June 26, 2011 at 3:08pm
Let's face it. Phlebology, the diagnosis and treatment of venous disease, is just not as appealing as Neurology. The word phlebology is hard to spell, hard to pronounce. Reminiscent of phelgm, phlegmatic, other unsexy words that start with phl.
The root of this word, phleb, is from the Latin fluere, meaning "to flow"
Truth is, phlebology is turning out to be a very, very important medical practice. Veins, once thought to be uninvolved in disease, are turning out to be equally important as their brother arteries. Maybe more so.
Veins take deoxygenated blood back to the heart. If they are blocked, blood flow and hemodynamics are altered. The influx of blood from the heart via the arteries is changed. In the liver, in the kidneys, in the brain. Any organ can be affected. We think of varicose veins when we hear venous disease...again, not sexy. But veins run throughout the body, and if they are malformed, it can ruin our organs.
I got to meet and listen to a premiere phlebologist in Bologna in 2009. Dr. Byung B. Lee was at the first symposium organized by Dr. Zamboni. Dr. Lee talked about his introduction to venous disease as a liver transplant surgeon.
Here are my notes from the conference. Dr. Lee on venous malformations, in his own words.
Byung B. Lee- Georgetown University School of Medicine, Washington-Embryology of the venous system and origin of truncular venous malformations
Dr. Lee began as a transplant surgeon and admitted that his first liver transplant was a disaster. He learned the hard way that the vena cava is not just a single trunk, and a venous malformation was a most fearful thing, and a nightmare to a transplant surgeon.
"We doctors have a tendency to specialize in our narrow fields, but I want to appeal to all of us to take a bird’s eye view. We need to look at the whole picture. We now understand the lower venous system, but it has taken us much too long to bring this knowledge all the way up to the neck and all the way to the junction of the superior vena cava.
Vascular malformations are from embryological defective vessels involved in the later stages of embryogenesis. CVM can develop anywhere in the vascular system as a birth defect. The vascular malformation is one of the CVMS which affects mainly the venous system. There is much we do not know, and we do not know how much we do not know."
Two classifications of venous malformations:
Extratruncular- this is formed by embryonic tissue remnant which carries a risk of growth, because it is mesenchymal. When stimulated by hormones, pregnancy, etc, it can reactivate and grow.
Truncular VM- this is formed as part of the later stage of embryonic development. This form does not have mesenchymal cell characteristics. Truncular lesions present as a fetal remnant- such as sciatic veins or superior vena cava malformations.
"We cannot stop investigating at the neck in CCSVI! We need to investigate all the way down to the superior vena cava.
Truncular venous malformation lesions are obstructive of dilated lesions: such as we see in IJV aneurisms or iliac vein stenosis. They are more serious to direct involvement of the venous system, and will bring about hemodynamic issues. Why has the jugular been ignored previously? Chronic venous congestions leaves more damage along its related organ or tissue. Venous congestion of the IJV is related to ischemia.
The cardio system is the first system to develop in an embryo. At 15-16 days from gestation, there is a primitive vascular system. Veins are so important, that God made them in pairs- to overcome any defects. They are more important than arteries."
The IJVs are the dominant deep vein to drain the brain. Below the diaphragm, the veins converge, and problems can also arise there. Dr. Lee couldn't repair the IVC after taking the liver out of his patient, because of stenosied veins. Often, the liver is the victim - such as Budd Chiari syndrome.
Just because the doctors studying venous disease are called phlebologists does not mean their research isn't credible. Just because they are paid less than neurologists, just because pharmaceutical companies do not frequent their offices, just because they don't get the big research bucks at their universities--none of this has any bearing on the importance of their work.
Here's Dr. B.B. Lee's paper on the lesions found in CCSVI veins being congenital, truncular venous malformations. How can he say this? He sees the same congenital lesions in Budd Chiari disease---his specialty. This is what he studies. This is what he treats. Here's the paper:
CCSVI is created by congenital truncular venous malformations--malformed valves, webs, hypoplasia, atresia.
I hope this information is helpful.
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