Symptoms of restless leg syndrome are 34.5% more prevalent in patients with superficial venous insufficiency, according to a retrospective study presented by Aaron Dezube (St Elizabeth Medical Center, Brighton, USA). Although restless leg syndrome was identified in those without superficial venous reflux, it was overwhelmingly noted to occur in patients who had physical evidence of underlying superficial venous reflux.
Speaking at the annual meeting of the American Venous Forum (VENOUS 2020; 3–6 March, Amelia Island, USA), Dezube described venous reflux as a common condition caused by venous valvular incompetence. He continued, explaining that “a few limited studies” have identified a correlation between restless leg syndrome and superficial venous insufficiency.
Although not the focus of this investigation, Dezube also acknowledged that there is evidence to suggest that restless leg syndrome can be successfully treated with such methods as endovenous laser ablation (EVLA), in patients with both restless legs and superficial venous insufficiency proven by duplex ultrasound.
In order to investigate the association between restless legs syndrome and superficial venous insufficiency, investigators at a single vein centre performed a retrospective chart review of prospectively collected patients undergoing evaluation between December 2018 and February 2019. Moreover, all patients who presented with symptoms of venous disease, for which duplex ultrasound was performed, were included in the study. These patients were routinely questioned during their initial visit about the presence of restless leg syndrome.
Data collection for this group included either the presence or absence of restless legs syndrome, the presence or absence of superficial venous insufficiency (defined as less than 0.5 seconds), CEAP classification, and demographic information. These data were then analysed to identify any correlation between symptoms of restless legs syndrome and superficial venous insufficiency.
Overall, 207 patients, who reported venous symptoms during the study period, underwent duplex ultrasound and were analysed. Of these patients, 137 were found to have superficial venous insufficiency, while 70 were not. In the group with superficial venous insufficiency confirmed by ultrasound, 78% (n=108) also reported symptoms of restless legs, compared to just 44.3% (n=31) in the 70 patients found not have superficial venous disease (95% CI, 20.0%-49.1%; p<0.0001).
Concluding, Dezube emphasised that the correlation demonstrated by himself and his colleagues is clinically relevant and, furthermore, may support the use of duplex ultrasound in the initial evaluation of restless legs syndrome, “as this may suggest a potentially treatable alternative not utilised in current practice”.
He said: “There are other factors, such as venous pain presence, phlebitis, swelling and family history, but when we performed a multivariate analysis, the only one which actually stood out was superficial venous reflux. It is possible, then, that restless leg syndrome may be an underreported symptom of venous disease that we are currently not targeting.”
Nevertheless, he also posited that future studies are required in order to establish any association between venous disease and restless legs in the general population, as well as evaluate the impact of treating superficial venous insufficiency on symptoms of restless legs syndrome.
