Phlebolymphology 44 – Editorial

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The articles in this issue of Phlebolymphology deal with very interesting areas of phlebolymphology.

A special mention is to be given to the Latin American consensus on the management of lymphedema which held its prior conference under the chairmanship of Dr Ciucci. We do welcome this excellent initiative.

New proposals for a classification of primary varicose veins of the lower extremities have come from a Latin American consensus group under the leadership of Roberto Simkin and Jorge Ulloa. The authors state that their intention is not to replace the CEAP classification, but to simplify and to refine the clinical segment of the “C.” This initiative contributes to the ongoing discussion on making the CEAP more user-friendly.

During recent years basic research has provided fascinating new insights into the pathophysiology of venous ulceration. Dr Herouy from the Dermatological University clinic in Freiburg, Germany, gives a stimulating review on the role of matrix metalloproteinases and their inhibitors in venous leg ulcer healing.

Many years ago, van der Molen had already proposed the term “chronic venolymphatic insufficiency” as being more appropriate than the commonly used “chronic venous insufficiency” (CVI). However, up to now the role of the lymphatic drainage in any form of CVI is still highly neglected. Pearson and Mortimer present a convincing survey on the close relationship between venous and lymphatic anatomy and pathophysiology. The main targets of any kind of treatment in patients with CVI are:
1. A decrease in capillary filtration, and
2. An improvement in lymphatic function.

Encouraging data show that these two effects may also be obtained by medications containing micronized purified flavonoid fraction (MPFF), so such drugs may offer a useful adjunctive treatment modality.

Hugo Partsch, MD