Servier – Phlebolymphology

Renate van den Bos and Marianne de Maeseneer, both working at the Dermatological University clinic in Rotterdam and outstanding experts in the field, discuss the strengths and weaknesses of the endovenous thermal ablation of varicose veins. They point out that duplex-guided endovenous procedures have widely replaced classical stripping and that the newly developed steam ablation procedure has a promising future, being safer, faster, easier, and cheaper than endovenous laser and radiofrequency ablation (see also the article by René Milleret: Obliteration of Varicose Veins with Superheated Steam. Phlebolymphology. 2011;19:174-187).

In an extensive review article, Professor Byung-Boong Lee, George Washington University School of Medicine, shows that knowledge of embryology may be key to understanding vascular pathologies, for instance for the differentiation between truncular and extratruncular forms of vascular malformations. His article contains beautiful illustrations of clinical conditions: radiological, MRI, and nuclear medicine pictures and schematic drawings, which are helpful to understand this very complex topic.

Jean-Jérôme Guex from Nice, together with a group of prominent coauthors working on the Vein Consult Program, a worldwide epidemiological survey (see the article by Francoise Pitsch in the last issue of Phlebolymphology; 2012;19:132-137), has analyzed a large group of symptomatic C0 patients, a cohort of patients that is well-known to every phlebologist. Out of a total of 91 545 subjects, 19.7% did not show any visible or palpable signs of venous disease—this is the definition of the C0 class according to the CEAP classification—but presented with subjective symptoms. Most of the 14% of patients who underwent a duplex scan examination had superficial reflux, and 18% had deep reflux. The authors suggest that an “inflammatory hypothesis” may be the cause of the symptoms, which include a reduced quality of life, and propose that venoactive drugs should be used for treatment.

Based on their extraordinary experience with sclerotherapy using Sigg’s technique, Francesco and Giovanni Ferrara from Naples have showed, in a case series of 60 patients, that diabetes mellitus with good glycemic control (HbA1c<6.5%) is not a contraindication for this technique, but rather gives equally good results and no more complications than in nondiabetics.