Phlebolymphology N°53 – Editorial

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Edema is one of the leading symptoms of acute and chronic venous diseases. As demonstrated in Pascal Priollet’s contribution to this issue of Phlebolymphology, many other disorders may also cause edema of the lower extremities. This can make differential diagnosis difficult, since a wide spectrum of various pathologies must be considered, sometimes occurring in addition to varicose veins or venous insufficiency.

It is not surprising, therefore, that leg edema is a frequent finding, even in the general population.

However, phlebologists, who are aware of the high incidence of varicose veins, may be surprised to learn that in a large population of more than 3000 individuals (not patients) leg edema was found nearly as frequently as varicose veins. In total, 13.4% of the population had manifest leg edema (CEAP C3) and 14.3% had large varicose veins (CEAP C2). These results are presented by Eberhard Rabe and Felicitas Pannier and summarize the highlights of their Bonn study. One of the strengths of this epidemiological study is the fact that a duplex examination was performed in every individual case and that, based on these examinations, the population was described and categorized according to the CEAP classification.

An interesting multicenter study from the Czech Republic shows that pain after conventional varicose vein surgery seems to depend on several technical details. Lenka Veverková, from Brno, and coworkers were able to demonstrate that the administration of two tablets of Daflon 500 mg may have reduced pain and bruising.

Foam sclerotherapy is currently one of the hottest topics in phlebology, stimulating the interest of an increasing number of colleagues. George Geroulakos, an academic vascular surgeon, gives a convincing overview of our present knowledge of this technique for treating varicose veins. In reading his article, it seems clear that this method is poised to present an increasingly challenging competition for classical varicose vein surgery. This is obviously especially true for patients with venous ulceration and vascular malformations, cases that are not very attractive to vascular surgeons, in general. However, more studies are needed, especially for the promising indication of abolishing long refluxes in the saphenous veins using foam in order to promote faster ulcer healing.

Last but not least, a true specialist in this field, Marianne de Maeseneer, from Antwerp, Belgium, gives an eloquent review of the different methods that have been used may to prevent neovascularization after varicose vein surgery. Endovenous procedures may be a promising alternative.

Enjoy your reading!

Hugo Partsch, MD