Journal of vascular surgery. Venous and lymphatic disorders最新文献

Laparoscopic and robotic extravascular stenting of the left renal vein for anterior nutcracker syndrome in a single-center series 单中心系列左肾静脉前胡桃钳综合征的腹腔镜和机器人血管外支架植入术。

IF 2.8 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2026-05-01 Epub Date: 2026-02-12 DOI: 10.1016/j.jvsv.2026.102459

Shuai Tang MD , Kai Li MD , Fan Chang MD , Song Li MD , Zheng Lv MD , Jianghui Zhang MD , Wensong Wu MD , Huiyuan Shi MD , Fangmin Chen MD, PhD

Background

Nutcracker syndrome (NCS) arises from extrinsic compression of the left renal vein (LRV) between the superior mesenteric artery and the abdominal aorta. Extravascular stenting (EVS) has emerged as a minimally invasive alternative to historical operations and endovascular stents. We report a single-center series spanning 2010 to 2025 and propose a standardized, reproducible framework that couples intraoperative process quality with objective postoperative hemodynamic targets.

Methods

We retrospectively analyzed 22 consecutive NCS patients treated with laparoscopic or robot-assisted EVS. We standardized five intraoperative steps (five-in-a-row: fibrotic-ring resection, proper length tailoring/placement, sufficient superior mesenteric artery mobilization, complete division of LRV tributaries, stable anterior fixation). Postoperative duplex ultrasound metrics included aortomesenteric (AM) LRV peak systolic velocity and the AM/hilum peak systolic velocity (PSV) ratio. Thresholds were determined by receiver operating characteristic-Youden index; performance was summarized at fixed cutoffs, with bootstrap for the ratio and exploratory OR/AND combinations.

Results

Complete success was achieved in 18 of 22 patients (81.8%). Data-driven analysis identified a postoperative AM PSV of ≤72 cm/s as the primary attainment threshold, yielding a sensitivity of 1.00, specificity of 0.75, accuracy of 0.95, and area under the receiver operating characteristic curve (AUC) of ≈0.917. The AM/hilum ratio showed a Youden-optimal cutoff of ≈1.90 (clinically ≈2.0) with an AUC of ≈0.56, supporting its role as a sensitivity/replicability metric rather than a standalone gatekeeper. OR and AND combinations demonstrated expected trade-offs; a simple 0/1/2 composite score achieved an AUC of ≈0.78. The five-in-a-row checklist was concordant with attaining the AM-PSV target on Doppler ultrasound examination.

Conclusions

Laparoscopic or robot-assisted EVS is a safe, feasible, and effective option for NCS. We a propose postoperative AM PSV of ≤72 cm/s as a unified, reproducible primary quantitative end point, with an AM/hilum ratio of ≈2.0 as a secondary, replicability-oriented metric. Integrating these targets with a standardized five-in-a-row checklist establishes a process-outcome loop that enhances procedural reproducibility and supports sustained symptom relief over the available follow-up.

背景：胡桃夹子综合征（NCS）起源于肠系膜上动脉和腹主动脉之间的左肾静脉（LRV）的外源性压迫。血管外支架植入术（EVS）已成为历史手术和血管内支架的一种微创替代方法。我们报告了一项跨越2010-2025年的单中心研究，并提出了一个标准化的、可重复的框架，将术中过程质量与客观的术后血流动力学指标结合起来。方法：我们回顾性分析了22例连续使用腹腔镜或机器人辅助EVS治疗的NCS患者。我们标准化了五个术中步骤（“五连一排”：纤维环切除、适当长度的剪裁/放置、充分的SMA活动、LRV分支的完全划分、稳定的前路固定）。术后双超声指标包括主动脉-肠系膜LRV峰值收缩速度和AM/门脉PSV比。阈值采用ROC-Youden法测定；在固定截止点总结性能，并对比率和探索性OR/ and组合进行自举。结果：18/22例（81.8%）手术完全成功。数据驱动分析确定术后AM PSV≤72 cm/s为主要达到阈值，敏感性1.00，特异性0.75，准确性0.95,AUC≈0.917。AM/门门比显示约登最佳截止≈1.90（临床上≈2.0），AUC≈0.56，支持其作为敏感性/可复制性指标的作用，而不是独立的看门人。OR和and组合展示了预期的权衡；简单的0/1/2综合评分达到AUC≈0.78。“五连”检查表与达到DUS上的AM-PSV目标一致。结论：腹腔镜或机器人辅助EVS是一种安全、可行、有效的治疗NCS的方法。我们建议术后AM PSV≤72 cm/s作为统一的、可重复的主要定量终点，AM/门比值≈2.0作为次要的、可重复的指标。将这些目标与标准化的“一行五项”检查表相结合，建立了过程-结果循环，提高了程序可重复性，并支持在现有随访期间持续缓解症状。

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引用次数: 0

Midterm clinical outcomes of mechanical versus rheolytic thrombectomy for iliofemoral or iliocaval deep vein thrombosis 机械与流变性取栓治疗髂股或髂腔深静脉血栓的中期临床结果。

IF 2.8 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2026-05-01 Epub Date: 2026-02-05 DOI: 10.1016/j.jvsv.2026.102457

Gabor Forgo MD , Silvia Cardi MD , Riccardo Fumagalli MD , Tim Sebastian MD , Daniel Périard MD , Stefano Barco MD (Prof) , Nils Kucher MD (Prof) , Rolf P. Engelberger MD

Objective

In patients with iliofemoral deep vein thrombosis (DVT), early thrombus removal reduces the risk of post-thrombotic syndrome (PTS). It remains uncertain if mechanical thrombectomy (MT) using the ClotTriever system may offer advantages as compared with rheolytic thrombectomy (RT) using the AngioJet ZelanteDVT.

