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Endovenous Laser Ablation ...PAGE 51 07_DN_031_BA_COUV 12/03/07 18:09 Page C1 ISSN 1286-0107 Vol 14 • No.2 • 2007 • p49-96 Endovenous laser ablation . PAGE 51 Steven E. Zimmet (Austin, USA) Recent findings in the pathogenesis . PAGE 59 of venous wall degradation Michel René Boisseau (Bordeaux, France) Subjective venous symptoms: . PAGE 74 review and presentation of a pilot study Michael Kendler (Leipzig, Germany) Artificial venous valves: . PAGE 80 an ongoing quest to treat end-stage deep venous insufficiency Michael C. Dalsing (Indianapolis, USA) 07_DN_031_BA_COUV 12/03/07 18:09 Page C2 AIMS AND SCOPE Phlebolymphology is an international scientific journal entirely devoted to venous and lymphatic diseases. Phlebolymphology The aim of Phlebolymphology is to pro- vide doctors with updated information on phlebology and lymphology written by EDITOR IN CHIEF well-known international specialists. H. Partsch, MD Phlebolymphology is scientifically sup- Professor of Dermatology, Emeritus Head of the Dematological Department ported by a prestigious editorial board. of the Wilhelminen Hospital Phlebolymphology has been published Baumeistergasse 85, A 1160 Vienna, Austria four times per year since 1994, and, thanks to its high scientific level, was included in the EMBASE and Elsevier BIOBASE databases. EDITORIAL BOARD Phlebolymphology is made up of several sections: editorial, articles on phlebo- C. Allegra, MD logy and lymphology, review, news, and Head, Dept of Angiology congress calendar. Hospital S. Giovanni, Via S. Giovanni Laterano, 155, 00184, Rome, Italy U. Baccaglini, MD CORRESPONDENCE Head of “Centro Multidisciplinare di Day Surgery” University Hospital of Padova Centro Multidisciplinare Day Surgery, Ospedale Busonera, Via Gattamelata, 64, 35126 Padova, Italy Editor in Chief Hugo PARTSCH, MD Baumeistergasse 85 P. Coleridge Smith, DM, FRCS A 1160 Vienna, Austria Consultant Surgeon & Reader in Surgery Tel: +43 431 485 5853 Fax: +43 431 480 0304 Thames Valley Nuffield Hospital, Wexham Park Hall, Wexham Street, Wexham, Bucks, SL3 6NB, UK E-mail: [email protected] A. Jawien, MD, PhD Editorial Manager Department of Surgery Françoise PITSCH, PharmD Servier International Ludwik Rydygier University Medical School, Ujejskiego 75, 85-168 Bydgoszcz, Poland 192, avenue Charles de Gaulle 92578 Neuilly sur Seine Cedex, France P. S. Mortimer, MD, FRCP Tel: +33 (1) 55 72 68 96 Consultant Skin Physician & Senior Lecturer in Medicine (Dermatology) Fax: +33 (1) 55 72 36 18 E-mail: [email protected] St George’s Hospital, Blackshaw Road, London SW17 OQT, UK Publisher : A. N. Nicolaides, MS, FRCS, FRCSE Les Laboratoires Servier 22, rue Garnier Emeritus Professor at the Imperial College 92578 Neuilly sur Seine Cedex, France Visiting Professor of the University of Cyprus Tel: +33 (1) 55 72 60 00 16 Demosthenous Severis Avenue, Nicosia 1080, Cyprus Fax: +33 (1) 55 72 68 88 G. W. Schmid Schönbein, MS, PhD Professor of Bioengineering and Medicine Indexed in EMBASE, PASCAL The Whitaker Institute for Biomedical Engineering, University of California San Diego, and Scopus 9500 Gilman Drive, La Jolla, CA 92093-0412, USA © 2007 Les Laboratoires Servier - All rights reserved throughout the world M. Vayssairat, MD and in all languages. No part of this publication Professor of Vascular Medicine may be reproduced, transmitted, or stored in any form or by any means either mechanical Hôpital Tenon, 4 rue de la Chine, 75020 Paris Cedex 20, France or electronic, including photocopying, recording, or through an information storage and retrieval system, without the written permission of the copyright holder. Opinions expressed do not necessarily reflect the views of the publisher, EDITORIAL MANAGER editors, or editorial board. The authors, editors, and publisher cannot be held responsible for F. Pitsch, PharmD errors or for any consequences arising from the use of the information contained in this journal. ISSN 1286-0107 07_DN_031_BA_int_ok 12/03/07 18:05 Page 49 CONTENTS EDITORIAL H. Partsch (Vienna, Austria) Page 50 PHLEBOLOGY Endovenous laser ablation Page 51 S. E. Zimmet (Austin, USA) Recent findings in the pathogenesis Page 59 of venous wall degradation M. R. Boisseau (Bordeaux, France) Daflon 500 mg and chronic venous insufficiency Page 69 F. Pitsch (Paris, France) Subjective venous symptoms: Page 74 review and presentation of a pilot study M. Kendler (Leipzig, Germany) Artificial venous valves: an ongoing quest Page 80 to treat end-stage deep venous insufficiency M. C. Dalsing (Indianapolis, USA) BOOK REVIEW M. Cazaubon (Paris, France); M. Perrin (Chassieu, France) Page 86 CONGRESS Congress and conference calendar Page 90 Phlebolymphology. Vol 14. No. 2. 