Phlebolymphology N°99

VIII. Debates session

VIII. Debates session • The dangers of stenting for nutcracker syndrome far outweigh any benefits For the motion Gerard O’Sullivan (Galway, Ireland) Venography and pressure gradient, noninvasive imaging, laboratory studies, clinical examination, and symptom history help achieve a diagnosis. Approximately 75% of patients which can occur early, but also as late as 5 months; 2 of the stents migrated into the heart. There are multiple surgical techniques, such as left renal vein (LRV) transposition, LRV transposition±patch/cuff, and LRV transposition±patch±stent, LRV-inferior vena cava bypass, left gonadal vein transposition, superior mesenteric artery transposition, auto-transplantation, and nephrectomy. Surgery is invasive, but can be…

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VII. Lymphoedema session

VII. Lymphoedema session Optimal lymphoedema diagnosis and management in 2019 Peter Mortimer (London, UK) Genomic medicine is the future for the diagnosis and management of primary lymphedema and vascular anomalies. Genomic medicine is the use of the genomic information of an individual to guide their clinical care. Genomic information is the sequencing and analysis of an organism’s entire DNA. Milroy disease is caused by a germ-line mutation in vascular endothelial growth factor receptor 3 (VEGRF3) that is associated with venous reflux and hydroceles in boys. Lymphedema distichiasis is caused by germ-line mutation in Forkhead Box C2 (FOXC2) that leads to…

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VI. Pelvic venous disease session

VI. Pelvic venous disease session How to decide when pelvic venous reflux is clinically relevant and pelvic congestion syndrome Neil Khilnani (New York, NY, US) Pelvic venous reflux can be due to lower extremity and vulvar varicose veins. The symptoms can be lower limb swelling and/or claudication, left flank pain and/or hematuria. The new nomenclature for pelvic venous disorders consists of ovarian vein reflux, iliac vein reflux, renal vein compression, and iliac vein compression. The pathophysiology is clearly defined and inter-related and it can have an origin related to pelvic congestion, Nutcracker syndrome, and May-Turner syndrome. Pelvic venous disorders are…

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V. Miscellaneous venous topics

V. Miscellaneous venous topics Latest advances in managing C1 disease Paul Pittaluga (Monaco, Monaco) Sclerotherapy of telangiectasia and reticular veins is the oldest, but still the most common method of treatment. On one hand, it is simple, cheap, office-based, and requires no anesthesia. On the other hand, it needs several sessions, is not easy to perform, has variable results, and leads to pigmentation. The other option is skin laser because it requires no injections, it is office-based, it allows for the treatment of matting, and it is perceived as a modern technique; however, it is expensive, provides unequal results, and…

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IV. Venous ulceration session

IV. Venous ulceration session Novel treatments for intractable leg ulcers Alfred Obermayer (Vienna, Austria) Detecting the source of local venous hypertension straining the skin by duplex ultrasound is an important maneuver. Great saphenous vein reflux causes axial-type medial ulcers and small saphenous vein reflux causes axial-type lateral ulcers. On the contrary, small saphenous vein reflux can cause crossover-type medial ulcers. The presence of a swinging blood column is the evidence for the diagnosis of a venous ulcer. A crossover pattern or a small diameter may lead to inaccurate treatment and early recurrence. Sourcing helps to detect the responsible superficial reflux…

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III. Deep venous system session: chronic venous outflow/ obstruction/ acute reflux DVT treatment/ deep venous

III. Deep venous system session: chronic venous outflow/ obstruction/ acute DVT treatment/ deep venous reflux Optimizing pathways for acute DVT treatment Prakash Saha (London, UK) Deep vein thrombosis (DVT) is a common medical condition that occurs in 1 UK resident out of 1000 every year, and the iliofemoral venous segment is involved in 10% to 15% of cases. DVT results in a postthrombotic syndrome in 30% of all cases and costs the National Health Service about 1 billion pounds per year. Improving the outcomes of DVT requires providing appropriate management of these patients in an ambulatory setting with around-the-clock ultrasound…

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II. Advanced venous disease session

II. Advanced venous disease session Role of elevated central venous pressures in chronic venous insufficiency Raghu Kolluri (Columbus, OH, US) Marked changes in intrathoracic pressure lead to decreased intrathoracic pressure, resulting in central hypovolemia (from pulmonary vasoconstriction) and an increase in peripheral fluid retention. Intermittent nocturnal right ventricular failure leads to venous pressure within the lower extremities and manifests as edema. Activation of the renin-angiotensin- aldosterone system leads to periodic left ventricular dysfunction during apnea and results in lower extremity edema. Apneic episodes increase systolic blood pressure during sleep, which leads to left ventricular diastolic dysfunction and peripheral edema. The…

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I. Venous and lymphatic challenges: superficial veins

I. Venous and lymphatic challenges: superficial veins Foam sclerotherapy can replace phlebectomy for the management of varicosities Claudine Hamel-Desnos (Caen, France) A review of the literature on truncal vein ablation showed no difference in terms of recurrences between concomitant and delayed treatment; moreover, Sutton et al1 showed that deep vein thrombosis occurred more when concomitant phlebectomy is performed. International guidelines are not all in accordance. An important factor for foam sclerotherapy is a relevant choice of access site. Key points before starting are disconnection of the large tributaries and a precise duplex ultrasound examination. Sclerotherapy is possible for large veins…

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