Pub Date : 2026-01-01DOI: 10.1016/S2213-333X(25)00207-0
{"title":"Events of Interest","authors":"","doi":"10.1016/S2213-333X(25)00207-0","DOIUrl":"10.1016/S2213-333X(25)00207-0","url":null,"abstract":"","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"14 1","pages":"Article 102372"},"PeriodicalIF":2.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924159","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}
Pub Date : 2025-12-29DOI: 10.1016/j.jvsv.2025.102440
Karissa M. Wang MD, Blake E. Murphy MD, Jake F. Hemingway MD
<div><h3>Objective</h3><div>Inferior vena cava (IVC) occlusion resulting from deep vein thrombosis (DVT) or embryologic developmental abnormalities can result in debilitating symptoms, including lower extremity pain, edema, and venous ulceration. This study describes the outcomes associated with endovascular recanalization and stenting of chronic IVC occlusions with dedicated venous nitinol stents.</div></div><div><h3>Methods</h3><div>Patients who underwent endovascular recanalization and nitinol venous stenting at a single institution from 2022 to 2025 were identified. Demographics, comorbidities, CEAP classification, venous reconstruction details, and outcomes, including symptomatic improvement and 30-day complications, were collected. Descriptive analysis was completed. Primary and secondary patency was assessed using Kaplan-Meier analysis.</div></div><div><h3>Results</h3><div>A total of 22 patients with symptomatic IVC occlusions underwent attempted recanalization. The median age at the time of treatment was 41 years (interquartile range [IQR], 37-71 years), and patients were predominantly male (77%). Patient comorbidities included active tobacco use (55%), hypertension (41%), and hypercoagulable disorders (32%). On presentation, 20 patients (91%) had post-thrombotic syndrome, 12 (55%) had CEAP class 4 to 6 chronic venous disease, six (27%) had occluded IVC filters, four (18%) had a prior failed venous intervention, and five (23%) had chronic stent occlusions. The etiology of chronic IVC occlusion included DVT in 13 patients (59%), IVC filter-associated thrombosis in four patients (18%), surgical-related IVC stenosis in two patients (9%), congenital abnormalities in two patients (9%), and IVC clipping in one patient (5%). Cranial extent of stenting was infrarenal in 11 patients (52%) and suprarenal in 10 patients (48%). Common femoral veins were stented in 27 patients (64% of limbs). Sharp recanalization was required in three patients (14%). A total of 21 patients (95%) achieved technical success. All patients were anticoagulated postoperatively, and the median length of stay was 1 day (IQR, 0-2 days). Two patients (9.5%) experienced bleeding-related complications within 30 days. The median follow-up was 259 days (IQR, 78-473 days). Primary patency for the IVC stents was 100% at 12 months. Primary and secondary patency for all components within the venous reconstruction, including IVC and iliofemoral stents, was 84% and 100% at 1 year, respectively. All patients reported symptomatic improvement and venous ulcers healing (if present at index presentation) within 1 year following intervention.</div></div><div><h3>Conclusions</h3><div>Treatment of chronic IVC occlusions using dedicated venous nitinol stents is safe with excellent midterm patency and symptom improvement at 1 year postoperatively. Multi-institutional studies with larger patient populations and standardized outcomes, including quality of life and cost measures, are required to furt
{"title":"Results of dedicated venous nitinol stents in treating chronic inferior vena cava occlusions","authors":"Karissa M. Wang MD, Blake E. Murphy MD, Jake F. Hemingway MD","doi":"10.1016/j.jvsv.2025.102440","DOIUrl":"10.1016/j.jvsv.2025.102440","url":null,"abstract":"<div><h3>Objective</h3><div>Inferior vena cava (IVC) occlusion resulting from deep vein thrombosis (DVT) or embryologic developmental abnormalities can result in debilitating symptoms, including lower extremity pain, edema, and venous ulceration. This study describes the outcomes associated with endovascular recanalization and stenting of chronic IVC occlusions with dedicated venous nitinol stents.</div></div><div><h3>Methods</h3><div>Patients who underwent endovascular recanalization and nitinol venous stenting at a single institution from 2022 to 2025 were identified. Demographics, comorbidities, CEAP classification, venous reconstruction details, and outcomes, including symptomatic improvement and 30-day complications, were collected. Descriptive analysis was completed. Primary and secondary patency was assessed using Kaplan-Meier analysis.</div></div><div><h3>Results</h3><div>A total of 22 patients with symptomatic IVC occlusions underwent attempted recanalization. The median age at the time of treatment was 41 years (interquartile range [IQR], 37-71 years), and patients were predominantly male (77%). Patient comorbidities included active tobacco use (55%), hypertension (41%), and hypercoagulable disorders (32%). On presentation, 20 patients (91%) had post-thrombotic syndrome, 12 (55%) had CEAP class 4 to 6 chronic venous disease, six (27%) had occluded IVC filters, four (18%) had a prior failed venous intervention, and five (23%) had chronic stent occlusions. The etiology of chronic IVC occlusion included DVT in 13 patients (59%), IVC filter-associated thrombosis in four patients (18%), surgical-related IVC stenosis in two patients (9%), congenital abnormalities in two patients (9%), and IVC clipping in one patient (5%). Cranial extent of stenting was infrarenal in 11 patients (52%) and suprarenal in 10 patients (48%). Common femoral veins were stented in 27 patients (64% of limbs). Sharp recanalization was required in three patients (14%). A total of 21 patients (95%) achieved technical success. All patients were anticoagulated postoperatively, and the median length of stay was 1 day (IQR, 0-2 days). Two patients (9.5%) experienced bleeding-related complications within 30 days. The median follow-up was 259 days (IQR, 78-473 days). Primary patency for the IVC stents was 100% at 12 months. Primary and secondary patency for all components within the venous reconstruction, including IVC and iliofemoral stents, was 84% and 100% at 1 year, respectively. All patients reported symptomatic improvement and venous ulcers healing (if present at index presentation) within 1 year following intervention.</div></div><div><h3>Conclusions</h3><div>Treatment of chronic IVC occlusions using dedicated venous nitinol stents is safe with excellent midterm patency and symptom improvement at 1 year postoperatively. Multi-institutional studies with larger patient populations and standardized outcomes, including quality of life and cost measures, are required to furt","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"14 2","pages":"Article 102440"},"PeriodicalIF":2.8,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145878051","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}
Venous thromboembolism (VTE) and cancer exhibit a bidirectional correlation. The probability of detecting occult cancer in unprovoked VTE patients is significantly increased, and the cancer is often diagnosed at an advanced stage. Early screening is critical for improving prognosis; however, the effectiveness of current risk stratification and screening strategies remains controversial.
