Phlebolymphology N°110

Phlebolymphology N°110 (Vol 30 – N°2 – 2023)

Editorial PHLEBOLOGY The role of a multidisciplinary approach to the management of chronic venous disease Phlebolymphology – 2023 ; 30 (2): 60 Diagnostic problems in a symptomatic patient with May-Thurner syndrome George GEROULAKOS, Aikaterini POULOU, Efthymios AVGERINOS (Greece) Phlebolymphology – 2023 ; 30 (2): 61 The natural history of varicose vein progression Matthieu JOSNIN (France) Phlebolymphology – 2023 ; 30 (2): 71 Challenging chronic venous disease treatment within the background of comorbidities Chung-Dann KAN (Taiwan) Phlebolymphology – 2023 ; 30 (2): 80 Chronic occlusion of inferior vena cava and pelvic venous disease Kirill LOBASTOV, Anastasia AKULOVA (Russia) Phlebolymphology – 2023…

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Phlebolymphology N°110 – Editorial

Dear Readers, In this new issue of Phlebolymphology, you will find an original concept of scientific discussion based on clinical cases. These cases cover a wide range of venous pathology and were prepared by international experts within the Vein Inception Programme. This program aims to increase awareness of chronic venous and hemorrhoidal diseases (CVD and HD) and their management over time. All cases come from real clinical practice and represent the need for multidisciplinary involvement in diagnosis and treatment. This original approach includes an opinion expressed by each participating expert on every clinical case presented. So, you may find different…

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

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…

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CLINICAL CASE 1. Diagnostic problems in a symptomatic patient with May-Thurner syndrome

George Geroulakos, MD, PhD Aikaterini Poulou, MD, PhD Efthymios Avgerinos, MD, PhD Department of Vascular Surgery, “Attikon” University Hospital, National and Kapodistrian University of Athens, Athens, Greece A52-year-old male presented a 1-year history of heaviness, dull ache, and swelling from the calf down on both legs. Over the same period, he developed mild punctuated pigmentation on both legs that extended from the ankles to mid-calf, gradually getting worse. There was no previous or current history of deep venous thrombosis. On examination, no varicose veins existed. Circumferential bilateral punctuated pigmentation on the ankles was noticed, being worse on the left lower…

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CLINICAL CASE 2. The natural history of varicose vein progression

Matthieu Josnin, MD, PhD St Charles Clinic, Department of Vascular Medicine Interventional Phlebology Unit Wound Care Center, La Roche-sur-Yon, France This is an evolving clinical case in a patient first presenting at the age of 20, followed through the age of 75. We will start with the first consultation where the patient, aged 20 years, consulted you for the first time with the main reason being occasional discomfort along the inner side of the right lower limb during prolonged standing, especially in summer. The patient had no children, no particular history apart from a family history of chronic venous disease…

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CLINICAL CASE 3. Challenging chronic venous disease treatment within the background of comorbidities

Chung-Dann Kan, MD, PhD Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan A 51-year-old female patient visited our cardiovascular surgery outpatient clinic with a chief complaint of small, visually obvious veins in her left leg, with soreness and pain sensation noted for years. She had no history of diabetes or hypertension. However, she had undergone splenectomy for an idiopathic thrombocytopenic purpura (ITP) state and a total abdominal hysterectomy 10 years earlier for a uterine mass and adenomyosis, complicated by pelvic adhesions the following year. In the photo taken at her visit…

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CLINICAL CASE 4. Chronic occlusion of inferior vena cava and pelvic venous disease

Kirill Lobastov, MD, PhD Pirogov Russian National Research Medical University, Moscow, Russia Anastasia Akulova, MD, PhD Central Clinical Hospital “Railway-Medicine,” Moscow, Russia A woman, 29 years old, asked for medical attention in 2021 due to complaints of heaviness in the lower limbs, varicose veins on the left thigh, and painful menstruation. As known from her personal history, at the age of 7 months, she sustained an extensive skin burn that required skin grafting. After that, she had no complaints till 2016, when, at 24 years old, she initially noted varicose veins on the left lower limb. In 2018, at 26…

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CLINICAL CASE 5. Timing of superficial and deep vein endovascular interventions for the treatment of venous leg ulcers

Nadelin Nikolov, MD, PhD Department of Vascular Surgery, National Heart Hospital, Sofia, Bulgaria We present a case of a 66-year-old female with a recurrent venous leg ulcer (VLU) in the left medial malleolus. The patient had suffered iliofemoral deep venous thrombosis (DVT) 10 years ago. She was treated with oral anticoagulation for 2 years and venoactive drugs but no compression stockings. Since then, she has complained of visible varicose veins, swelling, and discomfort in her left leg. Five years after the index DVT, she developed a small VLU in the area of the left medial malleolus, which became bigger over…

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CLINICAL CASE 6. Prevention of postthrombotic syndrome after proximal DVT

Zoubida Tazi Mezalek, MD, PhD Department of Clinical Hematology, Internal Medicine, Mohammed V University, Ibn Sina Hospital, Rabat, Morocco A38-year-old female patient, a nurse in a hospital ward, presented 6 months earlier with extensive iliofemoral deep venous thrombosis (DVT) of the right lower limb. She was treated with rivaroxaban 15 mg twice daily for 21 days, followed by 20 mg once daily. The DVT remained unexplained by a classical risk factor. She has not had any surgery or hospitalization and has not traveled recently. She has 2 children aged 9 and 4 years. She has been on oral hormonal contraception…

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