Phlebolymphology N°86

Comments on recent publications

Foreword VEINews; a new heading The VEINews rubric is now incorporated in Phlebolymphology and may take various forms such as comments on a recent international publication (the most common) or on several publications on the same topic. It might also be controversial views of 2 authors on the same publication, or a state-of-the-art article on a timely topic. In this issue, Bo Eklöf (Lund, Sweden), Jerry G. Ninia (New York, USA), and Paolo Prandoni (Padua, Italy) will comment on the following publications: “Comparative effectiveness of surgical interventions aimed at treating underlying venous pathology in patients with chronic venous ulcer” authored…

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Comparative effectiveness of surgical interventions aimed at treating underlying venous pathology in patients with chronic venous ulcer

Malas MB, Quasi U, Lazarus G, et al. J Vasc Surg: Venous Lymphat Disord. 2014;2:212-25. This review was contracted by the US Agency for Health Care Research and Quality (AHRQ) for the Johns Hopkins Evidence-based Practice Center. Two key questions were developed: 1. For patients with a chronic venous ulcer (CVU), what are the benefits and harms of surgical procedures? 2. For patients with a CVU, what are the comparative benefits and harms of different surgical procedures for a given type of venous reflux and obstruction? A systematic review was conducted and 10 646 citations were identified, of which, 22…

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Changes in the diameter and valve closure time of leg veins across the menstrual cycle

Asbeutah AM, Al-Enezi M, Al-Sharifi NM, et al. J Ultrasound Med. 2014;33:803-809. This article presents an evaluation of a specific cohort of young, nulliparous women with duplex ultrasound of the lower extremities at various stages of the menstrual cycle. The study was comprised of an evaluation of 106 limbs in 53 women with homogeneity in their demographic makeup. They lacked, for the most part, any of the classic risk factors for the development of chronic venous deficiency and were all classified as class 0 (no venous disease) on the 7-point clinical, etiologic, anatomic and pathophysiologic (CEAP) scale. The study showed…

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Residual rates of reflux and obstruction and their correlation to post-thrombotic syndrome in a randomized study on catheter-directed thrombolysis for deep vein thrombosis.

Haig Y, Enden T, Slagsvold CE, Sandvik L, Sandset PM, Kløw NE. J Vasc Surg: Venous Lymphat Disord. 2014;2:123-130. Catheter-directed thrombolysis, venous abnormalities, and postthrombotic syndrome Despite appropriate anticoagulant therapy, at least 1 of every 2 to 3 patients with proximal deep vein thrombosis (DVT) of the lower extremities will develop (severe) postthrombotic sequelae (PTS). Among parameters that have been found to be associated with an increased risk of PTS are venous thrombosis of the common femoral or iliac vein, obesity, previous ipsilateral DVT, older age, and female sex.1,2 By contrast, the role played by the development of venous reflux…

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Management of superficial vein thrombosis of the lower limbs: update and current recommendations

Management of superficial vein thrombosis of the lower limbs: update and current recommendations Jean-Luc GILLET Vascular Medicine and Phlebology, Bourgoin-Jallieu, France Abstract Initially, superficial vein thrombosis (SVT) was considered a benign disease or a common complication of varicose veins. Recent studies have shown the potential severity of SVT and defined its place within the venous thromboembolic (VTE) diseases, along with deep vein thrombosis (DVT) and pulmonary embolism (PE). A concomitant DVT was identified in 25% to 30% of patients at presentation and a PE in 4% to 7% of patients. Subsequent VTE were reported in 3 to 20% of patients,…

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Micronized Purified Flavonoid Fraction in the treatment of pelvic pain associated with pelvic varicose veins

Micronized Purified Flavonoid Fraction in the treatment of pelvic pain associated with pelvic varicose veins Sergey G. GAVRILOV, Anatoly V. KARALKIN, Ekaterina P. MOSKALENKO Leninskii Prospekt, Moscow, Russia Abstract Aim: To evaluate the benefit of micronized purified flavonoid fraction (MPFF) in women suffering from chronic pelvic pain associated with pelvic varicose veins (PVV) and possible gonadal varicose veins (GVV). Methods: Consecutive women consulting for pelvic pain lasting more than 6 months, where a differential diagnosis of PVV had been made and possible concomitant diseases ruled out, were included in the study. Selected patients received MPFF treatment: 1000 mg a day…

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The venous system of the foot: anatomy, physiology, and clinical aspects

The venous system of the foot: anatomy, physiology, and clinical aspects Stefano RICCI Ambulatorio Flebologico Rome, Italy Abstract Venous return from the foot is worthy of interest for both research and clinical purposes. This review summarizes the available knowledge of venous return from the foot with a special focus on research and clinical implications. The anatomy and physiology of venous return are described with an emphasis on the differences between standing and walking and the interplay between the venous systems of both the foot and the calf. Selected conditions of clinical interest are discussed and mechanistically interpreted, including the distinctive…

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Focus on venous embryogenesis of the human lower limbs

Focus on venous embryogenesis of the human lower limbs Jean-François UHL Descartes University Paris, France Abstract Embryogenesis of the venous system is a complex phenomenon that is not fully understood. In spite of the studies done by Born, Hochstetter, and Lewis, we do not know the precise chain of events leading to vasculogenesis of the venous network in humans. Yet, this is an important topic in order to improve our anatomical knowledge, which is of the highest interest in clinical practice. A good knowledge of anatomy is mandatory to perform in-depth assessments of chronic venous disorders by ultrasound mapping. Understanding…

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Phlebolymphology N°86 (Vol 22 – N°2 – 2015)

EDITORIAL Editorial By Alberto Caggiatti (Rome, Italy) – Phlebolymphology – 2015 ; 22 (2): 54 PHLEBOLOGY Focus on venous embryogenesis of the human lower limbs Jean-François UHL (Paris, France) – Phlebolymphology – 2015 ; 22 (2): 55 The venous system of the foot: anatomy, physiology, and clinical aspects Stefano Ricci (Rome, Italy) – Phlebolymphology – 2015 ; 22 (2): 64 Micronized Purified Flavonoid Fraction in the treatment of pelvic pain associated with pelvic varicose veins Sergey G. GAVRILOV, Anatoly V. KARALKIN, Ekaterina P. MOSKALENKO (Moscow, Russia) – Phlebolymphology – 2015 ; 22 (2): 76 Management of superficial vein thrombosis of…

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Phlebolymphology N°86 – Editorial

  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…

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