Chronic Venous Insufficiency in Men: A Systematic Review of Gender Patterns

Abstract Males with chronic venous insufficiency (CVI) often present later and with more advanced disease than females. Quantifying male-specific presentation patterns could inform earlier detection and tailored management. To synthesize male-specific epidemiological and clinical presentation data in CVI, with emphasis on Clinical, Etiological, Anatomical, and Pathophysiological (CEAP) class distribution and associated risk factors. We conducted a PRISMA-conform systematic review, searching PubMed, ScienceDirect, and Google Scholar. Eligible studies were observational or interventional designs reporting male-specific data for adults. Outcomes were CEAP class and clinical presentation. Study selection, data extraction, and risk-of-bias assessment were performed independently by two reviewers. A total of 10 studies involving 12,344 males were included. Across studies, males more frequently presented with advanced CEAP classes (C3–C6), whereas females more often had C1–C2 disease. Population cohorts reported a higher prevalence of saphenous reflux and trophic changes (C4–C6) in males, especially with increasing age. Factors associated with advanced disease in males included obesity, prolonged-standing occupations, smoking, and delayed consultation. Despite more females being affected overall, males comprised the majority of severe presentations in clinic-based series. Males with CVI present later and at more advanced stages, with risks amplified by age, adiposity, and occupational loading. These findings support sex-sensitive strategies, and future research should address the lack of male-focused interventional data. Clinically, this mandates proactive screening and targeted education for at-risk men to mitigate delays in diagnosis and prevent complications like venous ulcers.