J J Guex

AIM: The Vein Consult Program is an international, observational, prospective survey aiming to collect global epidemiological data on chronic venous disorders (CVD) based on the CEAP classification, and to identify CVD management worldwide. The survey was organized within the framework of ordinary consultations, with general practitioners (GPs) properly trained on the use of the CEAP classification. METHODS: Screening for CVD was to be performed by enrolling in the survey all consecutive outpatients >18 years whatever the reason for consultation, to record patient's data and classify them according to the CEAP, from the stage C0s to C6. The program enrolled 6232 GPs 91545 subjects were analysed. Their mean age was 50.6±16.9 years, younger patients being in the Middle East and older ones in Europe, and the proportion of women was higher than that of men. RESULTS: The worldwide prevalence of CVD was 83.6%: 63.9% of the subjects ranging C1 to C6, and 19.7% being C0s subjects. C0s patients were more frequently men whatever the age and the geographical zone. C1-C3 appeared to be more frequent among women whatever the country but the rate of severe stages (C4-C6) did not differ between men and women. GPs consider CVD subjects as patients eligible to specialist referral beginning from C2 but some geographical disparities were observed. CONCLUSION: The VCP survey provides reliable results on CVD global epidemiology and shows that CVD affects a significant part of the populations worldwide, underlining the importance of adequate screening for CVD and training of both GPs and specialist physicians.

Report of the meeting† held in Paris on 17th & 18th July 1998 with participation oft: Ugo Baccaglini, Italy; Pierre Barthelemy. France; Jean-Claude Couffinhal. France: Denis Creton. France: Simon Darke, United Kingdom; Ralph De Palma, United States of America; Bo Eklof, United States of America; Ermenegildo Enrici, Argentina; Gilbert Franco, France; Jean Pierre Gobin, France; Louis Grondin, Canada; Jean-Jerome Guex. France; Georges Jantet. France; Claude Juhan. France; Jordi Maeso y Lebrun. Spain; Philippe Nicolini. France; Andreas Oesch, Switzerland; Marcelo Paramo-Diaz. Mexico; Michel Perrin. France; Paul Puppinck, France; Eberhard Rabe, Germany: Rene Rettori, France; John Royle, Australia; Vaughan Ruckley, United Kingdom; Michel Schadeck, France; Jean Claude Schovaerdts, Belgium; John Scurr, United Kingdom; Georgio Spreafico, Italy; Jan Struckman, Denmark; Frederic Vin, France Recurrent varicose veins after surgery (REVAS) are a common, complex and costly problem. The frequency of REVAS is stated to be between 20 and 80% depending on the definition of the condition. A consensus meeting on the topic (Paris 1998, July) decided to adopt a clinical definition: the presence of varicose veins in a lower limb previously operated on for varices. The pathology of recurrent varicose veins has been poorly correlated with clinical examination and operative findings. Clinical diagnosis remains essential but does not allow a precise assessment of REVAS. Consequently, the use of imaging investigations is essential. Duplex scan is considered as the method of choice. Both clinical diagnosis and imaging investigations allow the development of a classification for every day usage and future studies. This new classification of CEAP needs to be expanded to define the sites, nature and sources of recurrence, the magnitude of the reflux and other (possible) contributory factors. Methods for REVAS treatment include compression, drugs, sclerotherapy and redo surgery. There was no general consensus in favour of sclerotherapy, surgery or both to treat REVAS. Very few data were available to assess the results of treatment. Factors responsible for recurrence and recommendations for primary prevention were debated and are presented in this article. Guidelines for well-planned prospective studies have been produced.

Various techniques may be used to assess leg edema. The value of these investigations has been discussed in depth in the consensus statement made in Vaux de Cernay in 1997 and supported by Servier Research Group. These techniques can be classified into three groups: The most simple is leg circumference measurement, which can be assessed by a tape measure, or more rigorously with a Leg-O-Meter. This device is a cheap and reproducible method that has been validated and that takes into account the height at which the circumference has been measured. However, circumference measurement is not always correlated with leg (including foot) volume measurement. The second group of techniques assess leg volume. The most simple method is water displacement volumetry, which has been validated in terms of reproducibility. Several other devices have been used: optoelectronic methods, computed tomography, magnetic resonance imaging (high resolution), dual X-ray absorptiometry. These methods are expensive and not all of them have been validated, but these might be the future investigations of choice. Some other investigations assess immediate variations in volume such as water displacement using dynamic foot volumetry, rheoplethysmography, strain gauge plethysmography, and air plethysmography. The assessment made by these methods (using postural, dynamic, or compressive maneuvers) is more an assessment of the venomuscular pump and/or venous outflow than volume assessment. In conclusion, edema, an early and frequent sign of chronic venous insufficiency (CVI), can be precisely measured by several methods. This measurement can be considered one of the most objective ways of assessing treatment efficacy in CVI-associated edema.

BACKGROUND: Visual disturbances (VDs) are reported with an average rate of 1.4% after foam sclerotherapy (FS). Some clinical clues indicate that they could correspond to migraine with aura (MA). AIMS: To validate the hypothesis that VDs occurring after FS correspond to MA and are not transient ischaemic cerebro-vascular events. METHOD: A prospective multicentre study was carried out by the French Society of Phlebology in collaboration with the Neurology Department of the Marseille University Hospital (France). We included prospectively and consecutively all patients who experienced VDs after FS using air to make the foam. The patients were assessed (1) clinically with a specific form describing procedures of FS and recording neurological symptoms, later analysed by a neurologist specialized in migraine; and (2) by a brain diffusion-weighted magnetic resonance imaging (MRI) (T1, T2, T2*, diffusion) carried out within two weeks and analysed by a neuroradiologist. RESULTS: Twenty patients, 16 women and four men, were included in 11 phlebology clinics. All kinds of veins were treated. VDs occurred in average seven minutes after FS. Clinical assessment showed that VDs presented characteristics of MA in all patients, with headache in 10 and without in 10. Paresthesia was observed in five patients and dysphasic speech disturbance in one. Fifteen patients (75%) had a personal history of migraine. Fifteen MRIs were performed within two weeks (mean: 8 days) and three were late (26 days). All of them were normal. MRI was not performed in two patients. CONCLUSION: These results show that VDs occurring after FS correspond to MA and are not transient ischaemic cerebro-vascular events. We suggest a pathophysiological hypothesis resting on the release of endothelin that would reach the cerebral cortex through a paten foramen ovale.