CONTENTS  •  Volume 7  Number 4 1992

The emergence of phlebology as a specialty, spreading from Europe to all continents, has stimulated much research. We are beginning to see a large number of national and international meetings, each serving as a forum for exchange of ideas about techniques and scientific research. The value of these meetings cannot he overestimated. It is, however, important to maintain the scientific quality of such meetings and to ensure active participation of all potential contributors.

How disappointing for the organizers of the Eleventh World Congress of the Union Internationale de Phlébologie (UIP) in Montréal to have so many absent presenters. Inclusion of an abstract in the proceedings may be sufficient for an individual’s curriculum vitae, but is at the expense of disrupting a meeting. In a meeting with so many parallel sessions on a wide variety of topics, it is necessary for members of the audience to move from room to room. If a paper is not presented, and the following paper advanced, by the end of a session the timetable has been disrupted. In Montréal there were a number of good presentations that were not adequately discussed because it was impossible to keep to the printed time. As a consequence I missed the presentation of a number of interesting papers, which was disappointing in view of the distance I had travelled to hear them. I found that other members of the audience had experienced similar frustrations.

Surely the time has come to penalize individuals who submit multiple abstracts to meetings, and then having had their abstract accepted, fail to turn up to present it. Would it be unreasonable to ban these individuals and their departments for 1 year from national meetings, and 3 years from international meetings, for failing to give adequate notice of their intention to withdraw the paper?

The success of a world congress depends on bringing together individuals from around the world. This involves considerable investment in time and money. We must recognize that we all have different interests, some purely scientific, sonic of a more practical nature, and some attending purely to learn new and specific skills. Can we group presentations more effectively? We could make use of plenary sessions, encouraging discussion, and yet provide everyone with an opportunity of presenting their own contributions by greater use of chaired poster sessions with an appointed discussant.

I welcome John Scurr as an Assistant Editor to Phlebology. He has already made a substantial contribution to the held of phlebology in the United Kingdom, and in his capacity as Chairman of the organizing committee for the 1995 World Congress of the UIP he is ready to make a substantial impact on the international arena of phlebology. I am grateful to him for the contributions he has made in promoting Phlebology in its new format.

Design: Randomized trial with factorial design and interaction analysis, enabling independent evaluation of both bandaging and dressings within the single-trial format. The duration of treatment was 12 weeks or until ulcer-healing, whichever occurred sooner.

Setting: The Leg Ulcer Clinics of Edinburgh and Falkirk and District Royal Infirmaries, Scotland.

Patients: 132 patients with chronic leg ulcers and clinical evidence of chronic venous disease, and excluding those with Doppler ultrasound ankle/brachial pressure indices of less than 0.8, diabetes or rheumatoid disease. There were 28 withdrawals who were classified for analysis as treatment failures.

Interventions: Elastic or non-elastic multilayer bandage systems were applied using similar application techniques by a team of trained nurse specialists. All other treatments were standardized, including the randomization of dressings to either a knitted viscose or a hydrocellular polyurethane dressing.

Main outcome measure: Complete ulcer healing.

Results: In the elastic group 35 out of 65 ulcers (54%) healed within 12 weeks compared with 19 out of 67 (28%) in the non-elastic group (95% confidence limits for percentage healed. 9% to 42%). Ulcer pain was also reported significantly less often in the elastic group (48% of visits versus 29%; p =0.03).

Conclusion: When applied by similar multilayer bandaging techniques, elastic bandaging was significantly better than non-elastic bandaging in the treatment of chronic venous leg ulcer.

Design: A randomized trial of factorial design, with interaction testing, to allow the evaluation of two different therapeutic components (dressing and bandages) within a single trial. The treatment period was 12 weeks or until healing, whichever occurred sooner.

Setting: The Leg Ulcer Clinics of Edinburgh and Falkirk and District Royal Infirmaries, Scotland.

Patients: 132 patients with chronic venous leg ulcers were randomized, 66 to HPD and 66 to KVD. Principal exclusions were patients with diabetes, rheumatoid disease or Doppler ankle/brachial pressure indices of less than 0.8. There were 28 withdrawals (15 KVD, 13 HPD). These were considered as treatment failures.

Interventions: Dressings and bandaging were applied by specialist leg ulcer nurses using standard techniques throughout, the bandaging being randomized to either elastic or non-elastic multilayer systems.

