Phlebolymphology N°110 – Editorial
Dear Readers,
In this new issue of Phlebolymphology, you will find an original concept of scientific discussion based on clinical cases. These cases cover a wide range of venous pathology and were prepared by international experts within the Vein Inception Programme. This program aims to increase awareness of chronic venous and hemorrhoidal diseases (CVD and HD) and their management over time. All cases come from real clinical practice and represent the need for multidisciplinary involvement in diagnosis and treatment. This original approach includes an opinion expressed by each participating expert on every clinical case presented. So, you may find different and possibly opposing practices, all based on scientific evidence and clinical experience.
The first case presented by G. GEROULAKOS, A. POULOU, and E. AVGERINOS (Greece) discusses the role of nonthrombotic iliac vein lesion in the development of progressive CVD with low response to the standard treatment for superficial reflux. The main question for the discussion is about what patients with varicose veins should be assessed for proximal venous obstruction.
The second case presented by M. JOSNIN (France) is dedicated to the natural history of varicose vein progression in women. Experts discuss different sex-based specifications of the treatment for superficial reflux according to the patient’s age: from maidenhood when she takes contraceptive pills, through adulthood when she plans another pregnancy, to elderly age when she receives oral anticoagulants.
The third case presented by C. D. KAN (Taiwan) is focused on a challenging combination of nonthrombotic iliac vein lesion and idiopathic thrombocytopenic purpura. Experts discuss the possibility of vein stenting and strategies for further antithrombotic treatment, considering bleeding risk.
The fourth case presented by K. LOBASTOV and A. AKULOVA (Russia) discusses the strategy of pelvic congestion syndrome treatment in the presence of chronic inferior vena cava obstruction. Experts express different opinions on the feasibility of embolization of gonadal veins in the presence of untreated obstruction, options for conservative treatment of pelvic pain, the impact of pelvic congestion syndrome on fertility, and the strategy of pregnancy management.
The fifth case presented by N. NIKOLOV (Bulgaria) is dedicated to the treatment of a recurrent venous leg ulcer in the patient with a combination of postthrombotic iliac vein occlusion and superficial venous reflux. Experts discuss the optimal sequences of interventions on deep and superficial veins, a strategy of antithrombotic treatment after venous stenting, and the efficacy of conservative treatment of venous ulcers in deep vein obstruction.
The sixth case presented by Z. T. MEZALEK (Morocco) is focused on the prevention of postthrombotic syndrome in patients with iliofemoral deep venous thrombosis. Experts discuss the role of endovascular thrombectomy, compression therapy, anticoagulants, and venoactive drugs in preventing postthrombotic syndrome. They also touch on the pathogenesis of the syndrome and the ambiguity of diagnostic methods.
Enjoy reading this issue!
Co-Editor
Dr Kirill Lobastov