2007 49 07_DN_031_BA_int_ok 12/03/07 18:05 Page 50 EDITORIAL Laser ablation of the great saphenous vein is a technique whose use has expanded dramatically during the last few years. Endovenous techniques without groin incision and high ligation are certainly less invasive than conventional vein stripping, and seem to involve less risk of neovascularization. Steven Zimmet from Austin, Texas, the immediate Past President of the American College of Phlebology, gives a well-balanced overview of laser ablation, including the mechanisms of action, technical details, results, adverse sequelae, and complications. Using tumescent anesthesia, this procedure can be performed in-office without general anesthesia or surgical incisions. Michel R. Boisseau, Pharmacology Department of the University of Bordeaux, contributes an interesting basic research paper entitled “Recent findings in the pathogenesis of venous wall degradation”. One of the central findings is that the leukocyte-mediated inflammatory chain-reaction is a key factor in the development of varicose veins. There is undoubtedly a vicious circle in which damage to venous walls to incompetent valves, which in turn results in further damage to the vein wall. Faced with this “chicken and egg” conundrum, Professor Boisseau favors the interesting view that it is not venous wall alterations that damage the valves, but rather the reverse. A survey, describing the role of Daflon 500 mg in the management of chronic venous insufficiency, is presented by Françoise Pitsch, the driving force behind Phlebolymphology. Michael Kendler and Eva Haas from Germany present an interesting pilot study on patients with “heavy leg syndrome”, which is associated with subjective leg symptoms but no objective signs of venous disease (C0,1 S; En; An; Pn), and is also called “functional phlebopathy” (see Giuseppe Andreozzi. Prevalence of patients with chronic venous disease-related symptoms but without visible signs (described as Cos in the CEAP classification): the Italian experience. Phlebolymphology. 2006;13:28-34). In a quality-of-life analysis using the SF-12 questionnaire, the authors found that a global psychological score deviated significantly from that of a healthy population. Michael Dalsing, the President of the American Venous Forum, presents an excellent overview of artificial venous valves in the treatment of the severe stages of deep venous insufficiency. Non-autogenous valve substitutes have failed in clinical evaluation. Hitherto, only valve cusps made of autogenous vein have shown promising results. It may be expected that some day this kind of “science fiction surgery” will offer a clinically important alternative treatment, at least for selected cases. The last contributions are reviews. Michèle Cazaubon, Paris, reviews a leading article on chronic venous disease, published by a group of prestigious authors (Bergan JJ, Schmid-Schönbein GW, Coleridge Smith PD, Nicolaides AN, Boisseau MR, Eklof B) in a recent issue of the New England Journal of Medicine. Those who are specifically interested should read and digest this landmark paper. Michel Perrin reviews the recently published “Vein Book” (Elsevier), whose editor-in-chief, J-J Bergan, and 89 authors, have risen to the challenge of covering this vast topic in 617 pages, divided into 65 chapters, with over one thousand references. The result is outstanding. Enjoy your reading! Hugo Partsch, MD 50 Phlebolymphology. Vol 14. No. 2. 2007 07_DN_031_BA_int_ok 12/03/07 18:05 Page 51 PHLEBOLOGY Endovenous laser ablation Steven E. ZIMMET ABSTRACT Zimmet Vein and Dermatology Clinic Endovenous laser ablation (EVLA) is a less invasive alternative to vein Austin, USA stripping. Outcomes seem equal to, or better than, those with stripping, with better quality of life scores in the post-operative period. EVLA has been shown to correct or significantly improve hemodynamic abnormality in patients with chronic venous insufficiency (CVI) with superficial venous reflux. Early reports suggest that endovenous ablation techniques, in contrast to surgical stripping, are associated with a low incidence of neovascularization. A variety of wavelengths are being used to perform EVLA. While the initial chromophore is water or hemoglobin, depending on the wavelength used, carbon appears to be a secondary but key chromophore that is probably independent of wavelength. The application of the principles of tumescent anesthesia to venous treatments, along with the development of endovenous ablation techniques, offer the possibility of treating the vast majority of patients with varicose veins in-office without general anesthesia or surgical incisions, while at the same time maximizing outcomes and minimizing recurrence. INTRODUCTION Saphenous vein reflux is the underlying primary abnormality in the majority of cases of superficial venous insufficiency. Thus, approaches
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