Importance of First Contact Physician Evaluation in Chronic Venous Disease

Introduction, Objectives, and/or Purpose: Some rural areas in Mexico are still uncommunicated and far from specialized medical services, going to first contact doctors, most of time without proper management; becoming important the training of these doctors to improve medical care and avoid diseases progression.
1. Present a group of patients from a rural area from Mexico with Chronic venous disease (CVD).

Methods: A complete medical history was obtained from the records of the patients in the Mazahua community seen during the last 6 months of 2021 and 2022.

Results: 174 patients, age range of 7 months-93 years (average 51.9 years); 76% female. 64.2% of men work in the fields and 76% of women are housewives. 60.8% reported family history of varicose veins. Regarding the number of pregnancies, 10.8% 0-2, 23% 3-5, 13% 6-8, 9.7% 9-12 and 1% 16. 14.1% of women reported a history of taking oral contraceptives. Regarding comorbidities, 13.3% Diabetes mellitus, 87.5% under treatment; 28.3% arterial hypertension, 82.3% under treatment. 72.5% are overweight or obese, and 80% do not perform any physical activity. One of the patients was diagnosed with Klippel Trenaunay syndrome and one with lymphangioma. 5 patients with deep vein thrombosis, one acute postCOVID. Regarding the presentation of CVD: 68.3% had some degree of C of the CEAP, C0 and C1 in 2.4%, C2 57.3%, bilateral in 65.9% of the cases. C4 in 25.6%, bilateral in 42.8%. C5 4.8% and C6 13.4%, four being recurrent. The average time of evolution of the disease was 13.7 years. 78% had pharmacological treatment and 8.5% compression treatment prior to vascular evaluation. After it, venotonic was indicated in 63.4% of the patients and glycosaminoglycan sulodexide in 92%, compression in 93% of the patients. 34% percent of the patients underwent a surgical procedure, after which all those with active ulcers healed.

Conclusion(s): Most of males are farmers, and women are mostly housewives. It was interesting the number of patients with a family history of venous disease, the highest prevalence of varicose veins and the time of its evolution. Most of the patients had already had a first contact medical evaluation, without being sent to the specialist; with no improvement or worsening of the clinical presentation. 41.6% of patients had significant comorbidities that must be monitored to prevent complications. We believe that the education of first contact physicians should be crucial to improve management of patients with CVD and comorbidities in rural areas, specially to prevent complications.