My friend and colleague, Dr. Mark Melin has been talking a lot about the endothelial glycocalyx (GCX) and why it matters to patients with lympho-venous disease and chronic ulceration. I’d been smiling and nodding, pretending that I understood what he was talking about, but I finally decided to admit to him that I was clueless about the GCX. I asked Mark to give me a “simple” explanation. Yes, this document is Mark’s idea of simple… He asked some of the most eminent experts on the topic to co-author this short article just for posting here. I am grateful to them all.

Simple or not, it’s worth the effort to read this because it makes perfect sense that excess permeability of the endothelium is a key part of the problem for many of our patients. Our attempts to control their lower extremity swelling feel as futile as dipping cups of water out of the ocean. It may also explain why they keep getting recurrent ulcerations. (As an aside, I am on board with trying Diosmin –  a Micronized Purified Flavonoid Fraction (MPFF) – since that’s safe and simple.) My real point is that if we don’t understand a problem, we can’t even begin to find a solution.

I hope this summary will be helpful in raising awareness about the importance of the GCX and will stimulate discussion as to what we should DO about it. Thank you to Drs. Melin, Kaufman, Fukaya, and Gloviczki for all the effort you went to in order to explain the GCX structure and function!