Servier – Phlebolymphology

In this new issue, Christine Biron-Andréani from Montpellier presents an excellent review on the clinically very important issue of the thromboembolic risk in the postpartum period. Based on recommendations from the Royal College of Obstetricians and Gynaecologists, categories of very high, high, and intermediate risk are defined and prenatal and postnatal prophylaxis with low-molecular-weight heparin is suggested to be given for a period of time that should be adjusted to the risk group.

An interesting overview on modern advancements in stent technologies including drug-eluting, biodegradable, and covered stents is presented by Nabil Chakfé and his group from Strasbourg, concentrating on stenting of superficial femoral arteries and iliac veins. The article not only discusses technical aspects, but also important questions of indications and outcome, and contains an updated reference list which will be helpful for those readers who are interested in obtaining more details.

Interesting first results from a Russian randomized multicenter study guided by Vadim Bogachev, Moscow, are presented which demonstrate, after endovenous procedures on varicose veins, improved VCSS and quality of life outcomes in the group taking 2 tablets of MPFF* 2 weeks before and 4 weeks after the procedure, compared with compression. This indication is certainly a model of considerable clinical relevance.

Superficial vein thrombosis is the “little sister” in the unfriendly family of venous thromboembolism. Denis Clément from Ghent summarizes in his contribution the evidence that this little sister is far less harmless than previously thought, and provides an excellent review about modern therapy. The cost-effectiveness discussion regarding routine therapy with fondaparinux is mentioned and—unlike in most other publications—suggestions are also made for the management of such patients after the acute event.

Veins constitute important components of our complex vascular organ system and are not simply passive conduits serving blood transport. The vein wall comprises several tissues and owns its own richly developed microvascular system, including the vena venarum, which can be the focus of thrombotic and inflammatory processes, a fact that has been ignored widely in clinical practice. The article written by Stephan Nees, Munich, and coworkers, containing some very informative illustrations, should not only arouse the curiosity of Phlebolymphology readers, but should also help them to understand that the vena venarum system plays an important role in the development of many forms of venous disease. Venous thrombotic events and the transition to a postthrombotic syndrome are good examples.

Only in recent years has it become clear that the postcapillary venules in all organ systems play a key role in the induction of hemostatic reactions and in the genesis of inflammatory cell activities and edema. Only recently has attention been directed to the vessel wall and its interaction with inflammation, hypercoagulabity and immune responses. The article by Nees et al offers considerable new detail in this respect.

The second part of this presentation, to be published in the next issue of this journal, will concentrate on therapeutic consequences of these basic research results.