Methods
This review systematically integrated evidence on the epidemiology, risk stratification, and screening methods for occult malignancies in individuals with unprovoked VTE.
Results
Cancer-induced hypercoagulability and VTE-related inflammation interact bidirectionally, promoting thrombosis and cancer progression. In terms of risk stratification, elderly patients with VTE, as well as those comorbid with diabetes, diverticular disease, dementia, or with a history of aspirin use, have a higher detection rate of occult cancer. Occult cancer may also be indicated in patients with VTE at special sites, such as splanchnic vein thrombosis, cerebral venous thrombosis, and lower extremity arterial thrombosis, as well as in those with recurrent VTE. However, the impact of sex on the presence of occult cancer in VTE patients remains controversial. International guidelines recommend limited screening as a first-line approach, because extensive screening does not significantly improve prognosis. Positron emission tomography with computed tomography scan may enhance accurate cancer diagnosis. The Registro Informatizado Enfermedad TromboEmbólica (RIETE) and Screening for Occult Malignancy in Patients with Idiopathic Venous Thromboembolism (SOME) risk scores show limited predictive efficacy, while biomarkers and machine learning models demonstrate high diagnostic efficacy, indicating their potential application.
Conclusions
Regular cancer screening is necessary for individuals with unprovoked VTE, and clinical practice should adopt individualized screening strategies based on risk stratification. Future research should focus on optimizing existing models and exploring the combined application of biomarkers and machine learning to improve cancer screening for this population.
{"title":"Advances in occult cancer screening for patients with unprovoked venous thromboembolism: A narrative review of epidemiology, risk, and clinical strategies","authors":"Jianbin Wen MB , Chunfang Zhang MB , Fei Wu MB , Qingfu Zeng MD","doi":"10.1016/j.jvsv.2025.102439","DOIUrl":"10.1016/j.jvsv.2025.102439","url":null,"abstract":"<div><h3>Background</h3><div>Venous thromboembolism (VTE) and cancer exhibit a bidirectional correlation. The probability of detecting occult cancer in unprovoked VTE patients is significantly increased, and the cancer is often diagnosed at an advanced stage. Early screening is critical for improving prognosis; however, the effectiveness of current risk stratification and screening strategies remains controversial.</div></div><div><h3>Methods</h3><div>This review systematically integrated evidence on the epidemiology, risk stratification, and screening methods for occult malignancies in individuals with unprovoked VTE.</div></div><div><h3>Results</h3><div>Cancer-induced hypercoagulability and VTE-related inflammation interact bidirectionally, promoting thrombosis and cancer progression. In terms of risk stratification, elderly patients with VTE, as well as those comorbid with diabetes, diverticular disease, dementia, or with a history of aspirin use, have a higher detection rate of occult cancer. Occult cancer may also be indicated in patients with VTE at special sites, such as splanchnic vein thrombosis, cerebral venous thrombosis, and lower extremity arterial thrombosis, as well as in those with recurrent VTE. However, the impact of sex on the presence of occult cancer in VTE patients remains controversial. International guidelines recommend limited screening as a first-line approach, because extensive screening does not significantly improve prognosis. Positron emission tomography with computed tomography scan may enhance accurate cancer diagnosis. The Registro Informatizado Enfermedad TromboEmbólica (RIETE) and Screening for Occult Malignancy in Patients with Idiopathic Venous Thromboembolism (SOME) risk scores show limited predictive efficacy, while biomarkers and machine learning models demonstrate high diagnostic efficacy, indicating their potential application.</div></div><div><h3>Conclusions</h3><div>Regular cancer screening is necessary for individuals with unprovoked VTE, and clinical practice should adopt individualized screening strategies based on risk stratification. Future research should focus on optimizing existing models and exploring the combined application of biomarkers and machine learning to improve cancer screening for this population.</div></div>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"14 2","pages":"Article 102439"},"PeriodicalIF":2.8,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145804759","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}
Pub Date : 2025-12-16DOI: 10.1016/j.jvsv.2025.102379
Hind Anan MD , Pamela EL. Hayek MD , Fanny Alie-Cusson MD , Leon Xuanyu Min BS , Elizabeth Andraska MD MSc , Jihane Jadi MD , Rabih Chaer MD, MSc , Marissa Jarosinski MD , Natalie Sridharan MD, MSc
Objective
Catheter-directed intervention (CDI) use in massive pulmonary embolism (PE) is rarely studied due to guideline recommendations for systemic thrombolysis (stPA). Nevertheless, surgical embolectomy (SE) and CDI remain well-accepted alternatives in massive PE management, particularly when patients have contraindications to or do not improve after stPA. We hypothesized that CDI and SE have comparable outcomes in the treatment of massive PE.
Methods
We conducted a retrospective review of patients presenting with massive PE who underwent CDI or SE at a multihospital health care system (2010-2024). Baseline characteristics, in-hospital outcomes, and long-term mortality were recorded. Data was analyzed using Kaplan-Meier survival curves and multivariate Cox regression.