Methods

In our multicenter, retrospective, observational study, we included 122 patients (mean age, 48 years; 57% women) with iliofemoral (78%) or iliocaval DVT (22%). All underwent early thrombus removal with either MT (n = 40) or RT (n = 82) and had a minimum of 3 months of follow-up. Periprocedural outcomes included periprocedural thrombolytic use, access complications, and stent placement rate. Clinical outcomes included stent patency rate and freedom from PTS.

Results

The median follow-up was 25 months (interquartile range, 11-52 months). Compared with RT, MT was associated with lower periprocedural thrombolytic use (38% vs 95%; P < .01) and a lower rate of stent placement (70% vs 98%; P < .01). Postprocedural access site thrombosis of the popliteal vein occurred in 5 MT patients (13%) and in none of the RT patients. At 1 year, primary and secondary patency rates were 80% (95% confidence interval [CI], 67%-95%) and 97% (95% CI, 93%-100%) in the MT group, and 88% (95% CI, 81%-96%) and 97% (95% CI, 94%-100%) in the RT group, respectively. Freedom from PTS at latest follow-up was observed in 98% of the MT group (95% CI, 93%-100%) and 94% of RT patients (95% CI, 87%-100%).

Conclusions

Both MT and RT were associated with high patency rates and freedom from PTS. MT may decrease the need for thrombolysis and venous stent placement. Popliteal vein thrombosis from large-bore access in MT patients requires further investigation.

目的：在髂股深静脉血栓形成（DVT）患者中，早期清除血栓可降低血栓后综合征（PTS）的风险。与使用AngioJet ZelanteDVT™的溶血性取栓（RT）相比，使用clottriver™系统的机械取栓（MT）是否具有优势尚不确定。方法：在我们的多中心、回顾性、观察性研究中，我们纳入了122例（平均年龄48岁，57%为女性）髂股深静脉血栓形成（78%）或髂腔深静脉血栓形成（22%）的患者。所有患者均通过MT （n=40）或RT （n=82）进行了早期血栓清除，随访时间至少为3个月。围手术期结果包括围手术期溶栓使用、通路并发症和支架置入率。临床结果包括支架通畅率和免于PTS。结果：中位随访25个月（IQR 11-52）。与RT相比，MT与术中溶栓使用率较低相关（38% vs 95%）。结论：MT和RT均与高通畅率和无PTS相关。MT可能减少溶栓和静脉支架置入的需要。MT患者大口径通路腘静脉血栓形成需要进一步研究。

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引用次数: 0

Artificial intelligence risk stratification from dynamic digital subtraction angiography radiomics predicts pulmonary embolism and associates with clinical outcomes in deep vein thrombosis: A retrospective cohort study 动态DSA放射组学的AI风险分层预测深静脉血栓形成的肺栓塞和相关临床结果：一项回顾性队列研究

IF 2.8 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2026-05-01 Epub Date: 2026-02-03 DOI: 10.1016/j.jvsv.2026.102450

Tao Kang MD , Song Han MD , Yao-Liang Lu MD , Xiao-Qiang Li MD, PhD

Objective

Current risk stratification for lower extremity deep vein thrombosis remains limited, often failing to identify high-risk patients for impending pulmonary embolism (PE) and leading to non-guideline-concordant overtreatment. We aimed to develop and validate a novel artificial intelligence (AI) system that processes dynamic digital subtraction angiography (DSA) radiomics, with the potential to guide precision therapy during endovascular intervention.

Methods

In a retrospective cohort study of 168 patients treated at a single vascular surgery center (2019-2023), we developed a hybrid deep learning model integrating a transformer-UNet for spatial feature extraction and a long short-term memory (LSTM) network for temporal hemodynamic analysis. This model processed intraprocedural dynamic DSA sequences to quantify novel thrombus kinematic parameters (eg, displacement velocity, oscillation angle θ) and hemodynamic parameters venous (quantitative flow ratio). The model's performance for predicting subsequent PE was compared against the Wells score. Its impact on clinical decision-making and 12-month outcomes was evaluated rigorously.

Results

The AI model demonstrated significantly superior discriminative performance for predicting PE compared with the Wells score (area under the curve, 0.88; 95% confidence interval [CI], 0.85-0.92 vs 0.76; 95% CI, 0.70-0.83; P = .026). Implementation of the AI-guided strategy was associated with markedly improved clinical outcomes at the 12-month follow-up: a 54% lower incidence of PE (3.4% vs 11.1%; relative risk [RR], 0.46; 95% CI, 0.08-0.82; P = .005), a 62% lower incidence of severe post-thrombotic syndrome (Villalta score ≥10; 8.0% vs 21.0%; RR, 0.38; 95% CI, 0.17-0.86; P = .008), and a lower prevalence of preexisting inferior vena cava filters in the AI-stratified high-risk group (25.3% vs 44.4%; RR, 0.57; 95% CI, 0.36-0.89; P < .001), without a significant increase in major bleeding events (2.3% vs 7.4%; P = .096).

Conclusions

An AI-guided risk stratification system based on dynamic DSA radiomics accurately identifies thrombus instability and hemodynamic impairment in real time and suggests its potential to help enable more personalized therapeutic decisions during intervention. In this retrospective analysis, AI-based risk stratification was associated with a significantly lower incidence of PE and severe post-thrombotic syndrome while safely curbing the overuse of inferior vena cava filters, representing a transformative advancement in the precision management of acute deep vein thrombosis.

