Servier – Phlebolymphology

Marianne DE MAESENEER

Dear Readers,

In this issue, Michel Perrin reviews the evidence–or the lack of thereof–for treatment of recurrent or residual varicose veins after previous treatment (PREsence of VArices after operatIve Treatment [PREVAIT]). Duplex ultrasound is essential for determining an adequate therapeutic approach. Several treatment methods have been reported, of which foam sclerotherapy is becoming the most popular. Unfortunately, the vast majority of available studies on surgical treatment, thermal ablation, or chemical ablation only report short-term results up to 1 year after the procedure. More prospective studies are definitely needed.

Giovanni Mosti sheds light on compression after treatment of varicose veins and superficial venous reflux. At the thigh, it is particularly difficult to exert efficacious compression on the treated great saphenous vein (GSV) by means of elastic stockings. To reduce postoperative pain and bruising, additional eccentric compression devices, or even inelastic bandages, may be required. Unfortunately, the studies available, so far, are not sufficient to draw definitive conclusions, but in cases with more extensive disease, compression may certainly be beneficial.

Tsoukanov et al reports on a selected, small group of 26 female patients with a Clinical, Etiological, Anatomical, Pathophysiological (CEAP) classification of C0s who did not have reflux in the GSV according to duplex ultrasound investigation in the morning, but developed at least a segmental reflux in the GSV when reexamined in the evening. The effect of micronized purified flavonoid fraction (MPFF) was studied in these particular patients. Tsoukanov’s interesting preliminary findings certainly warrant further investigation.

With the increasing frequency of long-haul flights, physicians receive many questions about the risk for developing venous thromboembolism (VTE). Michèle Cazaubon reviews the current knowledge on this subject and summarizes recommendations for clinical practice. Whereas some general rules are applicable to all air travelers, some additional measures may be required for selected travelers who are at intermediate or high risk of developing a VTE. These measures mainly consist of medical elastic compression stockings and/or pharmacologic thromboprophylaxis. Cazaubon illustrates the whole theme very well with a challenging clinical case.

Robert Launois explains the importance of measuring methods to evaluate quality of life (QOL) in patients with chronic venous disorders. Before being used in clinical trials, QOL tools should be constructed carefully, with a vocabulary that is understandable for most patients. The scale used should be as reliable as possible. Furthermore, these QOL tools need to be extensively validated, and revalidated, when translated into different languages. Generic QOL tools should always be used in addition to disease-specific QOL tools for scientific studies and audits.

Enjoy reading this issue!
Marianne De Maeseneer