Servier – Phlebolymphology

Szolnoky explained the left ventricular rotation and twist of the heart in normal situations. The experimental procedure on patients with lymphedema and lipedema consisted of 2D echocardiography and 3D echocardiography at baseline and after a 60-minute application of flat knitted panty hose (23 to 32 mm Hg). The experimental procedure on healthy volunteers consisted of 2D echocardiography and 3D echocardiography at baseline, after a 9-minute treadmill exercise test, and after 60 minutes of wearing 15 to 20 mm Hg sport socks, followed by a 9-minute treadmill exercise in socks. The results of the study clearly showed that lymphedema and lipedema are distinguishable on left ventricular function parameters. Elastic compression showed beneficial effects on left ventricular rotation in patients with lipedema and did not hamper left ventricular rotation in patients with lymphedema. Minor beneficial effects might be attributed to sport socks.

Metabolic profiling in experimental murine deep vein thrombosis was investigated. Deep vein thrombosis and sham control groups could be separated based on their serum metabolic profile. Metabolic pathways implicated in murine experimental deep vein thrombosis are carnitine, sphingolipid, lipid, and adenosine. Separation between deep vein thrombosis and sham laparotomy controls was greatest at 2 days in that murine model – release to ≈2 weeks in human deep vein thrombosis. Next, blood and urine samples were collected and venous duplex was performed in 200 individuals presenting with suspected deep vein thrombosis and 50 healthy controls. Deep vein thrombosis and healthy control groups could be separated, with statistical significance, based on their serum metabolic profile. The speaker summarized that collaborative research has advanced our understanding of the biomolecular signature of deep vein thrombosis. Shalhoub highlighted that NMR metabolome profiling of serum in human subjects, based on early analyses, can separate deep vein thrombosis and healthy controls.

Ochoa explained that the presence of telangiectasia and reticular veins affects 50% of women over the age of 50, which can significantly affect quality of life. Chemical sclerotherapy is the most widely used treatment method due to its technical simplicity and low costs. The reported incidence of hyperpigmentation is 10% to 30% and superficial thrombophlebitis is 7% to 10%. The speaker explained that hyperpigmentation is caused by the migration of melanin pigment to the skin and by the deposition of hemosiderin in the dermis. Risk factors are a large vein diameter, stronger sclerosant, high dose, and no compression. A benefit of early thrombi removal to reduce the incidence of hyperpigmentation has been reported. Ochoa presented the proposal that, if eliminating residual thrombi reduces the incidence of hyperpigmentation, then reducing the initial formation of thrombi using medication with an antithrombotic effect should limit the amount of pigmentation. He introduced sulodexide, a highly purified mixture of glycosaminoglycan consisting of low-molecular-weight heparin (80%) and dermatan sulfate (20%). The drug has profibrinolytic and anti-inflammatory effects. The Survet study that used sulodexide showed a low risk of side effects. The speaker presented the protocol of a 2-year prospective study consisting of a control and an antithrombotic group. The primary end point is the presence of hyperpigmentation at 1 to 3 months and the secondary end points are complications and patient satisfaction. A mid-term report is planned for 2019 and the final analysis and presentation for 2020.

An athlete’s artery has a larger lumen diameter, a thinner wall, and improved vasodilatation. It has been shown that short-term training enlarges the vein diameter. The objective of the planned trial is to determine the impact of endurance exercise on lower limb venous morphology and function in athletes and untrained controls. Results should show what adaptations occur, whether these changes predispose athletes to venous incompetence, and whether adaptations occur in individuals who already have varicose veins.