目的：目前下肢深静脉血栓形成（DVT）的风险分层仍然有限，通常无法识别即将发生肺栓塞（PE）的高危患者，同时导致不符合指南的过度治疗。我们的目标是开发和验证一种新的人工智能（AI）系统，该系统可以处理动态数字减影血管造影（DSA）放射组学，具有指导血管内介入期间精确治疗的潜力。方法：通过对某血管外科中心（2019-2023）168例患者的回顾性队列研究，我们开发了一个混合深度学习模型，该模型集成了用于空间特征提取的Transformer-UNet和用于时间血流动力学分析的长短期记忆（LSTM）网络。该模型处理术中动态DSA序列来量化新的血栓运动学参数（例如，位移速度，振荡角θ）和血流动力学参数静脉（定量流量比，QFR）。将该模型用于预测后续PE的性能与Wells Score进行了比较。严格评估其对临床决策和12个月预后的影响。结果：与Wells评分相比，AI模型在预测PE方面表现出显著优于Wells评分的判别性能（曲线下面积[AUC] 0.88, 95% CI: 0.85-0.92 vs. 0.76, 95% CI: 0.70-0.83; P = 0.026）。人工智能指导策略的实施与12个月随访时临床结果的显著改善相关：PE发生率降低54% (3.4% vs. 11.1%；相对风险[RR]=0.46, 95% CI: 0.08-0.82； P= 0.005)，严重血栓后综合征（PTS）发生率降低62% (Villalta评分≥10；8.0% vs. 21.0%； RR=0.38, 95% CI: 0.17-0.86； P=0.008)，人工智能分层高危组中已有IVC过滤器的患病率降低(25.3% vs. 44.4%； RR=0.57, 95% CI: 0.36-0.89；结论：基于动态DSA放射组学的ai引导风险分层系统可以实时准确地识别血栓不稳定性和血流动力学损伤，并表明其有助于在干预期间做出更个性化的治疗决策。在这项回顾性分析中，基于人工智能的风险分层与PE和严重PTS的发生率显著降低相关，同时安全地抑制了IVC过滤器的过度使用，代表了急性DVT精确管理的革命性进步。

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引用次数: 0

Relation between clinical findings and diagnostic parameters in patients undergoing superficial venous intervention for symptomatic chronic venous disease due to isolated venous reflux 孤立性静脉返流所致症状性慢性静脉疾病行浅静脉介入治疗患者临床表现与诊断参数的关系

IF 2.8 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2026-05-01 Epub Date: 2026-01-08 DOI: 10.1016/j.jvsv.2026.102445

Arjun Jayaraj MD, Jack Owens BS, Mary Meghan Dickerson BS

<div><h3>Objective</h3><div>Although a multitude of techniques exist for the treatment of superficial venous reflux in symptomatic patients with chronic venous disease (CVD), metrics used to determine and quantify superficial reflux and thereby assess the need for intervention remain unclear. This study explores this topic by evaluating duplex ultrasound (DUS) and air plethysmography (APG) metrics in terms of their relation to clinical parameters in the setting of isolated lower extremity venous reflux.</div></div><div><h3>Methods</h3><div>Analysis of retrospectively collected data of patients who underwent successful endovenous laser ablation of superficial venous reflux with/without stab phlebectomies for symptomatic CVD from venous reflux was carried out to determine predictors of initial clinical presentation and outcomes after successful intervention. Characteristics evaluated included the Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) clinical class, venous clinical severity score (VCSS), grade of swelling (GOS), and visual analog scale pain; DUS characteristics included superficial vein diameter, total reflux volume in the limb, and venous segmental disease score (VSDS). APG metrics included venous volume (VV) and venous filling index, in addition to calf pump function metrics (ejection fraction [EF] and residual volume fraction). Bivariate correlation analysis, paired/unpaired <em>t</em> tests, and regression analysis were used to evaluate the data.</div></div><div><h3>Results</h3><div>There were 131 patients (134 limbs) with a median age of 61 (25-87) years, of whom 96 were women and 35 men. The median body mass index was 28.3 (18-57). There were 44 limbs in the C2 class, 38 limbs in the C3 class, 42 limbs in the C4 class, 2 limbs in the C5 class, and 8 limbs in the C6 class. All limbs had superficial reflux, including 80 with superficial reflux in the great saphenous vein (GSV) alone, and 54 had reflux in both GSV and small saphenous vein (SSV). There were no limbs with isolated reflux in the SSV. A total of 57 limbs had additional reflux in the deep veins (30 axial deep venous reflux). There were 21 limbs with reflux in the perforator veins. All limbs underwent successful ablation of the GSV, whereas 120 underwent additional stab phlebectomies at the same time, 1 limb had additional sclerotherapy (also at the time of the index procedure), and 5 limbs underwent treatment of the SSV. The median follow-up was 188 days. The correlation between DUS metrics (GSV diameter and total reflux volume) and clinical parameters (CEAP clinical class, VCSS, GOS, and visual analog scale pain score) was weak (<em>r</em> = 0.1-0.3; <em>P</em> > .05), although VSDS had a moderate correlation (<em>r</em> = 0.4; <em>P</em> = .004) with VCSS. A weak correlation was also noted between the clinical parameters and APG metrics (venous filling index, EF, residual volume fraction), except VV, which had a moderate correlation (<em>r</em> = 0.4; <em>P</em

