr Kurortol Fizioter Lech Fiz Kult 2016; 93(6): 33-6. [In Russian].

McCulloch J, Mahoney E, McCallon S. Enhancing the role of physical therapy in venous leg ulcer management. JAMA Dermatol 2015; 151(3): 327.

Ducimetiere P, Richard JL, Pequignot G, Warnet JM. Varicose veins: A risk factor for atherosclerotic disease in middle-aged men? Int J Epidemiol 1981; 10(4): 329-35.

Moffatt CJ, Franks PJ, Doherty DC, Smithdale R, Martin R. Sociodemographic factors in chronic leg ulceration. Br J Dermatol 2006; 155(2): 307-12.

Jawien A, Grzela T, Ochwat A. Prevalence of chronic venous insufficiency in men and women in Poland: Multicentre cross-sectional study in 40,095 patients. Phlebology 2003; 18(3): 110-22.

Scott TE, Mendez MV, LaMorte WW, Cupples LA, Vokonas PS, Garcia RI, et al. Are varicose veins a marker for susceptibility to coronary heart disease in men? Results from the Normative Aging Study. Ann Vasc Surg 2004; 18(4): 459-64.

Franks PJ, Wright DD, Fletcher AE, Moffatt CJ, Stirling J, Bulpitt CJ, et al. A questionnaire to assess risk factors, quality of life, and use of health resources in patients with venous disease. Eur J Surg 1992; 158(3): 149-55.

Launois R. Health-related quality-of-life scales specific for chronic venous disorders of the lower limbs. J Vasc Surg Venous Lymphat Disord 2015; 3(2): 219-27.

How to Cite
Bozorgnezha M, Nodehi SN, Keyvan MK, Azizi S. Factors affecting the intensity of nurses’ lower limbs’ varicose veins in the hospitals of North Khorasan, Iran, in 2016. jbe. 4(1):36-.
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