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Lower limb venous and arterial peripheral diseases and work conditions: systematic review
  1. Samantha Huo Yung Kai1,2,
  2. Jean Ferrières2,3,
  3. Camille Carles4,
  4. Marion Turpin5,
  5. François-Xavier Lapébie6,
  6. Frederic Dutheil7,8,
  7. Alessandra Bura-Rivière6,
  8. Yolande Esquirol2,5
  1. 1 Department of Epidemiology, Toulouse University Hospital, Toulouse, France
  2. 2 Department of Epidemiology and Public Health, UMR INSERM 1027, INSERM – Université de Toulouse, Toulouse, France
  3. 3 Department of Cardiology, Rangueil Toulouse University Hospital, Toulouse, France
  4. 4 Occupational Health, University Bordeaux, INSERM UMR 1219, Equipe EPICENE. CHU Bordeaux, Bordeaux, France
  5. 5 Occupational Health Department, Toulouse University Hospital, Toulouse, France
  6. 6 Department of Vascular Medicine, Toulouse University Hospital, Toulouse, France
  7. 7 Occupational Medicine, CHU G Montpied, Clermont-Ferrand, France
  8. 8 CNRS LaPSCo, Universite Clermont Auvergne, Clermont-Ferrand, France
  1. Correspondence to Dr Samantha Huo Yung Kai, UMR 1027, INSERM, Université Paul Sabatier Toulouse III, Toulouse 31000, France; samantha.huo-yung-kai{at}


Objectives The individual peripheral vascular disease risk factors are well documented, but the role of work conditions remains equivocal. This systematic review aims to assess relationships between lower limb peripheral venous diseases (lower limb varicose veins (LLVV), venous thromboembolism (VTE) comprising deep vein thrombosis and pulmonary embolism), peripheral arterial disease (intermittent claudication, aortic dissection, aortic aneurysm) and occupational constraints among working adults.

Methods Several databases were systematically searched until February 2019 for observational studies and clinical trials. Preferred Reporting Items for Systematic Reviews and Meta-Analyses method was used for article selection. Quality assessment and risk of bias were evaluated using Strengthening the Reporting of Observational Studies in Epidemiology and Newcastle-Ottawa scales.

Results Among the 720 screened articles, 37 remained after full-text evaluation. Among the 21 studies on LLVV, prolonged standing was significantly associated to a higher risk of varicose veins with a threshold probably around >3 to 4 hours/day but exposure duration in years was not sufficiently considered. Seated immobility was often observed in workers, with no sufficient evidence to prove that prolonged sitting at work is related to VTE. Carrying heavy loads, stress at work and exposure to high temperatures have emerged more recently notably in relation to varicose veins but need to be better explored. Only three studies discussed the potential role of work on peripheral arterial disease development.

Conclusions Although some observational studies showed that prolonged standing can be related to varicose veins and that seated immobility at work could be linked to VTE, very little is known about peripheral arterial disease and occupational constraints. Clinical trials to determine preventive strategies at work are needed.

PROSPERO registration number CRD42019127652.

  • occupational health practice
  • cardiovascular
  • exposure assessment
  • physical work

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  • Contributors MT, YE, SHYK and JF: Conducted the article selection, and screening. YE and SHYK: Prepared the material and methods and results, and the discussion sections. FXL, CC, FD, JF, and ABR: Contributed substantially to the discussion and reviewed all the manuscript. All authors read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.