Servier – Phlebolymphology

In their article entitled “Interaction between ageing, inflammation process, and the occurence of varicose veins”, Julia Buján and coworkers from Spain report interesting immunohistochemical findings on leg veins in normal subjects and varicose veins in chronic venous disease patients. Specimens were obtained from aortocoronary bypass and varicose vein surgery and were differentiated according to age: patients under and over 50. This approach showed that inflammatory cells play an important role in both the aging process and the development of varicose veins.

Oscar Maleti and Marzia Lugli from Modena, Italy, give an overview of their experiences with the revolutionary surgical technique they have developed in which a neovalve is created in patients with postthrombotic syndrome and
massive, deep axial reflux. The essential idea of this method is to perform a vein wall dissection and to create an intimal flap that may act like a venous valve. The method was applied in carefully preselected patients only, some of them
suffering from congenital venous valvular aplasia. Valvular competence assessed by duplex ultrasound and air plethysmography was regained in 86% of cases, and 90% of leg ulcers healed. This new procedure is certainly an ingenious technique in the hands of extremely skilled and well-trained vascular surgeons.

A very useful collection of different instruments for describing patient-reported outcome can be found in the survey presented by Françoise Pitsch, Servier, Paris. Such tools are of increasing interest not only to assess the efficacy of phlebotonic drugs, but should also for use in longitudinal studies and after endovenous procedures. Good doctors do not base their judgment only on objective tests, but will always consider patient satisfaction as well.

Olle Nelzen from Sweden, who is a pioneer of modern epidemiological studies, specifically in the field of leg ulceration, gives us some important hints concerning data collection. It is very encouraging to read in his article how systematic
improvements in health care reduced the point prevalence of venous leg ulcers by 46% within a 14-year period in his region. This was mainly achieved by venous surgery based on Doppler/duplex investigations, which should be done in
every leg ulcer patient.

The three-dimensional computer reconstructions of blood vessels presented by Jean-François Uhl and co-workers from Paris at the end of this issue of Phlebolymphology are fascinating and their implications for our understanding
of vascular anatomy are self-explanatory. What a bright future for our students and young surgeons!

Happy reading.