Phlebolymphology 47 – Editorial

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This issue of Phlebolymphology contains many interesting articles, which will stimulate discussion.

Everyone dealing with practical phlebology will be convinced that, in patients with chronic venous disease, the insufficiency of the venous pump is caused not only by valvular damage and hindrances to venous backflow, but also by muscular dysfunction. However, it is not easy to differentiate these components by clinical testing. There are published data showing that a restriction of ankle movement, which is a frequent sequel of painful leg ulcers, leads to a reduction of the venous pumping capacity. Muscles that are not trained will become atrophic and therefore the motor of the venous pump will fail.

In his article, Dr Simka from Poland, discusses a plethysmographic method to evaluate whether measurements in the supine and standing position could determine the motor component of the venous pump. In this short paper, no methodological details are given and the results are only reported in terms of “percentage insufficiency” and not in absolute terms characterizing the efficiency of the venous pump. Therefore, it seems unlikely that his method will solve the problem.

Dr Corcos from Florence shows us the close relationship between morphological and hemodynamic changes in varicose veins, pointing to the unresolved question: which came first, the chicken or the egg? As we know, correction of the venous hemodynamics will improve morphological changes.

A real treasure is the article from Drs Humbert and Meaume from France, which gives a broad overview of the various technologies available for the assessment of leg ulcers. This will be a very useful aid for all investigators involved in ulcer trials.

Finally, Prof Lee from Korea gives us an insight into the difficult world of lymphedemaangiodysplasia syndromes and their management. His vast experience, especially in this field, is amazing

Hugo Partsch, MD