Servier – Phlebolymphology

Dear Readers,

This issue of Phlebolymphology once again brings topics of immediate interest to the fore.

A high number of chronic venous ulcers will have a prolonged healing, despite the best medical practices. This could be due to their malignant transformation into squamous cell carcinomas that are referred as “Marjolin’s ulcers.” P. Senet analyzes the connection between cancer and chronic venous ulcers in this issue. She points out that one of the key clues for Marjolin’s ulcer diagnosis is the prolonged duration of the preexisting wound.

The review of the foam sclerotherapy trials for the treatment of varicose veins as written by M. Perrin, highlights that foam sclerotherapy is a safe procedure with a low rate of adverse reactions. In terms of cost effectiveness yet, foam sclerotherapy is no doubt the “winner” but is credited with more frequent recurrences when compared with other operative procedures for treating varices.

The role of the venous component in both HD pathogenesis and the occurrence of postsurgery symptoms should not be ignored.. In their paper regarding the benefits of micronized purified flavonoid fraction (MPFF) in the reduction of symptoms after HD operation, the authors V. Astashov and D. Timchenko recommend the use of MPFF in association with HD surgery because the drug has a positive impact on the local hemodynamic component due to a normalization of venous tone in hemorrhoidal plexuses, a reduction in excessive capillary permeability and capillary walls fragility, an improvement of lymphatic drainage, and an inhibition of local inflammatory processes.

M. Boisseau points out in his review that many hereditary factors influence the quality of the venous wall in venous disease, and the always feared occurrence of an ulcer. Genetic screening include family studies, gene expression analysis (Single candidate gene expression, DNA microarrays), or genotyping methods (single nucleotide polymorphisms, mutation).

Other interesting aspects of the pathophysiology of chronic venous disease has been reported by S. Nees. He emphasizes that the goal of treatment must be to normalize venous pressure and the function of the “vasa venarum,” and all measures aimed at improving venous return such as compression, surgical interventions, and pharmacological therapies including flavonoids must be considered.