Phlebolymphology N°55 – Editorial

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Laser ablation of the great saphenous vein is a technique whose use has expanded dramatically during the last few years. Endovenous techniques without groin incision and high ligation are certainly less invasive than conventional vein stripping, and seem to involve less risk of neovascularization. Steven Zimmet from Austin, Texas, the immediate Past President of the American College of Phlebology, gives a well-balanced overview of laser ablation, including the mechanisms of action, technical details, results, adverse sequelae, and complications. Using tumescent anesthesia, this procedure can be performed in-office without general anesthesia or surgical incisions.

Michel R. Boisseau, Pharmacology Department of the University of Bordeaux, contributes an interesting basic research paper entitled “Recent findings in the pathogenesis of venous wall degradation”. One of the central findings is that the leukocyte-mediated inflammatory chain-reaction is a key factor in the development of varicose veins. There is undoubtedly a vicious circle in which damage to venous walls to incompetent valves, which in turn results in further damage to the vein wall. Faced with this “chicken and egg” conundrum, Professor Boisseau favors the interesting view that it is not venous wall alterations that damage the valves, but rather the reverse.

A survey, describing the role of Daflon 500 mg in the management of chronic venous insufficiency, is presented by Françoise Pitsch, the driving force behind Phlebolymphology.

Michael Kendler and Eva Haas from Germany present an interesting pilot study on patients with “heavy leg syndrome”, which is associated with subjective leg symptoms but no objective signs of venous disease (C0,1 S; En; An; Pn), and is also called “functional phlebopathy” (see Giuseppe Andreozzi. Prevalence of patients with chronic venous disease-related symptoms but without visible signs (described as Cos in the CEAP classification): the Italian experience. Phlebolymphology. 2006;13:28-34). In a quality-of-life analysis using the SF-12 questionnaire, the authors found that a global psychological score deviated significantly from that of a healthy population.

Michael Dalsing, the President of the American Venous Forum, presents an excellent overview of artificial venous valves in the treatment of the severe stages of deep venous insufficiency. Non-autogenous valve substitutes have failed in clinical evaluation. Hitherto, only valve cusps made of autogenous vein have shown promising results. It may be expected that some day this kind of “science fiction surgery” will offer a clinically important alternative treatment, at least for selected cases.

The last contributions are reviews. Michèle Cazaubon, Paris, reviews a leading article on chronic venous disease, published by a group of prestigious authors (Bergan JJ, Schmid-Schönbein GW, Coleridge Smith PD, Nicolaides AN, Boisseau MR, Eklof B) in a recent issue of the New England Journal of Medicine. Those who are specifically interested should read and digest this landmark paper. Michel Perrin reviews the recently published “Vein Book” (Elsevier), whose editor-in-chief, J-J Bergan, and 89 authors, have risen to the challenge of covering this vast topic in 617 pages, divided into 65 chapters, with over one thousand references. The result is outstanding.
Enjoy your reading!

Hugo Partsch, MD