目的：虽然有多种技术可用于治疗有症状的慢性静脉疾病（CVD）患者的浅静脉反流，但用于确定和量化浅静脉反流从而评估干预必要性的指标仍不清楚。本研究通过评估双工超声（DUS）和空气容积脉搏波（APG）指标与孤立下肢静脉回流设置的临床参数的关系来探讨这一主题。方法：回顾性分析经静脉内激光消融（EVLA）治疗浅表静脉反流（伴/不伴刀静脉切除术）治疗由静脉反流引起的症状性CVD的患者的资料，以确定干预成功后的初始临床表现和结果的预测因素。评估的特征包括CEAP临床分级、静脉临床严重程度评分（VCSS）、肿胀分级（GOS）、视觉模拟评分（VAS）疼痛；DUS特征包括浅静脉直径、肢体总反流量（TRV）和静脉节段性疾病评分（VSDS）。APG指标包括静脉体积（VV）、静脉充盈指数（VFI）以及小腿泵功能指标（射血分数（EF）和残余体积分数（RVF））。采用双变量相关分析、配对/非配对t检验和回归分析对数据进行评价。结果：131例患者（134条肢体），中位年龄61（25 ~ 87）岁，其中女性96例，男性35例。BMI中位数为28.3（18-57）。C2级44条，C3级38条，C4级42条，C5级2条，C6级8条。所有肢体均有浅表反流，其中80例仅发生大隐静脉（GSV）浅表反流，54例同时发生GSV和小隐静脉（SSV）反流。SSV无孤立性反流肢体。57个肢体在深静脉有额外的反流（30个轴向深静脉反流）。穿支静脉返流21肢。所有肢体均成功消融了GSV，同时有120个肢体进行了额外的刺伤静脉切除术，1个肢体进行了额外的硬化治疗（也是在第一次手术时），5个肢体进行了SSV治疗。中位随访时间为188天。DUS指标（GSV直径和TRV）与临床参数（CEAP临床分级、VCSS、GOS和VAS疼痛评分）的相关性较弱（r = 0.1-0.3; p = 0.05），而VSDS与VCSS有中度相关性（r = 0.4; p = 0.004）。临床参数与APG指标（VFI、EF、RVF）之间也存在弱相关性，但VV之间存在中度相关性（r = 0.4; p < 0.001）。在基线时，VSDS被发现是CEAP临床分类的重要预测因子（HR = 8.1, p = 0.005）和VCSS (HR = 5.3, p = 0.03)， VV被发现是GOS的重要预测因子（HR =17, p < 0.001）。浅表静脉干预成功后，临床、DUS （VSDS）和APG指标均有改善。VSDS再次是VCSS改善的显著预测因子（HR = 9.3, p = 0.003），而VV （HR = 5.5, p = 0.02）和EF （HR = 6.2, p = 0.01）是干预后GOS改善的显著预测因子。结论：孤立性静脉返流所致CVD症状患者的初始临床表现及浅静脉干预成功后的改善可通过DUS （VSDS）和APG （VV、EF）指标预测。经过这样的干预，临床、DUS和APG指标都有所改善。

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引用次数: 0

Prevalence of chronic venous disorders and its risk factors among rural adults in Tamil Nadu, South India 印度南部泰米尔纳德邦农村成人慢性静脉疾病（CVD）患病率及其危险因素

IF 2.8 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2026-05-01 Epub Date: 2026-01-09 DOI: 10.1016/j.jvsv.2026.102447

Jackwin Sam Paul MD , Prabhu Premkumar MCh , Sarah Sunil Joseph MPH , Anu Mary Oommen MD , Vinod Joseph Abraham MD

Objective

This study aimed to determine the prevalence of chronic venous disorders (CVDs) and identify the associated risk factors among rural adults in Tamil Nadu, South India.

Methods

This cross-sectional study was conducted in four rural villages in Tamil Nadu, involving 1151 participants aged ≥18 years. A two-stage cluster sampling approach was used, selecting one large village from each Primary Health Centre area and enrolling all eligible adults from consecutive streets until the sample size was met. Repeated visits ensured inclusion of temporarily absent individuals. Data were collected using structured interviews and clinical assessments, including anthropometric measurements. The prevalence of CVD and associated factors, such as socioeconomic status, smoking, alcohol consumption, parity, diet, and BMI, was assessed. Logistic regression analysis was used to identify independent predictors of CVD.

Results

The prevalence of CVD was 7.2% (95% confidence interval [CI], 5.7%-8.8%). The most common forms of CVD were varicose veins (4.5%) and telangiectasias (2.1%). Among women, multivariate logistic regression analysis identified parity of one or less (adjusted odd ratio [aOR], 0.07; 95% CI, 0.01-0.53; P = .010) and daily fruit consumption (aOR, 0.26; 95% CI, 0.14-0.49; P < .001) as factors independently associated with lower odds of CVD.

Conclusions

CVDs are prevalent in rural Tamil Nadu, with varicose veins and telangiectasia being the most common. Parity of one or less and daily fruit intake were identified as factors independently associated with a lower odds of CVD. Public health interventions that promote healthy lifestyle choices, including weight management and improved dietary habits, could play a crucial role in preventing CVD in rural populations.

目的：本研究旨在确定印度南部泰米尔纳德邦农村成年人慢性静脉疾病（CVD）的患病率，并确定相关危险因素。方法：本横断面研究在泰米尔纳德邦的四个农村进行，涉及1151名18岁及以上的参与者。采用两阶段整群抽样方法，从每个初级保健区选择一个大村庄，从连续街道招募所有符合条件的成年人，直到满足样本量。反复的探访确保了暂时缺席的人也被纳入其中。数据收集采用结构化访谈和临床评估，包括人体测量。评估心血管疾病的患病率和相关因素，如社会经济地位、吸烟、饮酒、胎次、饮食和BMI。采用Logistic回归分析确定CVD的独立预测因素。结果：CVD患病率为7.2% （95% CI: 5.7-8.8%）。最常见的CVD形式是静脉曲张（4.5%）和毛细血管扩张（2.1%）。在女性中，多因素logistic回归分析发现，产次≤1 （aOR = 0.07; 95% CI: 0.01-0.53; p = 0.010）和每天吃水果（aOR = 0.26; 95% CI: 0.14-0.49; p < 0.001）是心血管疾病发病率较低的独立相关因素。结论：CVD在泰米尔纳德邦农村普遍存在，以静脉曲张和毛细血管扩张最为常见。胎次≤1和每日水果摄入量被确定为与CVD发生率较低独立相关的因素。促进健康生活方式选择的公共卫生干预措施，包括体重管理和改善饮食习惯，可能在预防农村人口心血管疾病方面发挥关键作用。

