June 26th – June 28th, 2008. Barcelona, Cataluña, Spain.
by Jean-Jérôme GUEX, MD, FACPh.
Growing in audience every year, the European Venous Forum annual meeting is now the must-attend venous meeting in Europe. Thanks to an imposed limit on the number of selected abstracts, the meeting’s scientific committee is able to offer a program of excellent scientific and formal value, which is also full of innovations.
The EVF has become a place where institutions vie to have their latest research papers presented. This high level of field-specific exposure makes it necessary to safeguard the quality of submitted abstracts, thus increasing the worth of the presentations. Also, not all selected papers are coming from academic institutions, and many are the work of private practices, demonstrating the sincerity and the will of independent specialists in the field of phlebology.
This year, Doctor Marc Cairols organized an important phlebological event in his hometown of Barcelona, the capital of Cataluña. Well known for its art, industry, nightlife, and Gaudí architecture, Barcelona has demonstrated its ability to host a medical meeting of international prestige. Easily accessible by plane, the city has many connections with the Americas and other continents, thus explaining the great success of this year’s EVF.
In order not to limit its content to free papers, an official EVF lecture gives attendees the opportunity to experience a comprehensive, extensive, and up to date conference given by an international expert.
This year, Pr Jawed Fareed presented “Current transitions in anti-coagulant therapies. Are heparins and oral anticoagulants challenged ?” This impressive summary (including a combination of drugs that are commonly used, drugs that have been recently licensed, and drugs that are still under Phase III trials) emphasized the value of low molecular weight heparins, oral anticoagulants, clopidogrel and aspirin, and reveals that the potential benefits of newer drugs are still disputed, despite their use of specific targets and convenient oral administration.
A limited number of industry sponsored symposia have reported the current situation in industrial, clinical, and fundamental research in the fields of venotonic drugs, anticoagulation and compression.
From this year’s program, we have selected several abstracts, and summarize them below.
The following three papers were award-winners:
1st Prize Inelastic compression increases venous ejection fraction more than elastic bandages. By G Mosti, V Mattaliano, H Partsch. (Italy, Austria). In this carefully designed study, haemodynamic parameters in 30 patients were assessed, ultimately demonstrating the superiority (and better clinical tolerance) of stiff bandages.
2nd Prize Side effects and complications of foam sclerotherapy of the great and small saphenous veins: A controlled multicentre prospective study including 1025 patients. By JL Gillet, JM Guedes, JJ Guex, C Hamel-Desnos, M Schadeck, M Lauseker, FA Allaert. (France). This prospective registry has analyzed post-foam sclerotherapy complications with the use of a duplex ultrasound, involving a short term follow-up of 99% of patients. No severe or lethal outcome has been reported. A total of 11 thromboembolic events have been observed (4 muscular VT, 4 deep distal VT, 2 common femoral VT, 1 pulmonary emboli). One case of TIA with O2-based foam has been reported, in addition to one case of sepsis. Incidence of other side effects was similar to other studies. An ancillary result is a 90.3% initial success of the method. We await the publication of the full paper for invaluable information on the method.
3rd Prize Progression of chronic venous disease in post-thrombotic limbs is more rapid when compared to primary. By A Gasparis, N Labropoulos, D Pefanis, LR Leon, SB Psalms, AK Tassiopoulos. (USA). The five year evaluation of CVD in three groups (DVT patients, primary patients, controls) has shown that post-thrombotic patients have a higher CEAP class than others, as well as more haemodynamic abnormalities.
In addition, we have selected:
Symptoms relief after compressive therapy can predict results of surgical treatment of chronic venous disease limited to superficial and perforating vein reflux. By F Lurie, RL Kistner, C Ly and J Akamine.
(USA). Using a clinical self-questionnaire derived from the SQOR-V, the authors have shown that improvement after one month of compression is correlated with post-surgical reduction of symptoms.
Importance of the varicose reservoir for the mid-term results of the surgical treatment of varices by phlebectomy with conservation of a refluxing saphenous vein. By P Pittaluga, S Chastanet, B Rea, R Barbe and JJ Guex. (France). This paper has evaluated the effect of varicose reservoir removal on symptoms of primary CVD. The clinical improvement observed and the predominant saphenous reflux reduction or abolition evidence the efficacy of a conservative and mini-invasive strategy in select cases.
Impedance and duplex haemodynamic parameters modifications induced by haemodynamic correction type 1 (CHIVA 1). By G Tacconi, E Menegatti, P Fortini, A Legnaro, S Giannesi, and P Zamboni. (Italy). The authors of this paper have observed that even if the flow in the saphenous vein remained reverted, the elimination of reflux point and reservoir effect have greatly improved both haemodynamic and clinical abnormalities. As in the previous paper, this abstract demonstrates that saphenous veins ablations are not always necessary, and that new strategies are emerging and gaining support.
Does corona phlebectatica indicate chronic venous insufficiency? By E Rabe and F Pannier. (Germany). The significance of the corona phlebectatica has been commonly noted as a possible tool in the classification of CEAP. In their presentation, the authors have demonstrated that severe CP is indeed associated with C4-C5 CVI.
Assessment of quality of life in patients with varicose veins: what are the options? By A Sheherd, MS Gohel, M Hamish, CS Lim, AH Davies. (UK). Controlled studies frequently rely on disease-specific, health-related, patient-reported outcomes, and the authors of this paper have reviewed several of these questionnaires and discovered the SQOR-V to be sensitive in lower CEAP classes.
Prognostic signification of venous symptoms in the Basel venous study. By P Carpentier, MT Widmer, E Zemp, JF Uhl, A Corun-Thenard. Using data retrieved from Widmer’s study in 1971, the authors have been able to correlate initial isolated venous symptoms indicating clinical edema, but were unable to use them to predict an evolution towards varicose veins or skin changes development.
New endovenous therapies of lower extremity varicosities are at least as effective as surgical stripping and sclerotherapy: meta-analysis and meta-regression of case series and randomized clinical trials. By R Van den Bos, M Kockaert, M Neumann and T Nijsten. (Netherland). Based on an extensive analysis of clinical trials, the authors have demonstrated – despite the lack of a large, comparative study – that with an average follow-up of 32 months, all three methods of endovenous ablation (foam sclerotherapy, laser, radio frequency) are not inferior to surgery. In fact, laser demonstrated some superiority when compared with other methods, indicating that reliance on surgical stripping may decrease.
Foam sclerotheraoy of saphenous veins with or without medical suport stockings (compression). Biological effects of foam sclerotherapy. Randomized study. By C Hamel Desnos, B Guis, P Quehe, A Mesgard, P Desnos, B Ferre and A Le Quere. ( France). Comparison of two randomized groups of patients submitted to foam sclerotherapy (of great or small saphenous veins) with or without compression failed to reveal any difference in biological markers of potential pro-thrombotic status. Figures remained normal in both groups, in addition to troponin levels. The authors also emphasize an efficacy in 100% of saphenous veins in both groups, despite low volumes of polidocanol 1 or 2 % foam (average 4mL per patient).
Next year's 10th annual meeting of the EVF will take place in Copenhagen:
Friday 5 - Sunday 7 June 2009
Hotel Scandic Copenhagen, in Copenhagen, Denmark under the presidency of Dr Niels Baekgaard
Further Information: [email protected]
Deadline for abstracts: Friday 13 March 2009