Results
A total of 99 patients with massive PE were analyzed, with 24 (24.2%) undergoing SE and 75 (75.8%) receiving CDI (41 suction thrombectomies and 34 catheter-directed thrombolysis). SE and CDI baseline characteristics were similar with mean age of 58.5 years in SE and 64.5 years in CDI (P = .09). The majority in both groups had absolute (CDI, 17.3%; SE, 16.7%; P = .94) or relative contraindication (CDI, 58.7%; SE, 66.7%; P = .49) to stPA. The use of preoperative stPA was similar in both groups (CDI, 13.3%; SE, 25.0%; P = .21). Median time to procedure was also similar (CDI, 14.3 hours; SE, 18.5 hours; P = .42). CDI was associated with a lower total intensive care unit (ICU) length of stay (LOS) (median, 2.2 vs 3.3 days; P = .04) and lower major bleeding complications (9.3% vs 79.2%; P < .001). However, there was no statistically significant difference in fatal bleeding (CDI, 5.33%; SE, 4.17%; P = 1.00), need for bailout intervention (CDI, 8.0%; SE, 16.7%; P = .25), resolution of right heart strain (CDI, 27.8%; SE, 41.2%; P = .37), or median hospital LOS (CDI, 8 days; SE, 5 days; P = .12) between both groups. In-hospital mortality occurred equally (CDI, 21.3%; SE, 20.8%; P = 1.00). On Kaplan-Meier analysis, there was no survival difference between the two groups. On Cox regression, procedure type was not a significant predictor for mortality (adjusted hazard ratio 1.36; 95% confidence interval, 0.58-3.20; reference: SE).
Conclusions
CDI is a minimally invasive alternative to SE in massive PE and offers comparable outcomes and similar survival rates. Nevertheless, CDI offers advantages in terms of shorter ICU stay and fewer major bleeding complications.
目的：由于指南推荐全体性溶栓（stPA），导管定向干预（CDI）在大规模肺栓塞（PE）中的应用很少被研究。尽管如此，外科栓塞切除术（SE）和CDI仍然是大规模PE治疗中被广泛接受的替代方案，特别是当患者有禁忌症或stPA后没有改善时。我们假设CDI和SE在治疗大量PE方面具有相当的结果。方法：我们对在多医院医疗系统（2010-2024）接受CDI或SE治疗的大量PE患者进行了回顾性研究。记录基线特征、住院结果和长期死亡率。数据分析采用Kaplan-Meier生存曲线和多变量Cox回归。结果：共分析99例大块性PE患者，其中24例（24.2%）行SE， 75例（75.8%）行CDI（41例吸盘取栓术，34例导管溶栓术）。SE和CDI的基线特征相似，SE的平均年龄为58.5岁，CDI的平均年龄为64.5岁（p= 0.09）。两组大多数患者对stPA有绝对禁忌症（CDI 17.3%, SE 16.7%, p= 0.94）或相对禁忌症（CDI 58.7%, SE 66.7%, p= 0.49）。两组术前stPA的使用相似（CDI 13.3%, SE 25.0%; p= 0.21）。中位手术时间也相似（CDI 14.3小时，SE 18.5小时；p= 0.42）。CDI与较低的总重症监护（ICU）住院时间（LOS）（中位2.2天vs 3.3天；p= 0.04）和较低的大出血并发症（9.3% vs 79.2%）相关。结论：CDI是一种微创替代SE治疗大面积PE的方法，可提供相似的结果和相似的生存率。然而，CDI在缩短ICU时间和减少大出血并发症方面具有优势。
{"title":"Catheter-directed interventions versus surgical embolectomy in massive pulmonary embolism","authors":"Hind Anan MD , Pamela EL. Hayek MD , Fanny Alie-Cusson MD , Leon Xuanyu Min BS , Elizabeth Andraska MD MSc , Jihane Jadi MD , Rabih Chaer MD, MSc , Marissa Jarosinski MD , Natalie Sridharan MD, MSc","doi":"10.1016/j.jvsv.2025.102379","DOIUrl":"10.1016/j.jvsv.2025.102379","url":null,"abstract":"<div><h3>Objective</h3><div>Catheter-directed intervention (CDI) use in massive pulmonary embolism (PE) is rarely studied due to guideline recommendations for systemic thrombolysis (stPA). Nevertheless, surgical embolectomy (SE) and CDI remain well-accepted alternatives in massive PE management, particularly when patients have contraindications to or do not improve after stPA. We hypothesized that CDI and SE have comparable outcomes in the treatment of massive PE.</div></div><div><h3>Methods</h3><div>We conducted a retrospective review of patients presenting with massive PE who underwent CDI or SE at a multihospital health care system (2010-2024). Baseline characteristics, in-hospital outcomes, and long-term mortality were recorded. Data was analyzed using Kaplan-Meier survival curves and multivariate Cox regression.</div></div><div><h3>Results</h3><div>A total of 99 patients with massive PE were analyzed, with 24 (24.2%) undergoing SE and 75 (75.8%) receiving CDI (41 suction thrombectomies and 34 catheter-directed thrombolysis). SE and CDI baseline characteristics were similar with mean age of 58.5 years in SE and 64.5 years in CDI (<em>P</em> = .09). The majority in both groups had absolute (CDI, 17.3%; SE, 16.7%; <em>P</em> = .94) or relative contraindication (CDI, 58.7%; SE, 66.7%; <em>P</em> = .49) to stPA. The use of preoperative stPA was similar in both groups (CDI, 13.3%; SE, 25.0%; <em>P</em> = .21). Median time to procedure was also similar (CDI, 14.3 hours; SE, 18.5 hours; <em>P</em> = .42). CDI was associated with a lower total intensive care unit (ICU) length of stay (LOS) (median, 2.2 vs 3.3 days; <em>P</em> = .04) and lower major bleeding complications (9.3% vs 79.2%; <em>P</em> < .001). However, there was no statistically significant difference in fatal bleeding (CDI, 5.33%; SE, 4.17%; <em>P</em> = 1.00), need for bailout intervention (CDI, 8.0%; SE, 16.7%; <em>P</em> = .25), resolution of right heart strain (CDI, 27.8%; SE, 41.2%; <em>P</em> = .37), or median hospital LOS (CDI, 8 days; SE, 5 days; <em>P</em> = .12) between both groups. In-hospital mortality occurred equally (CDI, 21.3%; SE, 20.8%; <em>P</em> = 1.00). On Kaplan-Meier analysis, there was no survival difference between the two groups. On Cox regression, procedure type was not a significant predictor for mortality (adjusted hazard ratio 1.36; 95% confidence interval, 0.58-3.20; reference: SE).</div></div><div><h3>Conclusions</h3><div>CDI is a minimally invasive alternative to SE in massive PE and offers comparable outcomes and similar survival rates. Nevertheless, CDI offers advantages in terms of shorter ICU stay and fewer major bleeding complications.</div></div>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"14 2","pages":"Article 102379"},"PeriodicalIF":2.8,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145781556","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}
Pub Date : 2025-12-13DOI: 10.1016/j.jvsv.2025.102365
Chien Lin Soh MBBChir, MA(Cantab), MRCS, Matthew Tan MBBS, BSc(Hons), PhD, MRCS, FHEA, Alun H. Davies DM, FRCS, MA, DSc, FHEA, FEBVS, FACPH, BM, BCh, Sarah Onida BSc(Hons), MD, PhD, FRCS
Background
Chronic venous disease (CVD) arises from venous hypertension secondary to impaired venous return, causing significant morbidity and diminished quality of life. Genetic factors are likely important in the pathogenesis and susceptibility of a patient to develop CVD. This systematic review summarizes genome-wide association studies (GWASs) that investigate the link between genetic variants and CVD.