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引用次数: 0

Long-term efficacy following venous stenting for symptomatic iliofemoral venous obstruction: 5 year clinical and stent outcomes in a Southeast Asian population 静脉支架植入术治疗症状性髂股静脉阻塞的长期疗效：东南亚人群5年临床和支架结果

IF 2.8 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2026-05-01 Epub Date: 2026-01-29 DOI: 10.1016/j.jvsv.2026.102449

Yun Sun Lim MBBS , Prajwala S. Prakash MRCSEd , Qiantai Hong FRCSEd , Malcolm Mak FRCSEd , Lawrence Han Hwee Quek FRCR , Uei Pua FRCR , Gavin Lim FRCR , Justin Kwan FRCR , Yi-Wei Wu FRCR , Gabriel Chan FRCR , Glenn Wei Leong Tan FRCSEd , Lester Rhan Chaen Chong FRCSEd , Li Zhang MRCSEd , Enming Yong FRCSEd, MBA

Objective

Endovenous stenting is the standard of care for symptomatic iliofemoral venous obstruction with good short-term patency. We present our long-term outcomes in a Southeast Asian cohort.

Methods

We conducted a single-center retrospective review of 76 patients (98 limbs) who underwent iliofemoral venous stenting between 2015 and 2020. Clinical data and stent outcomes were analyzed over a median follow-up of 65.3 months. Primary, assisted primary, and secondary patency were reviewed using Kaplan-Meier analysis. Stent-related complications, long-term clinical outcomes and factors associated with stent occlusion, were assessed.

Results

Of 98 limbs, 82.6% had nonthrombotic iliac vein lesions, 9.2% post-thrombotic syndrome, and 8.2% acute deep vein thrombosis. A 100% technical success rate was achieved. The 5-year cumulative primary, assisted primary, and secondary patency rates were 88.2%, 92.5%, and 98.9%, respectively. Primary patency for stenting for nonthrombotic iliac vein lesion, post-thrombotic syndrome, and deep vein thrombosis was 92.0%, 77.8%, and 62.5%, respectively. Loss of patency occurred mainly within the first year, largely from noncompliance and inadequate anticoagulation. Stent-related complications were rare (fracture 1.3%, migration 1.3%). The rate of stent occlusion (per limb) was 8.2%. At 5 years, ulcer-free rate was 82.7%, pain relief 91.8%, and sustained swelling relief 53.1%. No patient required major amputation, and all-cause mortality was unrelated to venous disease.

Conclusions

Dedicated venous stenting for symptomatic iliofemoral obstruction is safe and durable, with good long-term patency and clinical outcomes in this Southeast Asian cohort. Most reinterventions occurred early, highlighting the importance of procedural technique, inflow optimization, and adherence to antithrombotic therapy. These data support endovenous stenting as a long-term treatment strategy for iliofemoral venous obstruction.

目的：静脉内支架置入术是短期通畅良好的症状性髂股静脉阻塞的标准治疗方法。我们在东南亚队列中展示了我们的长期结果。方法：我们对2015年至2020年间接受髂股静脉支架术的76例（98条肢体）患者进行了单中心回顾性分析。在65.3个月的中位随访期间分析了临床数据和支架结果。使用Kaplan-Meier分析回顾原发性、辅助原发性和继发性通畅。评估支架相关并发症、长期临床结果和支架闭塞相关因素。结果：98条肢体中，82.6%存在非血栓性髂静脉病变（NIVL）， 9.2%存在血栓后综合征（PTS）， 8.2%存在急性深静脉血栓形成（DVT）。100%的技术成功。5年累计原发性、辅助原发性和继发性通畅率分别为88.2%、92.5%和98.9%。NIVL、PTS和DVT的初始通畅率分别为92.0%、77.8%和62.5%。通畅的丧失主要发生在第一年，主要是由于不遵医嘱和抗凝治疗不足。支架相关并发症很少见（骨折1.3%，移位1.3%）。支架闭塞率（每条肢体）为8.2%。5年时，无溃疡率为82.7%，疼痛缓解率为91.8%，持续肿胀缓解率为53.1%。没有患者需要截肢，全因死亡率与静脉疾病无关。结论：专用静脉支架治疗症状性髂股梗阻是安全且持久的，在东南亚队列中具有良好的长期通畅和临床结果。大多数再干预发生在早期，强调了手术技术、血流优化和坚持抗血栓治疗的重要性。这些数据支持静脉内支架置入术作为髂股静脉阻塞的长期治疗策略。

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引用次数: 0

The effect of prolonged complex decongestive therapy for lower limb secondary lymphedema 长期综合消血治疗下肢继发性淋巴水肿的疗效观察。

IF 2.8 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2026-05-01 Epub Date: 2026-01-07 DOI: 10.1016/j.jvsv.2026.102444

Kotaro Suehiro MD , Takasuke Harada MD , Yuriko Takeuchi MD , Takahiro Mizoguchi MD , Hiroshi Kurazumi MD , Mototsugu Shimokawa MD , Kimikazu Hamano MD

Objective

To clarify the effect of prolonged complex decongestive therapy (CDT) on limb volume in patients with lower limb lymphedema (LLL).

