The role of a multidisciplinary approach to the management of chronic venous disease

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Kirill Lobastov,1 MD, PhD; George Geroulakos,2 MD, PhD; Matthieu Josnin,3 MD, PhD; Chung-Dann Kan,4 MD, PhD; Nadelin Nikolov,5 MD, PhD; Zoubida Tazi Mezalek,6 MD, PhD; Olga Dzhenina,7 MD, PhD; Aikaterini Poulou,2 MD, PhD; Efthymios Avgerinos,2 MD, PhD; Anastasia Akulova,8 MD, PhD


1. Pirogov Russian National Research Medical University, Moscow, Russia. 2. Department of Vascular Surgery, “Attikon” University Hospital, National and Kapodistrian University of Athens, Athens, Greece. 3. St Charles Clinic, Department of Vascular Medicine Interventional Phlebology Unit Wound Care Center, La Roche-sur-Yon, France. 4. National Cheng Kung University Hospital, Department of Surgery, Tainan, Taiwan. 5. Department of Vascular Surgery, National Heart Hospital, Sofia, Bulgaria 6. Department of Clinical Hematology – Internal Medicine, Mohammed V University, Ibn Sina Hospital, Rabat, Morocco. 7. First Phlebological Center, Moscow, Russia. 8. Central Clinical Hospital “Railway-Medicine”, Moscow, Russia

INTRODUCTION

Chronic venous disease (CVD) is a prevalent condition and one of the most common vascular disorders in the world. According to the results of a recent meta-analysis of epidemiological studies, CVD could be found in 67% of the general population, represented by the following CEAP (clinical-etiological anatomical-pathophysiological) clinical classes: C0s in 9%, C1 in 26%, C2 in 19%, C3 in 8%, C4 in 4%, C5 in 1%, and C6 in 0.42%.1 Indeed, such prevalent pathology could consume up to 2% of the health care budgets of Western countries.2 CVD may be represented by venous symptoms like pain or aching, throbbing, tightness, heaviness, fatigue, sensation of swelling, cramps, itching, restless legs, tingling, heat or burning sensation, venous claudication and signs like telangiectasias, reticular veins, varicose veins (VVs), edema, dermatitis, skin hyperpigmentation, induration and atrophy, and healed and open venous ulceration underlined by deep or superficial venous reflux or obstruction.3-5 Besides lower-limb CVD, specific attention is required for pelvic venous disease (PVD), which can lead to pelvic congestion syndrome (PCS) development in men and women, perineal and genital varicosities, and renal and fertility complaints.6 Considering a broad spectrum of clinical symptoms and signs that may significantly affect the quality of life (QOL), treatment of individual CVD and PVD cases may require the input of different medical specialists: surgeons and vascular surgeons, angiologists and phlebologists, intervention radiologists, dermatologists and cosmetologists, gynecologists and urologists, hematologists, and others. So, searching for the best treatment option for every individual patient may require a multidisciplinary discussion.

Here, we present 6 clinical cases discussed by the multidisciplinary team to provide the best medical care, putting current scientific evidence at the top while not ignoring each expert’s individual experience.

References
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