Methods
A systematic review was conducted in accordance with the PRISMA guidelines, with the search dates ranging from January 1, 1994, to July 17, 2025. Abstract and full-text screening were completed by two independent reviewers, with any conflicts referred to a third senior reviewer. GWASs in adults investigating links between genetic variants and CVD were included. Exclusion criteria included patients with venous thromboembolism, arterial or diabetic disease, or animal models.
Results
Thirteen studies were included after screening 517 studies from a search of PubMed, EMBASE, and Ovid. Database sources included UK Biobank, FinnGen, PopGen, and country- or hospital-specific databases with a majority Caucasian and European patient cohort. A total of 602,760 patients were identified with varicose veins and 3,664,604 control cases that were studied with GWASs and other statistical methods including a two-sample Mendelian randomization approach, functional mapping, and genetic correlations. A variety of statistically significant genetic polymorphisms were identified that can be attributed to the heritability of varicose veins affecting inflammation and immunity (eg, PPP3R1, EBF1, and GATA2), hypertension (eg, CASZ1), and vascular architecture (eg, CASZ1, PIEZO1, and STIM2). Protective variants (eg, GJD3, MMP10, and 4EBP1) were also identified in Finnish populations. However, replication studies showed that these genetic polymorphisms are not generalizable to specific populations.
Conclusions
This systematic review highlights genes contributing to the development of CVD that have been identified in the literature. An improved understanding of genetic contributions to the pathogenesis of CVD may inform future diagnostics, prognostics, and personalized treatment. Further larger scale studies representative of global populations, including meta-analyses of genome-wide association datasets, are required owing to individual GWASs being statistically insufficient to draw generalizable conclusions.
{"title":"Genome-wide association studies in chronic venous disease: A systematic review","authors":"Chien Lin Soh MBBChir, MA(Cantab), MRCS, Matthew Tan MBBS, BSc(Hons), PhD, MRCS, FHEA, Alun H. Davies DM, FRCS, MA, DSc, FHEA, FEBVS, FACPH, BM, BCh, Sarah Onida BSc(Hons), MD, PhD, FRCS","doi":"10.1016/j.jvsv.2025.102365","DOIUrl":"10.1016/j.jvsv.2025.102365","url":null,"abstract":"<div><h3>Background</h3><div>Chronic venous disease (CVD) arises from venous hypertension secondary to impaired venous return, causing significant morbidity and diminished quality of life. Genetic factors are likely important in the pathogenesis and susceptibility of a patient to develop CVD. This systematic review summarizes genome-wide association studies (GWASs) that investigate the link between genetic variants and CVD.</div></div><div><h3>Methods</h3><div>A systematic review was conducted in accordance with the PRISMA guidelines, with the search dates ranging from January 1, 1994, to July 17, 2025. Abstract and full-text screening were completed by two independent reviewers, with any conflicts referred to a third senior reviewer. GWASs in adults investigating links between genetic variants and CVD were included. Exclusion criteria included patients with venous thromboembolism, arterial or diabetic disease, or animal models.</div></div><div><h3>Results</h3><div>Thirteen studies were included after screening 517 studies from a search of PubMed, EMBASE, and Ovid. Database sources included UK Biobank, FinnGen, PopGen, and country- or hospital-specific databases with a majority Caucasian and European patient cohort. A total of 602,760 patients were identified with varicose veins and 3,664,604 control cases that were studied with GWASs and other statistical methods including a two-sample Mendelian randomization approach, functional mapping, and genetic correlations. A variety of statistically significant genetic polymorphisms were identified that can be attributed to the heritability of varicose veins affecting inflammation and immunity (eg, PPP3R1, EBF1, and GATA2), hypertension (eg, CASZ1), and vascular architecture (eg, CASZ1, PIEZO1, and STIM2). Protective variants (eg, GJD3, MMP10, and 4EBP1) were also identified in Finnish populations. However, replication studies showed that these genetic polymorphisms are not generalizable to specific populations.</div></div><div><h3>Conclusions</h3><div>This systematic review highlights genes contributing to the development of CVD that have been identified in the literature. An improved understanding of genetic contributions to the pathogenesis of CVD may inform future diagnostics, prognostics, and personalized treatment. Further larger scale studies representative of global populations, including meta-analyses of genome-wide association datasets, are required owing to individual GWASs being statistically insufficient to draw generalizable conclusions.</div></div>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"14 2","pages":"Article 102365"},"PeriodicalIF":2.8,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145757052","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}
Pub Date : 2025-12-08DOI: 10.1016/j.jvsv.2025.102363
Garyn Metoyer MD , Ethan Chervonski MD, MPH , Giancarlo Speranza MD, MBA , Caron B. Rockman MD , Glenn R. Jacobowitz MD , Thomas S. Maldonado MD , Mikel Sadek MD