Methods

We reviewed patients who first visited our clinic for cancer-related LLL between April 2009 and March 2015 and continued CDT at our clinic for 7 years or longer. At 6- to 12-month intervals, limb volume was calculated from tape measurements, and ultrasound examination was performed to evaluate changes in the skin and subcutaneous tissue conditions.

Results

In 52 patients (68 lower limbs) who were on CDT for a median of 11.2 years, 54% maintained reduced limb volume, whereas limb volume increased in 46% of patients compared with their initial visits. An increase in circumference was mainly observed in the calf area, where the subcutaneous echo-free space (edema) increased. In multivariate analysis, relevant factors associated with the increase in limb volume were an increase in body mass index (odds ratio, 1.73; 95% confidence interval [CI], 1.15-2.93), the use of compression devices for fewer than 5 days per week (odds ratio, 4.57; 95% CI, 1.06-23.53), and the use of compression devices with interface pressure lower than 20 mm Hg (odds ratio, 36.47; 95% CI, 3.42-1061.90).

Conclusions

During prolonged CDT, limb volume increased in 46% of limbs with LLL, which was associated with an increase in edema, particularly in the calf area. The factors associated with increased limb volume were an increase in body mass index, the use of compression devices for fewer than 5 days per week, and the use of compression devices with interface pressure <20 mm Hg.

目的：探讨长期复合消血治疗（CDT）对下肢淋巴水肿（LLL）患者肢体体积的影响。方法：我们回顾了2009年4月至2015年3月期间首次到我们诊所就诊的癌症相关ll患者，并在我们诊所持续CDT 7年或更长时间。每隔6至12个月，通过胶带测量计算肢体体积，并进行超声检查以评估皮肤和皮下组织状况的变化。结果：52例患者（68条下肢）接受CDT治疗的中位时间为11.2年，其中54%的患者保持肢体体积减小，而46%的患者与初次就诊相比肢体体积增加。围度增加主要见于小腿区域，皮下无回声空间（水肿）增加。在多因素分析中，与肢体体积增加相关的因素是体重指数（BMI）增加（优势比1.73[95%可信区间1.15-2.93]）、每周使用压缩装置少于5天（优势比4.57 [95% CI 1.06-23.53]）、使用界面压力低于20 mmHg的压缩装置（优势比36.47 [95% CI 3.42-1061.90]）。结论：在长时间的CDT期间，46%的下肢LLL患者的肢体体积增加，这与水肿增加有关，特别是在小腿区域。与肢体体积增加相关的因素是BMI增加和使用压缩装置< 5天/周且界面压力< 20 mmHg。

{"title":"The effect of prolonged complex decongestive therapy for lower limb secondary lymphedema","authors":"Kotaro Suehiro MD , Takasuke Harada MD , Yuriko Takeuchi MD , Takahiro Mizoguchi MD , Hiroshi Kurazumi MD , Mototsugu Shimokawa MD , Kimikazu Hamano MD","doi":"10.1016/j.jvsv.2026.102444","DOIUrl":"10.1016/j.jvsv.2026.102444","url":null,"abstract":"<div><h3>Objective</h3><div>To clarify the effect of prolonged complex decongestive therapy (CDT) on limb volume in patients with lower limb lymphedema (LLL).</div></div><div><h3>Methods</h3><div>We reviewed patients who first visited our clinic for cancer-related LLL between April 2009 and March 2015 and continued CDT at our clinic for 7 years or longer. At 6- to 12-month intervals, limb volume was calculated from tape measurements, and ultrasound examination was performed to evaluate changes in the skin and subcutaneous tissue conditions.</div></div><div><h3>Results</h3><div>In 52 patients (68 lower limbs) who were on CDT for a median of 11.2 years, 54% maintained reduced limb volume, whereas limb volume increased in 46% of patients compared with their initial visits. An increase in circumference was mainly observed in the calf area, where the subcutaneous echo-free space (edema) increased. In multivariate analysis, relevant factors associated with the increase in limb volume were an increase in body mass index (odds ratio, 1.73; 95% confidence interval [CI], 1.15-2.93), the use of compression devices for fewer than 5 days per week (odds ratio, 4.57; 95% CI, 1.06-23.53), and the use of compression devices with interface pressure lower than 20 mm Hg (odds ratio, 36.47; 95% CI, 3.42-1061.90).</div></div><div><h3>Conclusions</h3><div>During prolonged CDT, limb volume increased in 46% of limbs with LLL, which was associated with an increase in edema, particularly in the calf area. The factors associated with increased limb volume were an increase in body mass index, the use of compression devices for fewer than 5 days per week, and the use of compression devices with interface pressure <20 mm Hg.</div></div>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"14 3","pages":"Article 102444"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145944816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A novel infrared fluorescence method to identify regions of superficial microvenous reflux in patients with chronic venous disease 一种新的红外荧光方法识别慢性静脉疾病患者浅表微静脉回流区域。

IF 2.8 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2026-05-01 Epub Date: 2026-01-19 DOI: 10.1016/j.jvsv.2026.102448

Gregory T. Jones PhD, Kari Clifford PhD, Geraldine B. Hill MSc, Kate N. Thomas PhD, Sarah Lesche MD, Jolanta Krysa MBChB

Objective

Reflux within the superficial microvenous network may play a critical role in the development of skin changes associated with chronic venous insufficiency. This study aimed to extend previous ex vivo observations to determine the in vivo utility of near infrared fluorescence (NIRF) imaging to assess superficial venous reflux in the leg.

Methods

A total of 28 limbs were examined in 17 participants. These included limbs with (CEAP C2, n = 6; C3, n = 1; and C4, n = 15) and without (CEAP C0, n = 6) venous disease. Indocyanine green (5 mL at 0.1 mg/mL) was infused via an (antegrade) cannula in the distal great saphenous vein and the medial leg imaged using NIRF. Venous reflux was assessed using the Valsalva maneuver, with or without superficial outflow obstruction (thigh cuff inflated to 50 mmHg).