Main outcome measure: The principal end-point was ulcer healing. Also monitored were healing rates, pain and the frequency of dressing changes.

Results: Pain relief was significantly better in the HPD group (p=0.0l). Thirty-one (47%) of the HPD patients healed within 12 weeks compared with only 23 (35%.) of the those treated with KVD (95% confidence limits for difference, -5% to +29%). The highest healing rates (61% for all ulcers and 74% for those less than 10cm²) were observed in the subgroup in which HPD was used in combination with an elastic bandaging system.

Conclusion: Patients treated with IIPD did significantly better in terms of pain relief, although the higher healing rates observed in this group failed to reach significance at the 5% level.

Design: The test is based on an indirect method we use for measuring ambulatory venous pressure by means of strain-gauge plethysmography.

Setting: University Hospital Nijmegen, The Netherlands.

Patients: The results of 28 limbs of 20 patients with deep venous insufficiency are compared with 32 limbs of 16 healthy volunteers.

Interventions: The same test is performed in all patients and volunteers: in the supine position a raised venous pressure in the limb is induced by venous congestion. The reduction in venous volume after standardized leg movements is measured by strain-gauge plethysmography and, with an additionally obtained pressure—volume relation, this volume reduction is converted into a pressure reduction.

Main outcome measure: The reduction by standardized leg movements of an increased venous pressure is a measure for calf muscle pump function.

Results: The mean pressure reduction in the patient group was 47% (standard deviation (SD) = 8%), in the healthy group 77% (SD = 6%).

Conclusions: The new ‘supine venous pump function test’ is a promising method for measuring the function of the deep veins. Since the whole procedure is performed in the horizontal position, the method offers several important advantages.

Data Sources: The author draws on his own considerable experience in the management of venous disease using bandaging techniques.

Conclusion: The technique of bandaging is invaluable in the management of patients with lower limb oedema and venous disease. It should be learnt by all clinicians and nurses managing such patients.

Design: Randomized, single blind, prospective, controlled trial.

Setting: Social security system related rehabilitation center for employees (nationwide assignment of in-patients).

Patients: 122 patients with primary varicose veins.

Interventions: Group A (n=60) received daily treatments during 24 days that consisted of external application of alternating cold and warm water to both lower extremities. Group B (n=62) served as controls and was not treated with hydrotherapy. Both groups were comparable in terms of concomitant diseases and treatments.

Main outcome measures: Foot volume, ankle circumference and venous re-fill time, using fight reflex rheography, served as objective variables, while a number of typical symptoms were recorded as subjective parameters.

Results: A more pronounced improvement in all objective signs in group A compared to B was observed. Four out of seven subjective symptoms improved more frequently in group A than in B.

Conclusions: Hydrotherapy is effective in treating primary varicose veins. It can be considered as an adjunct measure to compression therapy and other conservative treatments.

Objective: To establish the safety and efficacy of a silastic sling procedure for reconstructing popliteal vein.

Design: Prospective survey of patients undergoing surgical treatment for popliteal vein reflux.

Setting: Department of Surgery, County Hospital, Bad Karlshafen, Germany.

Patients: 209 patients undergoing surgery for popliteal vein incompetence.

Interventions: Silastic sling procedure (Technique II) for correction of popliteal vein incompetence.

Main outcome measures: Continuous wave Doppler ultrasound examination of popliteal vein, ambulatory foot vein pressure measurements, lower limb venography.

Results: One week following surgery 202 patients (of 209) reported relief of pain and reduction of limb oedema. 77 patients with ulcers (of 85) healed following the surgical procedure. Ambulatory venous pressure improved from 71 SD 11 mmHg to 36 SD 17 mmHg. There was prolongation of the venous refilling time from 9 SD 5 seconds to 27 SD 17 seconds. Postoperative phlebography in 92 patients was performed on the tenth post-operative day and in no patient was deep vein thrombosis observed. In 82 of these patients phlebography demonstrated that the constructed popliteal valve was patent.

Conclusions: Construction of a popliteal valve using the author’s silastic sling technique is a satisfactory method for managing patients with otherwise uncontrolled popliteal vein reflux due to either primary valvular failure or previous deep vein thrombosis.