<div><h3>Objective</h3><div>Chronic venous insufficiency (CVI) resulting in venous hypertension can cause lifestyle-limiting debilitation. Studies have identified racial and ethnic disparities in CVI presentation and clinical severity; however, there is limited literature examining disparities in CVI management and procedural outcomes among different racial and ethnic groups. The aim of this study was to characterize differences in endovenous treatment paradigms between racial and ethnic groups and to assess how this affected patient outcomes.</div></div><div><h3>Methods</h3><div>The national Vascular Quality Initiative Varicose Vein Registry database was queried for superficial venous interventions, including endovenous radiofrequency ablation, endovenous laser ablation, high ligation, stripping, and microphlebectomy, performed from April 2014 to March 2024. We categorized patients as non-Hispanic White (NHW), non-Hispanic Black (NHB), Hispanic/Latino, Asian, and Other (including American Indian, Alaskan Native, Native Hawaiian, other Pacific Islander, more than one race, and unknown/other). Baseline demographics, clinical and treatment characteristics, complication rates, and changes in quality-of-life endpoints (ie, revised Venous Clinical Severity Score [rVCSS] and Heaviness, Achiness, Swelling, Throbbing, Itching [HASTI] score) were compared between racial/ethnic groups with NHW as the reference category. Linear regression and logistic regression/χ<sup>2</sup> tests were used to compare continuous/ordinal and categorical variables, respectively.</div></div><div><h3>Results</h3><div>A total of 65,090 superficial venous procedures encompassing endovenous thermal ablations, stripping/high ligation, and microphlebectomy were included. NHW patients underwent interventions for less severe baseline CVI based on CEAP class and had more superficial venous interventions (2.45 ± 1.95; <em>P</em> < .001) and repeat thermal ablations (1.66 ± 1.14; <em>P</em> < .001) than other groups. NHB had more severe baseline CVI based on higher prevalence of severe CEAP (ie, C5, C6, and C6r disease: 5.8%, 11.8%, and 0.9%, respectively; <em>P</em> < .05). NHB patients were less likely to have concomitant microphlebectomy than NHW (odds ratio, 0.79; 95% confidence interval, 0.73-0.87; <em>P</em> < .001). NHB had the highest rVCSS score preoperatively (8.17 ± 4.02; <em>P</em> < .001) with the largest improvement at ≤3 (−4.40 ± 5.23; <em>P</em> < .001) and >3 months (−7.00 ± 5.00; <em>P</em> < .001) following intervention. Hispanic/Latinos had the highest preoperative HASTI score (10.34 ± 5.40; <em>P</em> < .001) and the largest score reduction at ≤3 months (−6.62 ± 6.51; <em>P</em> < .001). Post procedure, Hispanics and other study groups were more likely to experience blistering and medication induced ulcer (<em>P</em> < .05). The other group was less likely to experience hematoma postoperatively (<em>P</em> < .05).</div></div><div>
{"title":"Racial disparities in superficial venous disease management: A comparative study of interventions and patient-related outcomes","authors":"Garyn Metoyer MD , Ethan Chervonski MD, MPH , Giancarlo Speranza MD, MBA , Caron B. Rockman MD , Glenn R. Jacobowitz MD , Thomas S. Maldonado MD , Mikel Sadek MD","doi":"10.1016/j.jvsv.2025.102363","DOIUrl":"10.1016/j.jvsv.2025.102363","url":null,"abstract":"<div><h3>Objective</h3><div>Chronic venous insufficiency (CVI) resulting in venous hypertension can cause lifestyle-limiting debilitation. Studies have identified racial and ethnic disparities in CVI presentation and clinical severity; however, there is limited literature examining disparities in CVI management and procedural outcomes among different racial and ethnic groups. The aim of this study was to characterize differences in endovenous treatment paradigms between racial and ethnic groups and to assess how this affected patient outcomes.</div></div><div><h3>Methods</h3><div>The national Vascular Quality Initiative Varicose Vein Registry database was queried for superficial venous interventions, including endovenous radiofrequency ablation, endovenous laser ablation, high ligation, stripping, and microphlebectomy, performed from April 2014 to March 2024. We categorized patients as non-Hispanic White (NHW), non-Hispanic Black (NHB), Hispanic/Latino, Asian, and Other (including American Indian, Alaskan Native, Native Hawaiian, other Pacific Islander, more than one race, and unknown/other). Baseline demographics, clinical and treatment characteristics, complication rates, and changes in quality-of-life endpoints (ie, revised Venous Clinical Severity Score [rVCSS] and Heaviness, Achiness, Swelling, Throbbing, Itching [HASTI] score) were compared between racial/ethnic groups with NHW as the reference category. Linear regression and logistic regression/χ<sup>2</sup> tests were used to compare continuous/ordinal and categorical variables, respectively.</div></div><div><h3>Results</h3><div>A total of 65,090 superficial venous procedures encompassing endovenous thermal ablations, stripping/high ligation, and microphlebectomy were included. NHW patients underwent interventions for less severe baseline CVI based on CEAP class and had more superficial venous interventions (2.45 ± 1.95; <em>P</em> < .001) and repeat thermal ablations (1.66 ± 1.14; <em>P</em> < .001) than other groups. NHB had more severe baseline CVI based on higher prevalence of severe CEAP (ie, C5, C6, and C6r disease: 5.8%, 11.8%, and 0.9%, respectively; <em>P</em> < .05). NHB patients were less likely to have concomitant microphlebectomy than NHW (odds ratio, 0.79; 95% confidence interval, 0.73-0.87; <em>P</em> < .001). NHB had the highest rVCSS score preoperatively (8.17 ± 4.02; <em>P</em> < .001) with the largest improvement at ≤3 (−4.40 ± 5.23; <em>P</em> < .001) and >3 months (−7.00 ± 5.00; <em>P</em> < .001) following intervention. Hispanic/Latinos had the highest preoperative HASTI score (10.34 ± 5.40; <em>P</em> < .001) and the largest score reduction at ≤3 months (−6.62 ± 6.51; <em>P</em> < .001). Post procedure, Hispanics and other study groups were more likely to experience blistering and medication induced ulcer (<em>P</em> < .05). The other group was less likely to experience hematoma postoperatively (<em>P</em> < .05).</div></div><div>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"14 2","pages":"Article 102363"},"PeriodicalIF":2.8,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145724102","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}
Current single preoperative lymphatic imaging technique are inadequate to ensure the simplification and enhanced efficiency of lymphatic venous anastomosis (LVA) procedures. The application value of contrast-enhanced ultrasound (CEUS) examination combined with ultra-high-frequency ultrasound (UHFUS) examination in LVA has not been explored. This study aimed to systematically explore the clinical application value of CEUS examination integrated with UHFUS examination in guiding LVA.
