Venous Disorders as an Occupational Disease: Data, Pathophysiology, and Modification Strategies

Introduction, Objectives, and/or Purpose: Chronic Venous Disease (CVD) is closely linked to the modern working world. Tasks carried out in a standing or seated position play a role in the development of venous disorders. Though not commonly recognized as an occupational disease, venous disorders must be taken into account in the design of workspaces. This review aims to analyze the literature on the relationship between CVD and occupational exposure.

Methods: A systematic review through Pubmed and the library of the clinics for occupational medicine identified 306 articles. Full text articles, available in English and German, reporting the point CVD in an occupational context were included.

Results: Twenty three articles were identified. Various studies showed that women who spend an average of eight or more hours sitting or standing at work have a significantly higher risk of developing varicose veins than women who spend four or fewer hours in these positions. In contrast, no clear correlation between sedentary work and varicose veins can be established in men. However, there is a correlation between the number of years men worked in a standing position and the severity of CVD. A large observational study of >6000 randomly selected men and women concluded that the relative risk of hospitalization for varicose vein surgery increased 1.8-fold for those whose jobs consisted predominantly of standing or walking. The significance of sitting and standing as occupational cofactors in the development of varicose veins and venous symptoms was highlighted in a study of 2,000 randomly selected French volunteers. While height and a higher BMI had little correlation with the development of ankle edema, there was a significant link with activity (sitting and standing).
Venous pressure varies depending on the position of the body: approx. 5mmHg when lying down, 80mmHg when standing, 45-60mmHg when seated, and 25-30mmHg when walking. Patients with CVD exhibit muscular changes including atrophy of the myofibrils, dilatation, proliferation of the interfascial veins and inflammatory changes, which further reduce the pumping function. Lack of muscle activity causes endothelial dysfunction, increases vascular permeability of the veins, and activates leukocytes and platelets.
Studies show that compression therapy can lessen this effect.

Conclusion(s): Occupational stress impacts the venous system more than the risk factors of body weight, gender and predisposition. Hence preventive measures especially in the workplace - have the potential to be highly effective. Optimal venous hemodynamics in the workplace can be achieved through interventional changes to the work environment, the individual, and the organization of work. The three intervention strategies are to be applied in an additive manner.