Servier – Phlebolymphology

Up to now, our understanding of how venous valves work was mainly based on theoretical concepts. Modern ultrasound technology enables the observer to record simultaneously the motions of valve leaflets, and changes in size and shape of the venous sinus and blood flow through the valve during the respiratory cycle and during exercise in different body positions.

Fedor Lurie, together with Robert Kistner and coworkers from the University of Hawaii provide us with a meticulous analysis of the exact mechanisms of a valve cycle between the opening and closing of a valve. A spontaneous rhythm can be observed in the supine position, which is obviously influenced by respiratory and cardiac cycles. Valve closure does not need reversed flow!

Michel Perrin and coworkers provide a report of a survey conducted among 198 French angiologists who tested different severity scores in 1900 patients with chronic venous disease. In addition to the venous disability score from the CEAP-classification, the French team also used the venous clinical severity score (VCSS) and the venous segmental disease score (VSDS). This is a very interesting article, since for the first time the usefulness of the rather theoretical constructs have been tested in daily clinical practice by experienced clinicians.

A survey on the benefits of MPFF at a dose of 500 mg in venous edema is reported on by Françoise Pitsch.

According to the large epidemiological study by Eberhard Rabe in Germany, 14.3% of the adult population has some degree of leg swelling. Despite this enormous clinical importance the average interest in diagnosis and treatment of this common condition is rather poor. For many doctors it is a kind of therapeutic reflex to prescribe diuretics, forgetting that prolonged use may induce a disturbance in the rennin-angiotensin mechanism that will even exacerbate the edema.

Jean-François Uhl and coworkers discuss the vicinity of the sural nerve to the junction of the small saphenous vein and its clinical consequences. The reason for this vein-nerve association can be found in embryological development. Recently Stefano Ricci from Rome surprised us with Duplex pictures, showing that a trained eye is able to see the nerve in the popliteal fossa nearly in every case.

Last but not least, Giuseppe Andreozzi and colleagues from the University of Padova discuss the frequent and practically important clinical group of patients presenting with subjective leg symptoms without visible signs of a venous disorder. According to the CEAP classification they describe such cases as C0s, En, An, Pn. However, they were able to find some objective abnormalities in the venous tone by plethysmographic investigations and also by measuring the difference between the venous diameters in the supine and in the upright position using Duplex. The scoring “Pn” for “no pathophysiology detectable” may therefore be disputed. It would be interesting to see such tests established as routine methods, which could be carried out with multicenter cooperation between different vascular labs.

Enjoy reading,