Servier – Phlebolymphology

Dear Readers,

This issue of Phlebolymphology contains several highlights. Anthony Comerota, Director of the Jobst Vascular Center of the University of Michigan, Toledo, Ohio, USA, gives a very comprehensive overview of the current status of thrombolysis for acute deep vein thrombosis. Due to the development of various forms of special catheter techniques, the rate of successful procedures can be increased and the previous risks connected with systemic fibrinolysis seem to be diminished. Long-term studies will be needed in order to prove that the rate of postthrombotic syndrome can be diminished in comparison with conservative therapy with adequate anticoagulation, mobilization, and compression.

Athanasios Giannoukas of the University of Thessaly, Greece, presents a meta-analysis, which is based on four randomized, controlled studies demonstrating that the incidence of postthrombotic syndrome can be approximately halved if the patients wear medical compression stockings after proximal deep vein thrombosis. Early ambulation and compression together with low-molecular-weight heparin offer symptomatic relief in the acute phase of DVT, without an increased risk of recurrent thromboembolism.

One of the problems with compression therapy is poor patient compliance. Seshadri Raju and coworkers at the University of Mississippi Medical Center, Jackson, USA, demonstrate in a retrospective analysis that of 3144 chronic venous disease patients who had been under the prior care of primary care physicians or specialists, only 21% reported using the stockings on a daily basis, and 63% did not use them. These data correspond very well to findings from the recently published Bonn vein study showing that of 450 patients to whom compression stockings had been prescribed in the past, 69% did not wear them at the time of the survey (Pannier F, et al. Phlebologie. 2007;36:245-249). It can only be hoped that patients who would benefit from compression stockings, after deep vein thrombosis, for instance, do really wear them. Practitioners would certainly welcome recommendations concerning clear indications for compression stockings based on evidence and not just on convention.

Nicolas Danziger of the Pain Center at the Medical Faculty Pitié-Salpêtrière, Paris, discusses the pathophysiology of pain in venous disease and presents interesting experimental findings suggesting an activation of venous and perivenous nociceptors accounting for the occurrence of pain starting at the early stages of venous disease. The decreasing pain with more advanced stages of venous disease may be related to peripheral sensory neuropathy induced by venous microangiopathy.

Results from the TRIANGLE screening program initiated by Servier are presented by Prof Viera Stvrtinová, Medical Faculty of Comenius University, Bratislava. TRIANGLE is an international, observational research program concentrating on the triad of clinical signs, symptoms, and quality of life in patients with chronic venous disorders. The results from 3134 patients who were seen by 99 general practitioners in the Slovak Republic are reported. Patients with subjective symptoms or objective signs of chronic venous disease or both were enrolled and assigned to the clinical classes of the CEAP classification. Heaviness and pain in the lower limbs were present in 77% of patients, more frequently in higher than in lower CEAP classes. Leg swelling in the evening was reported by 20% of patients and edema during the daytime by 13%. Because of the selection criteria, the percentage of patients of CEAP class C1 was lower and of C6 higher than in epidemiological studies, like in the Bonn vein study in which a large, randomly selected population was examined clinically and by duplex scanning (Rabe E, et al. Phlebologie. 2003;32:1-14).

Enjoy reading!