Results

Consistent with our previous ex vivo study, NIRF imaging visualized a wide range of different microvenous reflux patterns in vivo. These included focal and diffuse regions of fluorescence within the skin, the extent of which appeared to be associated with venous disease (CEAP C classification) severity. The observed reflux patterns also appeared to be functional correlates of perforator vein or saphenofemoral junctional incompetence.

Conclusions

This preliminary in vivo study provides proof-of-principle observations suggesting a potential novel method for investigating microvenous reflux in superficial venous disease.

Clinical Relevance

This study reports the first in vivo use of near-infrared fluorescence (NIRF) imaging with indocyanine green to assess superficial microvenous reflux within intact limbs. This preliminary data suggests that the extent and distribution of skin fluorescence may be associated with venous disease severity (CEAP Clinical classification). It also provides potential mechanistic insight, identifying reflux patterns that appear to be functional correlates of venous incompetence. This study suggests that NIRF imaging could provide a novel tool for investigating microvenous contributions to chronic venous disease and its skin manifestations.

目的：浅表微静脉网络内的反流可能在慢性静脉功能不全相关皮肤变化的发展中起关键作用。本研究旨在扩展先前的离体观察，以确定近红外荧光（NIRF）成像在体内评估腿部浅表静脉回流的效用。方法：对17例患者共28条肢体进行检查。这些包括患有（CEAP C2 n=6, C3 n=1和C4 n=15）和没有（CEAP C0, n=6）静脉疾病的肢体。吲哚菁绿（5mL @ 0.1mg/mL）通过远端大隐静脉（顺行）插管输注，并使用NIRF对小腿内侧进行成像。采用Valsalva手法评估静脉回流，有无浅表流出物阻塞（大腿袖膨胀至50mmHg）。结果：与我们之前的离体研究一致，NIRF成像在体内显示了各种不同的微静脉反流模式。这些包括皮肤内荧光的局灶区和弥漫性区域，其程度似乎与静脉疾病（CEAP C分类）的严重程度有关。观察到的反流模式似乎也与穿支静脉或隐股关节功能不全有关。结论：这项初步的体内研究提供了原则性的观察结果，为研究浅表静脉疾病的微静脉回流提供了一种潜在的新方法。

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引用次数: 0

Efficacy and Safety of Cyanoacrylate Ablation versus Endovenous Radiofrequency Ablation for Varicose Veins in Chronic Great Saphenous Vein Insufficiency:A systematic review and meta-analysis. 氰基丙烯酸酯消融与静脉内射频消融治疗慢性大隐静脉不全曲张的疗效和安全性：一项系统综述和荟萃分析。

IF 2.8 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2026-03-20 DOI: 10.1016/j.jvsv.2026.102490

Xin Wen, Hongkun Wu, Yong He, Yongjin Luo, Hao Chen

Objectives: Endovenous radiofrequency ablation (RFA) and cyanoacrylate ablation (CA) are widely used for the treatment of chronic great saphenous vein (GSV) insufficiency. Compared with traditional surgery, both modalities have demonstrated well-recognized therapeutic benefits. However, controversy remains regarding the optimal choice between RFA and CA. The aim of this study was to conduct a systematic review and meta-analysis to compare the early and mid-term clinical outcomes of RFA versus CA.

Methods: A systematic review and meta-analysis was performed in accordance with the PRISMA guidelines. Comprehensive searches were conducted in PubMed, Embase, Cochrane Library, and Web of Science to identify relevant studies. Randomized controlled trials, cohort studies, and case-control studies evaluating RFA and CA for the treatment of GSV incompetence were included. The primary outcomes were GSV occlusion rate and venous clinical severity score (VCSS). Secondary outcomes included skin pigmentation, phlebitis, deep vein thrombosis (DVT), ecchymosis, and procedure-related phlebitis. Data extraction and quality assessment were independently performed by two reviewers. Statistical analyses were conducted using Review Manager 5.3.

Results: A total of 21 studies were included, encompassing 7,844 patients and 9,677 limbs. In terms of efficacy, there were no significant differences between CA and RFA in GSV occlusion rate or VCSS. Regarding safety, pooled data showed that CA was associated with a lower incidence of ecchymosis (5.96% vs. 10.97%; P = 0.01) and paresthesia (1.24% vs. 2.97%; P = 0.04). No significant differences were observed between the two groups in the incidence of phlebitis, DVT, or pigmentation. In addition, the procedure time was significantly shorter in the CA group than in the RFA group (P < 0.001).

Conclusions: For the treatment of incompetent saphenous veins, CA provides comparable efficacy to RFA. However, CA is associated with lower rates of skin pigmentation and ecchymosis, as well as a shorter procedure time.

目的：静脉内射频消融术（RFA）和氰基丙烯酸酯消融术（CA）被广泛应用于治疗慢性大隐静脉（GSV）功能不全。与传统手术相比，两种方式都显示出公认的治疗效果。然而，关于RFA和CA的最佳选择仍然存在争议。本研究的目的是进行系统回顾和荟萃分析，比较RFA和CA的早期和中期临床结果。方法：根据PRISMA指南进行系统回顾和荟萃分析。在PubMed、Embase、Cochrane Library和Web of Science中进行综合检索以确定相关研究。随机对照试验、队列研究和病例对照研究评估RFA和CA治疗GSV无能。主要结果为GSV闭塞率和静脉临床严重程度评分（VCSS）。次要结果包括皮肤色素沉着、静脉炎、深静脉血栓形成（DVT）、瘀斑和手术相关的静脉炎。数据提取和质量评估由两名审稿人独立完成。使用Review Manager 5.3进行统计分析。结果：共纳入21项研究，涉及7844例患者，9677条肢体。在疗效方面，CA和RFA在GSV闭塞率和VCSS方面无显著差异。在安全性方面，汇总数据显示CA与较低的瘀斑发生率（5.96%比10.97%,P = 0.01）和感觉异常发生率（1.24%比2.97%,P = 0.04）相关。在静脉炎、深静脉血栓或色素沉着的发生率方面，两组之间没有显著差异。此外，CA组的手术时间明显短于RFA组（P < 0.001）。结论：CA与RFA治疗隐静脉功能不全的疗效相当。然而，CA与较低的皮肤色素沉着和瘀斑发生率以及较短的手术时间有关。