Methods
Patients undergoing LVA after localization with indocyanine green (ICG) lymphography (group B) or CEUS examination combined with UHFUS examination (group A) from November 1, 2023, to March 1, 2025, were enrolled sequentially. Preoperative localization time and number of lymphatic vessels (LVs), skin incision length, time and number of LVs anastomoses during LVA, postoperative reduction in the maximum circumference of the affected limb, and improvement in subjective symptoms were compared.
Results
A total of 19 patients with lymphedema who underwent LVA were included in our study. Compared with indocyanine green, CEUS combined with UHFUS examination can shorten preoperative LVs localization time, increase the number of end-to-end anastomoses during LVA, streamline the LVA procedure, and improve patient symptoms to some extent.
Conclusions
CEUS combined with UHFUS examination is a promising method for the preoperative evaluation of LVs that can enhance the efficiency and feasibility of LVA.
{"title":"Contrast-enhanced ultrasound combined with ultra-high-frequency ultrasound improves preoperative planning for lymphovenous anastomosis: A pilot study","authors":"Yuanyan Tang MD , Xing Huang MD , Zhongzeng Liang MD , Xiaoting Yu PhD , Zhengren Liu PhD , Jia Zhu PhD","doi":"10.1016/j.jvsv.2025.102361","DOIUrl":"10.1016/j.jvsv.2025.102361","url":null,"abstract":"<div><h3>Background</h3><div>Current single preoperative lymphatic imaging technique are inadequate to ensure the simplification and enhanced efficiency of lymphatic venous anastomosis (LVA) procedures. The application value of contrast-enhanced ultrasound (CEUS) examination combined with ultra-high-frequency ultrasound (UHFUS) examination in LVA has not been explored. This study aimed to systematically explore the clinical application value of CEUS examination integrated with UHFUS examination in guiding LVA.</div></div><div><h3>Methods</h3><div>Patients undergoing LVA after localization with indocyanine green (ICG) lymphography (group B) or CEUS examination combined with UHFUS examination (group A) from November 1, 2023, to March 1, 2025, were enrolled sequentially. Preoperative localization time and number of lymphatic vessels (LVs), skin incision length, time and number of LVs anastomoses during LVA, postoperative reduction in the maximum circumference of the affected limb, and improvement in subjective symptoms were compared.</div></div><div><h3>Results</h3><div>A total of 19 patients with lymphedema who underwent LVA were included in our study. Compared with indocyanine green, CEUS combined with UHFUS examination can shorten preoperative LVs localization time, increase the number of end-to-end anastomoses during LVA, streamline the LVA procedure, and improve patient symptoms to some extent.</div></div><div><h3>Conclusions</h3><div>CEUS combined with UHFUS examination is a promising method for the preoperative evaluation of LVs that can enhance the efficiency and feasibility of LVA.</div></div>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"14 2","pages":"Article 102361"},"PeriodicalIF":2.8,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145696267","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}
Pub Date : 2025-12-04DOI: 10.1016/j.jvsv.2025.102362
Alexandra Natalie Ascher MD , Enrico Ascher MD , Anil Hingorani MD , John Fang DO
<div><h3>Background</h3><div>Perivenous tumescence with saline or a dilute lidocaine solution is used routinely for thermal ablation of refluxing superficial lower extremity veins to displace sensitive structures away from the thermal probe and provide better contact with the treated venous endothelium. In this study, we introduce an adjunctive technique of tumescence infiltration at the most efferent segment of refluxing saphenous veins treated with 1% polidocanol endovenous microfoam (PEM). We hypothesize that, by reducing the vein diameter, proximal tumescence (PT) prolongs apposition time of PEM to the endothelium by delaying venous outflow and microfoam propagation speed. We evaluated PT effects on vein closure and volume of PEM used as well as the incidence of superficial venous thrombosis and ablation-related thrombus extension (ARTE).</div></div><div><h3>Methods</h3><div>A single institution retrospective study was performed with PEM ablations for the above-knee great saphenous vein (GSV), below-knee GSV, and small saphenous vein (SSV) by two operators over a 12-month period. Duplex ultrasound (DUS) within 3 to 7 days after ablation followed by a serial surveillance DUS schedule were used to evaluate for vein closure, venous thrombosis, and ARTE per institutional protocol. Any treated vein segment found to be completely or partially patent with reflux after treatment was deemed an ablation failure. Demographics and outcomes of tumescent PEM (T-PEM) ablations were compared with nontumescent PEM (NT-PEM) ablations through univariate and generalized estimating equation modeling.