Servier – Phlebolymphology

Phlebolymphology is a fascinating field encompassing important clinical entities, which often are widely ignored or neglected in general medicine.

The contributions in this issue of our journal, all written by top experts in their field, provide some very impressive examples.

Together with lymphatic malformations, venous angiodysplasias are the most common form of congenital vascular malformations. B. B. Lee from Seoul, Korea, one of the world’s most experienced authorities in this field, presents his data on diagnosis and management of these congenital venous anomalies. The indication for active treatment depends on complications such as hemorrhage, pain, functional disability, or chronic venous hypertension; on a critical location, which threatens vital functions or carries a high risk of complication; and on the severity of the cosmetic deformity. The author has wide experience with ethanol sclerotherapy. Extratruncular malformations are treated by embolo-sclerotherapy using acrylate before surgical excision.

Peter Neglen from Raju’s department in Jackson, Mississippi, reports on his experiences with stents for the treatment of venous iliofemoral obstructions, which date back 6 years, and which certainly comprise one of the largest series ever published. The intravascular procedure is less invasive and safer than open surgery, which has broadened the indication for an aggressive approach in pelvic venous obstructions. The indication for this procedure should not only be based on morphological criteria but should also take into account hemodynamic parameters. Some important technical hints for the procedure are given.

Tomohiro Ogawa and Shunichi Hoshino, two leading specialists in the field of venous diseases from Fukushima, Japan, present an interesting review on the epidemiology of pulmonary embolism in Japan, it has been demonstrated that the frequency of this entity is approaching the Western level, while some years ago it was only between one third to one tenth as common as in the West. The incidence of deep venous thrombosis after surgery is presently in the same range as reported in Europe or in the US. The reason for this development is obviously associated with the westernization of the Japanese lifestyle, and with the growing life expectancy.

Corradino Campisi and his group from the famous school of Tosatti in Genova, Italy, not only report on their own vast experience with microsurgical techniques in over 600 patients with lymphedema, but also give us an informative overview on the historical development of surgical techniques in this indication. The authors underline the importance of prevention of lymphedema, for instance after surgery for breast cancer, and advocate an interdisciplinary concept, in which conservative therapy plays a major role.

I hope you will all enjoy the extraordinary quality of the articles.