Phlebolymphology N°52 – Editorial
Hospital staff have a high risk of developing venous leg problems, particularly in connection with long periods of standing. This is the main message from an interesting study by Dr Ziegler from Vienna. The highest prevalence of chronic venous disorders was found in general hospital staff and cleaners. It may be assumed that the number of surgeons in this study was too low to put them into the same risk group of predominantly standing occupation.
Dr Fischer from Göttingen discusses in his paper the difficulties for a general practitioner in handling patients with symptoms suspicious of deep vein thrombosis (DVT). Deep vein thrombosis could be diagnosed only in 10% of all patients referred to specialized centers. It remains to be determined how many patients who had not been sent for a detailed examination had a DVT.
The results from a Bulgarian survey in more than 3000 patients are presented by Prof Zahariev and coworkers. A considerable number of the patients with subjective leg symptoms were assigned to the group of CEAP class C0 showing no clinical signs of venous disease. Is this “functional phlebopathy” or may it be caused by another, unrecognized pathology?
Dr Neglen, working with Professor Raju in Mississippi, advocates an early invasive approach in patients with post-thrombotic syndrome. Based on his extensive experience and on a comprehensive literature survey, he convincingly demonstrates that beneficial clinical results may be obtained, even when the hemodynamic situation can only be partially improved but not normalized. He refers to leg compression and local wound care as “old-fashioned and counterproductive, which may deny patients modern treatment.” Up to now only a minority of colleagues involved in venous surgery seems to share this opinion, most of them preferring to operate on “clean” varicose veins and defending classical stripping operation from several less invasive procedures, for obvious reasons.
Vascular surgery also plays an important role in the management of venous aneurysms. This is demonstrated in an article by Dr Perrin from France, reflecting the state of the art in this field. The authors postulate that usiform popliteal aneurysms with a diameter larger than 20 mm should be resected as a preventive measure, even when no previous thrombotic complication has occurred.
Again, several fascinating issues and stimulating ideas can be found in this issue of Phlebolymphology.
Enjoy!
