Indian Journal of Vascular and Endovascular Surgery

EXPERT COMMENT
Year
: 2018  |  Volume : 5  |  Issue : 4  |  Page : 217--218

Caring for the orphan children of vascular surgery


Robbie George 
 Head of Department, Narayana Institute of Vascular Sciences, Narayana Health City, Bengaluru, Karnataka, India

Correspondence Address:
Dr. Robbie George
Head of Department, Narayana Institute of Vascular Sciences, Narayana Health City, Bengaluru, Karnataka
India




How to cite this article:
George R. Caring for the orphan children of vascular surgery.Indian J Vasc Endovasc Surg 2018;5:217-218


How to cite this URL:
George R. Caring for the orphan children of vascular surgery. Indian J Vasc Endovasc Surg [serial online] 2018 [cited 2019 Jun 26 ];5:217-218
Available from: http://www.indjvascsurg.org/text.asp?2018/5/4/217/247274


Full Text



This issue of IJVES includes publications on two areas of vascular surgery that have been the orphan children of vascular surgery for a variety of reasons: venous disease without prominent lower-limb symptoms and lymphedema. Both diseases cause significant morbidity, and the occasional mortality yet has been underdiagnosed or ignored by the vascular community at large.

Lymphatic disease has been the orphan child of vascular surgery for many years. In the absence of industry and research support, as is seen in the endovascular device market, lymphatic disease has remained a neglected field. Fortunately, of late, there has been increasing interest in the treatment of this challenging pathology.

The history of treatment of lymphedema is testament to the absence of any definitive therapies. The past decades have seen a variety of therapies ranging from extensive debulking procedures to micro-vascular procedures. This issue of IJVES includes a very thorough overview of lymphedema and what's new in its management by Dr. Peter Gloviczki and Dr. Monica Gloviczki.[1] There are also articles on the real-world experience of decongestive therapy in an Indian setting[2] and of the application of the technique of manual lymphatic drainage in venous disease.[3] There is exciting new developments in the fields of imaging and also of surgical interventions in lymphatic disease and it will fall upon those managing vascular disease to take this forward. There is a huge burden of secondary lymphedema within the borders of our country and large parts of the developing world and a solution to this would be a godsend for many.

The other lead articles in this issue are centred on pelvic congestion syndrome (PCS). Like many diseases of the venous system, our diagnostic eye fails to see what our mind doesn't recognize. This is a syndrome many of us are unfamiliar with but would have seen, and perhaps never suspected; for example, when we spot the medial thigh varicosity disappearing toward the pelvis. Pathology of the venous system has always been more difficult to understand than that of the arterial system. The huge capacitance and the ability to compensate that exists within the deep veins masks significant pathology. Diagnosis of venous disease is further complicated by the lack of objective and easily quantifiable and reproducible tests. Over the last few decades, the existence of deep venous disease and its contribution to lower-limb pathology has been increasingly clarified especially when it pertains to lower limb advanced chronic venous insufficiency. While we often understand the impact of venous occlusive or refluxive disease on the lower-limb, we do not always appreciate the impact of this within the concealed spaces of the abdomen and pelvis. Three articles in this edition of IJVES by the team at the Whiteley clinic provide an excellent overview and review of pelvic congestion syndrome. Pelvic congestion syndrome (PCS) has been hard to suspect and often even harder to diagnose and prove. The principles and details of when to suspect and how to approach the treatment of this problem are addressed comprehensively by Prof. Whiteley.[4] The detailed methodology for ultrasound evaluation and assessment of pelvic reflux and congestion is described in detail with plentiful images by Angie White and Judy Holdstock.[5] The techniques of its treatment are detailed by Diwakar, Beckett, and Whiteley in their review of the endovascular management of symptomatic venous insufficiency.[6]

I trust that the articles in this edition on the less glamorous diseases that affect our patients shall catch the interest of the vascular community and enable us to provide better care to an underserved population.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Gloviczki ML, Gloviczki P. Advances and Controversies in the Contemporary Management of Chronic Lymphedema. Indian J Vasc Endovasc Surg 2018;5:219-26.
2Gohil AJ, Harinatha S, Selvaraj AD, Babu A, Tyagaraj P, Gupta AK. Decongestive Lymphatic Therapy in Postfilarial Lymphedema: A Prospective Study. Indian J Vasc Endovasc Surg 2018;5:259-65.
3Samuel V, Premkumar P, Selvaraj D, Kota AA, John JM, Stephen E. Manual Lymphatic Drainage in Venous Disease: A Forgotten Weapon in Our Armory. Indian J Vasc Endovasc Surg 2018;5:266-9.
4Whiteley MS. The Current Overview of Pelvic Congestion Syndrome and Pelvic Vein Reflux. Indian J Vasc Endovasc Surg 2018;5:227-33.
5White AM, Holdstock JM. Ultrasound Assessment of Pelvic Venous Reflux. Indian J Vasc Endovasc Surg 2018;5:234-43.
6Diwakar P. Pelvic Congestion Syndrome: A Review of the Treatment of Symptomatic Venous Insufficiency in the Ovarian and Internal Iliac Veins by Catheter-Directed Embolization. Indian J Vasc Endovasc Surg 2018;5:244-52.