Servier – Phlebolymphology

Alberto Caggiatti

Dear Readers,

Jean Francois Uhl from Paris (France) undertakes the challenge of explaining venous embryogenesis of the lower limbs. In fact, most referenced studies in phlebology (Lewis, Hochstetter, etc) relate not to humans, but to other mammals, and even to birds or reptiles. After an interesting review of the techniques of embryological studies, Dr Uhl provides an updated summary of current knowledge on the development of leg veins. Moreover, he illustrates the text with his original, magnificent, and time-consuming 3D reconstructions. Finally, Dr Uhl describes the close relationship between embryology and clinically relevant vascular malformations.

In his paper, Stefano Ricci from Rome (Italy) reviews current knowledge on the anatomy of foot veins. Starting from anatomy (and ultrasound anatomy), Dr Ricci sheds light on the complex mechanisms of the venous foot pump and how this pump connects with the more proximal pumps of the anterior and posterior leg. Moreover, he highlights the possible implications of functional abnormalities in this “chain of pumps,” paying particular attention to the phlebologist’s point of view. When should a dilated vein on the dorsum of the foot be considered varicose, and therefore, treated? And how should it be treated? What are the causes and significance of corona phlebectatica? Do primary varicose veins of the foot exist?

Sergey G. Gravilov and colleagues from Moscow (Russia) report on a selected group of 85 women with pelvic pain and lower limb varicose veins, treated with micronized purified flavonoid fraction for 8 weeks. Pelvic pain (self-assessed using a visual analog scale) was significantly reduced in all women during the period of administration. Pelvic pain soon recurred in women with evidence of pelvic varices. In turn, pain was still reduced after 14 weeks in women with only leg varicose veins. In conclusion, the authors suggest the need for long-term administration of micronized purified flavonoid fraction in women with pelvic varices, especially in those “wishing for a future pregnancy or reluctant to undergo surgery.”

Jean-Luc Gillet from Bourgoin-Jallieu (France) reviews the evidence, or lack thereof, for the correct treatment of superficial vein thrombosis. Once considered a benign disease or a common complication of varicose veins, superficial vein thrombosis is currently included among the venous thromboembolic diseases because of the frequent concurrence of deep vein thrombosis and pulmonary embolism. Although longterm anticoagulant treatment was recently proposed, Dr Gillet points out that the guidelines assign such treatment a low-grade recommendation. He concludes that further research is needed to define subgroups of patients with a higher incidence of deep vein thrombosis or pulmonary embolism, in whom long-term anticoagulation may be warranted.

Bo Eklöf from Lund (Sweden) critically analyzes an excellent paper by Malas et al on the effectiveness of surgery of superficial veins in ulcerated patients. Curiously, Malas et al report that “adding superficial vein ligation and stripping to compression did not improve the wound healing rate,” whereas Dr Eklof considers that “ablation is suggested for ulcer healing due to weak evidence; while for the prevention of recurrence, ablation is recommended due to stronger evidence.” More prospective studies are surely needed!

Jerry G. Ninia from NY (USA) comments on an important article by Asbeutah et al showing that cyclic morphological and functional changes occur in the leg veins of women. These consist of a significant increase in vein diameter and in valve closure times. Dr Ninia describes the relationship between these venous changes and cyclic hormonal variations.

Finally, Paolo Prandoni from Italy analyzes for Phlebolymphology readers the randomized study of Haig et al on residual rates of reflux and obstruction after catheter-directed thrombolysis. Dr Prandoni shows how the results of this study and others are strongly suggestive of the protective role of early restoration of vein patency in preventing postthrombotic syndrome.

Enjoy reading this issue!
Alberto Caggiatti