LAUSR

We read the article published by Mosmiller et al. with great interest. In their well-designed study, they evaluated the inflammatory cell biomarkers in chronic venous insufficiency (CVI) patients. They found higher white blood cell count, neutrophil count and neutrophil-to-lymphocyte ratio (NLR) levels in severe CVI patients compared to mild CVI patients. In addition, they found more reduced lymphocyte count in severe CVI patients than mild CVI patients. Besides, an increased NLR level was an independent predictor of severe CVI. Although this study has a few limitations such as small sample size and retrospective design, there are several take home messages might be gathered from this study. Venous disease is a general problem affecting both the morbidity and mortality. CVI is defined as a condition affecting the lower extremity venous system with venous hypertension and dilatation. However, varicoceles, hemorrhoids and pelvic congestion syndrome are examples of CVI, theoretically. Therefore, the term ‘Dilating Venous Disease’ can be used as a general definition. It is known that there is a close relationship between these vascular diseases. Besides, a similar relationship has also been shown between venous and arterial dilating diseases in various studies. In this context, it is reasonable to suggest that CVI or dilating venous diseases should be considered as a local manifestation of systemic vascular wall pathology rather than a disease of a specific organ or system. From the pathophysiological point of view, systemic inflammatory status can explain the underlying mechanism linked with common vascular wall pathology in these patients. In another words, these patients have prone to dilate and inflammation is the cornerstone in the pathogenesis. Therefore, increased systemic inflammatory parameters in CVI patients described by Mosmiller et al. shed light on our knowledge about the pathophysiology of dilating vascular diseases. NLR is a useful, cost-effective and easy-to-calculate inflammatory marker, which was shown to be associated various cardiovascular and valvular disorders. Besides, there are also other biomarkers such as lymphocyte-to-monocyte ratio (LMR) and platelet-tolymphocyte ratio (PLR), which can be calculated easily from a complete blood count test. These biomarkers are also known to be associated with cardiovascular diseases reflecting a higher inflammatory status. We recommend the authors to evaluate these biomarkers in their patient population and the association between dilating vascular diseases in further studies. The study published by Mosmiller et al. led us to the suggestion that there is an increased systemic inflammation in CVI patients, although this is a local vessel disease of the body and this can be the explanation of the coexistence of dilating vascular diseases.