</div></div><div><h3>Results</h3><div>Between June 2023 and May 2024, 183 adult patients (64 male, 119 female) treated with 1% PEM in 246 lower extremities (113 right, 133 left) met the study criteria. Nineteen patients without documented follow-up DUS examinations were excluded from this study. Overall, 293 ablations (23 above-knee SV, 199 below-knee GSV, 71 small saphenous vein) were performed with a mean PEM volume of 2.8 ± 0.6 mL per ablation with a combined closure rate of 91.8% (269 of 293). One hundred nineteen ablations (40.6%) were augmented with PT (mean tumescence volume, 6 ± 2.4 mL; range, 3-16 mL). Veins treated with T-PEM were significantly larger (mean vein diameter, 4.8 ± 1.3 mm) than veins treated with NT-PEM (mean vein diameter, 4.0 ± 0.9 mm; <em>P</em> < .001). There were no significant differences in patient age (<em>P</em> = .37), sex (<em>P</em> = .06), laterality (<em>P</em> = .29), preoperative Clinical-Etiology-Anatomy-Pathophysiology clinical severity scores (<em>P</em> = .34), PEM volume used (<em>P</em> = .09), venous thrombosis (<em>P</em> = .65), ARTE (<em>P</em> = .41), or rate of treatment success (<em>P</em> = .16) on univariate comparison of T-PEM and NT-PEM ablations. Generalized estimating equation regression predicts lower microfoam volume use with PT (B = −0.4; <em>P</em> = .003) and similar treatment success rates when correct
{"title":"Proximal tumescence during treatment of saphenous veins with polidocanol endovenous microfoam provides successful ablation of larger veins and predicts reduced microfoam volume","authors":"Alexandra Natalie Ascher MD , Enrico Ascher MD , Anil Hingorani MD , John Fang DO","doi":"10.1016/j.jvsv.2025.102362","DOIUrl":"10.1016/j.jvsv.2025.102362","url":null,"abstract":"<div><h3>Background</h3><div>Perivenous tumescence with saline or a dilute lidocaine solution is used routinely for thermal ablation of refluxing superficial lower extremity veins to displace sensitive structures away from the thermal probe and provide better contact with the treated venous endothelium. In this study, we introduce an adjunctive technique of tumescence infiltration at the most efferent segment of refluxing saphenous veins treated with 1% polidocanol endovenous microfoam (PEM). We hypothesize that, by reducing the vein diameter, proximal tumescence (PT) prolongs apposition time of PEM to the endothelium by delaying venous outflow and microfoam propagation speed. We evaluated PT effects on vein closure and volume of PEM used as well as the incidence of superficial venous thrombosis and ablation-related thrombus extension (ARTE).</div></div><div><h3>Methods</h3><div>A single institution retrospective study was performed with PEM ablations for the above-knee great saphenous vein (GSV), below-knee GSV, and small saphenous vein (SSV) by two operators over a 12-month period. Duplex ultrasound (DUS) within 3 to 7 days after ablation followed by a serial surveillance DUS schedule were used to evaluate for vein closure, venous thrombosis, and ARTE per institutional protocol. Any treated vein segment found to be completely or partially patent with reflux after treatment was deemed an ablation failure. Demographics and outcomes of tumescent PEM (T-PEM) ablations were compared with nontumescent PEM (NT-PEM) ablations through univariate and generalized estimating equation modeling.</div></div><div><h3>Results</h3><div>Between June 2023 and May 2024, 183 adult patients (64 male, 119 female) treated with 1% PEM in 246 lower extremities (113 right, 133 left) met the study criteria. Nineteen patients without documented follow-up DUS examinations were excluded from this study. Overall, 293 ablations (23 above-knee SV, 199 below-knee GSV, 71 small saphenous vein) were performed with a mean PEM volume of 2.8 ± 0.6 mL per ablation with a combined closure rate of 91.8% (269 of 293). One hundred nineteen ablations (40.6%) were augmented with PT (mean tumescence volume, 6 ± 2.4 mL; range, 3-16 mL). Veins treated with T-PEM were significantly larger (mean vein diameter, 4.8 ± 1.3 mm) than veins treated with NT-PEM (mean vein diameter, 4.0 ± 0.9 mm; <em>P</em> < .001). There were no significant differences in patient age (<em>P</em> = .37), sex (<em>P</em> = .06), laterality (<em>P</em> = .29), preoperative Clinical-Etiology-Anatomy-Pathophysiology clinical severity scores (<em>P</em> = .34), PEM volume used (<em>P</em> = .09), venous thrombosis (<em>P</em> = .65), ARTE (<em>P</em> = .41), or rate of treatment success (<em>P</em> = .16) on univariate comparison of T-PEM and NT-PEM ablations. Generalized estimating equation regression predicts lower microfoam volume use with PT (B = −0.4; <em>P</em> = .003) and similar treatment success rates when correct","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"14 2","pages":"Article 102362"},"PeriodicalIF":2.8,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145696280","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}
Pub Date : 2025-11-29DOI: 10.1016/j.jvsv.2025.102360
Elena Goranova MD, PhD , Rashad A. Bishara RVPI, MSc, FRCS , Alexander Lazarov PhD
In our view, artificial intelligence (AI) will never substitute for a physician. Still, physicians who integrate AI into their practice may replace those who do not. With this concept in mind, this article aims to promote the concept of cautious integration of AI into patient care by explaining the fundamentals of AI.