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引用次数: 0

Short-term outcomes of ultrasound-assisted catheter-directed thrombolysis and mechanical thrombectomy in management of intermediate-risk pulmonary embolism. 超声辅助导管溶栓和机械取栓治疗中危肺栓塞的短期疗效。

IF 2.8 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2026-03-20 DOI: 10.1016/j.jvsv.2026.102489

Crista E Horton, Matthew S Wi, Matthew Sayegh, Douglas Mancuso, Lauren A Huntress, Joseph Savarese, John Ricotta, Joseph J Ricotta

Objectives: To compare preoperative right ventricle-to-left ventricle (RV/LV) ratios by computed tomography angiography (CTA) and echocardiography and evaluate treatment outcomes of ultrasound-assisted catheter-directed thrombolysis (USAT) or mechanical thrombectomy (MT) in patients with intermediate-risk pulmonary embolism (PE).

Methods: We retrospectively identified patients treated for intermediate-risk PE from 2018-2023 defined by systolic blood pressure (BP) >90 mmHg and right ventricle dysfunction defined by RV/LV ratio >0.9 via echocardiogram. RV/LV ratios were also evaluated on diagnostic CTA for comparison to echocardiogram values. Patients underwent USAT or MT based on thrombus location and contraindications to thrombolysis. Primary outcomes were intensive care unit (ICU) length of stay (LOS), hospital LOS (HLOS), and 30-day and 1-year survival. Secondary outcomes included RV/LV change post-treatment on echocardiography, concomitant deep vein thrombosis (DVT), elevated cardiac biomarkers, blood transfusion, history of DVT/PE or malignancy, and imaging modality comparison in determination of RV/LV and RV/LV changes.

Results: Of 120 patients from a single center treated for intermediate-risk PE, 100 underwent USAT and 20 MT. There was no difference in ICU LOS (2.4 vs 2.6, p=0.67) or HLOS (4.8 vs 5.7, p=0.41) for USAT and MT, respectively. There was no difference in 30-day (98% vs 100%), or 1-year survival (96% vs 90%). MT patients had greater incidence of blood transfusion (25% vs 5%, p=0.011). CTA overestimated RV/LV ratios preoperatively compared with echocardiography (1.4, SD=0.4 vs 1.3, SD 0.2, p=0.027). Patients undergoing MT were more likely to have identified lower extremity (LE) DVT compared to USAT (90% vs 65%, p=0.033). Other secondary outcomes showed no significant differences between treatment groups.

Conclusions: Both USAT and MT provide excellent short-term and intermediate outcomes in patients with intermediate-risk PE, similar survival rates, similar post-treatment change in right heart dysfunction, and comparable ICU and hospital stays. MT is associated with higher transfusion rates, so caution should be exercised in patients felt to be at risk from further blood loss. These findings support individualized, anatomy- and risk-based selection of catheter-based therapy within a multidisciplinary pulmonary embolism response framework.

目的：比较计算机断层血管造影（CTA）和超声心动图术前右心室与左心室（RV/LV）的比值，评价超声辅助导管溶栓（USAT）或机械取栓（MT）治疗中危肺栓塞（PE）患者的疗效。方法：回顾性分析2018-2023年接受超声心动图诊断为收缩压（BP） bbb90 mmHg和右心室功能障碍（右心室/左室比>0.9）的中危性PE患者。在诊断性CTA上评估RV/LV比值，并与超声心动图值进行比较。患者根据血栓位置和溶栓禁忌症接受USAT或MT治疗。主要结局为重症监护病房（ICU）住院时间（LOS）、住院时间（HLOS）、30天和1年生存率。次要结局包括治疗后超声心动图左室/左室变化、合并深静脉血栓形成（DVT）、心脏生物标志物升高、输血、DVT/PE或恶性肿瘤病史，以及在确定左室/左室和左室/左室变化时影像学方式的比较。结果：来自单一中心的120例中危PE患者中，有100例接受了USAT和20例接受了MT。USAT和MT在ICU LOS （2.4 vs 2.6, p=0.67）和HLOS （4.8 vs 5.7, p=0.41）方面没有差异。30天生存率（98% vs 100%）和1年生存率（96% vs 90%）无差异。MT患者输血发生率更高（25% vs 5%, p=0.011）。与超声心动图相比，术前CTA高估了RV/LV比值（1.4，SD=0.4 vs 1.3, SD 0.2, p=0.027）。与USAT相比，接受MT的患者更有可能发现下肢（LE） DVT （90% vs 65%, p=0.033）。其他次要结局在治疗组间无显著差异。结论：USAT和MT在中度风险PE患者中提供了良好的短期和中期预后，生存率相似，治疗后右心功能障碍变化相似，ICU和住院时间相似。MT与较高的输血率相关，因此对于感觉有进一步失血风险的患者应谨慎对待。这些发现支持在多学科肺栓塞反应框架内个体化、解剖和基于风险的导管治疗选择。

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引用次数: 0