In a recent review article in Phlebolymphology, Michel Perrin and George Geroulakos1 nicely summarized the pharmacological targets of phlebotropic drugs in chronic venous disease. The analgesic, antiedema, and capillary protection effects of such compounds have been demonstrated in many pharmacological trials. As a therapeutic consequence it is stated that in patients in whom invasive therapy (sclerotherapy, surgery) does not appear warranted, drugs are a good first-line treatment. New clinical reports show that phlebotropic drugs may also be useful in the postoperative management of patients undergoing varicose vein surgery.
In a previous issue of Phlebolymphology, Lenka Veverkova and coworkers2 from Brno demonstrated that Daflon 500 mg may have beneficial results after varicose vein surgery by reducing pain and hematoma.
The first article in this issue of Phlebolymphology supports these data. In a large Russian multicenter study,Victor S. Saveljev and coworkers compared the outcome of varicose vein surgery in two groups of patients. The treatment group (n= 200) received micronized purified flavonoid fraction (MPFF, Detralex®=Daflon® 500 mg, 1000 mg/day) starting two weeks before surgery and continuing for up to 30 days after the procedure. The control group (n=45) did not receive Daflon® 500 mg in the pre- and postoperative periods. It was shown that the drug significantly reduced pain and hematoma. As a practical consequence, the administration of MPFF should not only be considered in patients with chronic venous disorders, but also as an adjunctive treatment in connection with varicose vein surgery, in order to reduce the side effects of pain and bruising.
Marc Cairols and Josep Marinello from Barcelona describe interesting data concerning health care problems of chronic venous disorders in Spain. One of the intentions of their report is to extrapolate the present situation to the changes to be expected during the next few years. It may be assumed that the Spanish problems are very similar to those in other industrialized countries. Pelvic congestion syndrome is the third main focus of this issue of Phlebolymphology. Neslihan Zehra Gültasli and coworkers from Ankara used pelvic and transvaginal ultrasound to study 100 women complaining of chronic pelvic pain. The veins of the lower extremities were also scanned. Parauterine and paraovarian veins with a diameter of more than 5 mm were defined as pelvic varicose veins. Pelvic varices were found in 30 women, 21 of whom also presented with leg vein insufficiency, which interestingly was more common in the deep than in the superficial system.
A report from Brian Knipp, Department of Surgery, University of Michigan Health System, MI, USA, who won the last Servier-sponsored American Venous Forum fellowship, teaches us how an American in Paris views European practice. Book reviews conclude this issue of Phlebolymphology.