Phlebolymphology N° 88 – Editorial
Lourdes REINA GUTTIEREZ
Dear Readers,
In this new issue, Michel Perrin presents the first of two chapters on the updates in operative treatments for primary superficial vein incompetence. In this chapter, the various procedures for varicose vein ablation (endovenous thermal ablation, surgery, chemical ablation, mechanochemical ablation) and their possible complications are described. Endovenous treatment provides an office-based procedure that improves both the postoperative course and convalescence duration.
For prevention of the postthrombotic syndrome, catheter-directed thrombolysis can be used in acute iliofemoral venous thrombosis with promising long-term results. According to the review by Niels Baekgaard and Rikke Broholm, stenting of all residual obstructive lesions is mandatory. However, these results come from many single-center studies and a few randomized controlled trials. To shorten the treatment duration, the addition of mechanical devices to catheter-directed thrombolysis is currently under investigation.
Luigi Pascarella reviews the new pharmacological targets in chronic venous disease and explains the strong link between venous hypertension, valve failure, and venous inflammation. Currently, micronized purified flavonoid fraction (MPFF) is the only drug with evidence for protection against venous inflammation–related damage. The effects of MPFF on microvalves are still unknown, but clearly, this deserves further investigation.
In 2013, social alarm broke out in Europe after some studies reported a significantly increased risk of venous thromboembolism with the use of oral hormonal contraceptives combining estrogen and a third- or fourth-generation progestin. Christian Jamin reviews the results of the earlier studies that have been called into question due to methodological limitations. The article summarizes the recommendations from the official agencies (ie, WHO, FDA, EMA) that reviewed the recent epidemiological studies. They concluded that, although there may be differences in the risk of venous thromboembolism between products with different progestins, the absolute risk is very small and the benefit-risk ratio of all combined contraceptives is positive.
Marian Simka reviews the controversy surrounding the association of so-called venous symptoms with chronic venous disease and summarizes the research related to this problem in an attempt to explain conflicting results and interpretations of the studies.
For the first time, Dmitry Lishov and colleagues present the results of the Russian VEIN Act Program, a multicenter, prospective, observational survey designed to assess compliance with nonsurgical treatment for chronic venous disorders. The VEIN Act Program reflects the profile of chronic venous disorders among Russian patients consulting phlebologists and their behavior toward nonoperative treatments.
Enjoy reading this issue!
Lourdes Reina
