Background: Chronic venous insufficiency (CVI) in the occupational population is often poorly recognized. The dimensions of this problem have never been thoroughly investigated in the Netherlands. Objective: To study the epidemiology and risk factors of CVI in males with a standing position at work. To develop a simple diagnostic instrument for screening an (occupational) population for CVI. Methods: 387 male workers with a standing profession were examined by means of a questionnaire, physical examination, Doppler ultrasound investigation, light reflection rheography and optical leg volume measurements. Results: CVI was present in 29% of the subjects and correlated with age, weight and duration of standing work. Complaints of the legs were reported by 81% of the individuals with CVI but also by 63% of the persons without CVI. The questionnaire had a predictive value of 80% in detecting CVI. Conclusion: CVI was a major problem because of the quantity (29%) and the accompanying complaints. Neither the questionnaire nor other investigative measures proved to be as efficient in diagnosing CVI as physical examination in combination with Doppler ultrasound investigation.

Background: Chronic venous insufficiency (CVI) occurs frequently in the occupational population but is often not recognized. Objective: To evaluate leg volume measurements in the detection of CVI. Interventions: The lower leg volume was measured in 81 males with CVI and a standing occupation, at the beginning and end of 2 full working days using an optical leg volume meter. Results: A volume increase of over 50 ml was found in 60% of the legs. The mean volume change was +2.6% in legs with minor CVI and +3.6% in legs with major CVI. A high volume change was associated with a tired feeling and pain in the legs. In the detection of CVI, the predictive value of volume measurements was 71%, and in combination with a questionnaire 83%. Conclusion: A volume increase of the lower legs in the course of the day was common and associated with subjective complaints of the legs. As a predictor of CVI, isolated volume measurements were ineffective because an overlap was present with the distribution of volume changes in healthy workers.

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Objective: To investigate the reproducibility of an adapted optical leg volume meter and to determine intraindividual volume changes of the lower legs on separate days and in the course of a working day in healthy volunteers. Design: Adaptation of a standard optical leg volume meter, ‘volometer’, and calibration on an artificial leg and on volunteers. Study of the behaviour of lower leg volume in volunteers. Setting: Free University Hospital, Amsterdam. Participants: Thirty-six healthy volunteers, workers in the hospital. Intervention: The lower leg volume was measured on five or six different days at the beginning and end of a full working day. Main outcome measures: Reproducibility of the adapted volometer, and volume changes of the lower legs at different times. Results: Adaptation of the volometer resulted in a reproducibility of 0.07% in an artificial leg and of 0.46% in volunteers. A significant increase ( p<0.0001) in the volume of the lower legs in the course of the day was observed. Conclusion: Adaptation of the optical leg volume meter resulted in reproducible recordings of the volume of lower legs. In the course of the day an increase in volume occurs.

Diurnal volume changes of the lower legs were distributed as a Gaussian curve. A volume increase was common, but not obligatory. A volume increase of the legs was not associated with complaints of the legs or clinically evident oedema. This suggests that a volume increase can be a physiological phenomenon.

Chronic venous insufficiency (CVI) is a burden to many workers, especially to those with a standing profession. Preventive measures are seldom taken. A quasirandomized parallel group trial was performed in 114 male workers with CVI and a standing profession. For 3 months, class II compression stockings or rubber floor mats were used vs controls. Outcome measures were diurnal volume changes (leg swelling) and complaints of the lower legs. With the stockings, a significant decrease in complaints was found, as well as a significant decrease in leg swelling. Rubber mats were often not suitable for hygienic and safety reasons. The decrease in complaints in the group using rubber mats was less pronounced, and leg swelling did not differ from that of the control group. Compression stockings appeared to be superior to rubber mats with regard to applicability, diminishing subjective complaints, and decrease of diurnal leg swelling.

Objective: To study the value of light reflection rheography (LRR) as a diagnostic tool in subjects with varicose veins and venous insufficiency. Design: A prospective study comparing patients and workers with an occupation necessitating standing. Setting: Departments of Dermatology and Vascular Surgery, University Hospital VU, Amsterdam, The Netherlands and several manufacturing plants throughout the country. Subjects: Group I: 123 patients (168 legs) with a history of primary varicose veins attending the outpatient clinic; Group II: 374 male workers (748 legs) with an occupation necessitating standing. Methods: A questionnaire on venous disorders was administered, followed by clinical investigation, continuous-wave (c/w) Doppler ultrasound and LRR examination. LRR measurements were performed above the medial malleolus. A refilling time of at least 25 s after 10 dorsiflexions at the ankle was considered normal. In the case of shorter refilling times the procedure was repeated with a tourniquet above the probe. Normalization of the refilling time indicates an incompetent superficial venous system and a normal deep system. If there was no change we concluded deep venous insufficiency was present. Furthermore, in group I, duplex investigation of the venous system was performed. Main outcome measures: The diagnostic conclusions of the LRR measurements were compared with the diagnosis based on duplex investigation (group I) and clinical examination combined with c/w Doppler investigation (group II). Results: Group I: duplex investigation showed 156 cases of superficial venous insufficiency; LRR, 33. Sensitivity of LRR: 20%. Group II: Clinical and c/w Doppler examination showed 189 cases of superficial venous reflux; LRR, 29. Sensitivity of LRR: 7%. Conclusion: LRR has no apparent additive value in diagnosing superficial varicose veins in patients with a history of primary varicosities nor in screening a population for the presence of venous insufficiency.