Phebolymphology N°79 – Editorial
Dear Readers,
This issue of Phlebolymphology once again brings topics of immediate interest to the fore—venous ulcers, varicose vein treatment, venous pelvic congestion syndrome, and superficial vein thrombosis. Allow me to comment on them briefly.
For years, chronic venous diseases have been neglected and considered to be less important than other cardiovascular diseases. At present such a view is definitely not acceptable, at least in patients with venous ulcers, which is the most serious condition associated with chronic venous diseases and the development of chronic venous insufficiency. The results of the recent Vein Consult Program have shown that the incidence of such advanced stages of chronic venous insufficiency is much higher than expected and that it represents a worldwide problem, which is not limited to developed countries. The socioeconomic impact is enormous due to long lasting treatments, their costs, and high work-incapacity levels, which exceed the yearly numbers obtained in patients with peripheral arterial disease, myocardial infarction, and other cardiovascular events. That is why in recent years some measures have been put in place to reduce this problem. One very good example is that of the ambitious program prepared by the American Venous Forum to reduce the incidence of venous ulcers in the population of the USA. The main measures include professional and public awareness of the problem, early and standardized diagnosis, choice of management, selection of scientific research topics, and organizational health care policy initiatives. No doubt both the contribution of M. Perrin et al and that of S. Marinović Kulišić and J. Lipozenćić are in keeping with these measures. The first article deals with ulcers of combined etiology, which occur in the presence of both advanced venous and arterial insufficiency, while the second article describes good clinical practice in dermatology for the management of patients with chronic leg ulcers.
The contribution of A.O. Tonev et al presents the experience of a Bulgarian vascular department and compares two methods used for the treatment of varicose veins. The results show rather clearly the advantages of the endovenous radiofrequency ablation technique over the classical surgical technique using saphenophemoral ligation and stripping. This is in keeping with the recent guidelines of the Society of Vascular Surgery and the American Venous Forum, which consider endovenous ablation as the preferred technique for the treatment of varicose veins. In this respect, one can wonder whether the better clinical results, less invasive approach, greater availability, and better patient compliance reported with the endovenous techniques will result in a reduction in the incidence of the terminal stages of venous insufficiency in the future.
Pelvic congestion syndrome is very often neglected or little known in general practice. Patients with this condition are sometimes very limited in their everyday activities and unsuccesfully visit different doctors. The review prepared by J. Leal Monedero et al is valuable and presents a diagnostic algorithm and the currently recommended treatments for this condition, where endovenous techniques have priority.
Superficial vein thrombosis has long been considered an insignificant and benign disease. In comparison with deep vein thrombosis, it was expected not to carry a risk of pulmonary embolism. However, in recent years we have witnessed a change of opinion about the management of these conditions, and the paper of A. D. Giannoukas is an excellent survey of the current opinions. It is clear that we now have to include and consider superficial vein thrombosis as one of the regular types of venous thromboembolism—together with deep vein thrombosis, postthrombotic syndrome, pulmory embolism and chronic thromboembolic pulmonary hypertension.
