Strandness Lecture: The Glycocalyx in Venous Disease and Beyond

Honoring Eugene Strandness

The lecture opened with tribute to Eugene Strandness, a University of Washington ultrasound pioneer who co-developed duplex ultrasound, authored 15 books, and trained 22 vascular fellows before serving as AVF and SVS president.

The Endothelial Glycocalyx and Shear Sensing

Joseph Raffetto described the glycocalyx, a shear sensing coating of glycosaminoglycans, glycoproteins, and proteoglycans including syndecans and glypicans, that regulates permeability, coagulation, and inflammation through mechanosensing of blood flow.

Shedding, Inflammation, and Venous Disease

Loss of heparan sulfate and chondroitin sulfate under altered shear promotes leukocyte adhesion and vascular injury, with metalloproteases implicated in chronic venous disease and leg ulcers, while aging and albumin loss further destabilize the glycocalyx.

Restoration, Lymphatics, and Spaceflight

Sphingosine one phosphate and sulodexide restored glycocalyx components experimentally, new work showed the first human evidence of lymphatic glycocalyx, and NASA research linked spaceflight to glycocalyx injury and a case of astronaut jugular vein thrombosis.