{"title":"The new reality of artificial intelligence in health care","authors":"Elena Goranova MD, PhD , Rashad A. Bishara RVPI, MSc, FRCS , Alexander Lazarov PhD","doi":"10.1016/j.jvsv.2025.102360","DOIUrl":"10.1016/j.jvsv.2025.102360","url":null,"abstract":"<div><div>In our view, artificial intelligence (AI) will never substitute for a physician. Still, physicians who integrate AI into their practice may replace those who do not. With this concept in mind, this article aims to promote the concept of cautious integration of AI into patient care by explaining the fundamentals of AI.</div></div>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"14 2","pages":"Article 102360"},"PeriodicalIF":2.8,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145648798","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}
Pub Date : 2025-11-29DOI: 10.1016/j.jvsv.2025.102359
Laurens A. Oomen MD, MSc , Janette van Diest BSc , Felice R.M. Lucas BSc , Jitske Rijpkema MD , George L. Burchell MSc , Florianne J.L. van Zanten MD , Kee F. Choi MD , Marcella C.A. Muller MD, PhD , Angelique M.E. de Man MD, MSc, PhD , Alexander P.J. Vlaar MD, PhD, MBA , Jarom Heijmans MD, PhD , Bart J. Biemond MD, PhD , Nick van Es MD, PhD , Jasper M. Smit MD, PhD , Pieter R. Tuinman MD, PhD
Background
Catheter-related thrombosis (CRT) is a known complication of central venous catheters and peripherally inserted central catheters, yet optimal treatment remains uncertain. We conducted a systematic review and national survey to assess current CRT management strategies.
Methods
Following the PRISMA guidelines, we searched three databases through October 2024 for studies on CRT associated with central venous catheters or peripherally inserted central catheters. Meta-analyses and subgroup analyses were performed by anticoagulant type. A national survey among Dutch intensive care and hematology physicians explored current treatment practices.
Results
Of 4123 records screened, 34 observational studies were included, mostly involving patients with cancer. The venous thromboembolism recurrence rate per 100 patient-years was higher in patients with cancer (14.1; 95% confidence interval, 11.4- 17.4; I2 = 35.1) vs patients without cancer (2.0; 95% confidence interval, 0.6-6.0; I2 = 10.3; P = .0002). Recurrence was comparable between direct oral anticoagulants (DOACs) and low-molecular-weight heparin/vitamin K antagonists (LMWH/VKAs), at 11.0 vs 7.6 (P = .14). Major bleeding occurred in 10.5 vs 13.1 (P = .45), and clinically relevant nonmajor bleeding in 26.2 vs. 22.4 (P = .70), for DOACs vs LMWH/VKAs, respectively. All studies were observational, most at high risk of bias. Survey data showed LMWH was preferred for symptomatic CRT (50%), with treatment lasting 8 days to 6 months. In asymptomatic CRT, anticoagulant type and duration were left to physician discretion in 64% of cases.
Conclusions
Treatment with LMWH/VKA or DOACs shows similarly low venous thromboembolism recurrence, although rates are higher in patients with cancer. Bleeding was substantial and comparable across therapies. Evidence is limited by observational bias. Survey data show that LMWH predominates for CRT, with variable duration. Well-designed randomized controlled trials are warranted.
{"title":"Treatment of catheter related thrombosis: A systematic review, meta-analysis, and national survey","authors":"Laurens A. Oomen MD, MSc , Janette van Diest BSc , Felice R.M. Lucas BSc , Jitske Rijpkema MD , George L. Burchell MSc , Florianne J.L. van Zanten MD , Kee F. Choi MD , Marcella C.A. Muller MD, PhD , Angelique M.E. de Man MD, MSc, PhD , Alexander P.J. Vlaar MD, PhD, MBA , Jarom Heijmans MD, PhD , Bart J. Biemond MD, PhD , Nick van Es MD, PhD , Jasper M. Smit MD, PhD , Pieter R. Tuinman MD, PhD","doi":"10.1016/j.jvsv.2025.102359","DOIUrl":"10.1016/j.jvsv.2025.102359","url":null,"abstract":"<div><h3>Background</h3><div>Catheter-related thrombosis (CRT) is a known complication of central venous catheters and peripherally inserted central catheters, yet optimal treatment remains uncertain. We conducted a systematic review and national survey to assess current CRT management strategies.</div></div><div><h3>Methods</h3><div>Following the PRISMA guidelines, we searched three databases through October 2024 for studies on CRT associated with central venous catheters or peripherally inserted central catheters. Meta-analyses and subgroup analyses were performed by anticoagulant type. A national survey among Dutch intensive care and hematology physicians explored current treatment practices.</div></div><div><h3>Results</h3><div>Of 4123 records screened, 34 observational studies were included, mostly involving patients with cancer. The venous thromboembolism recurrence rate per 100 patient-years was higher in patients with cancer (14.1; 95% confidence interval, 11.4- 17.4; I<sup>2</sup> = 35.1) vs patients without cancer (2.0; 95% confidence interval, 0.6-6.0; I<sup>2</sup> = 10.3; <em>P</em> = .0002). Recurrence was comparable between direct oral anticoagulants (DOACs) and low-molecular-weight heparin/vitamin K antagonists (LMWH/VKAs), at 11.0 vs 7.6 (<em>P</em> = .14). Major bleeding occurred in 10.5 vs 13.1 (<em>P</em> = .45), and clinically relevant nonmajor bleeding in 26.2 vs. 22.4 (<em>P</em> = .70), for DOACs vs LMWH/VKAs, respectively. All studies were observational, most at high risk of bias. Survey data showed LMWH was preferred for symptomatic CRT (50%), with treatment lasting 8 days to 6 months. In asymptomatic CRT, anticoagulant type and duration were left to physician discretion in 64% of cases.</div></div><div><h3>Conclusions</h3><div>Treatment with LMWH/VKA or DOACs shows similarly low venous thromboembolism recurrence, although rates are higher in patients with cancer. Bleeding was substantial and comparable across therapies. Evidence is limited by observational bias. Survey data show that LMWH predominates for CRT, with variable duration. Well-designed randomized controlled trials are warranted.</div></div>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"14 2","pages":"Article 102359"},"PeriodicalIF":2.8,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145648894","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}
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