Phlebology最新文献

ObjectiveThe physiological effects produced by the calf pump are essential in multiple aspects of vascular health, and their absence leads to stasis which directly relates to venous insufficiency. Therefore, muscle activity has been considered a key element in calf pump function. In the present study, we used a mechanical foot board with passive range of motion including stimulated dorsiflexion and plantar flexion and compared the hemodynamic effects to those obtained during active voluntary movement.Methods11 healthy adult volunteers participated in an intervention study. In Intervention 1, the participants performed voluntary dorsiflexion and plantar flexion, and in Intervention 2, the same participants used the passive PumpCare^® device (OAK Healthtech, Brazil). Both legs were examined, but data were collected from the right leg. Femoral vein blood flow was assessed by ultrasound, and venous pump capacity (V₀) by photoplethysmography. Anthropometric data were collected to investigate their correlation with femoral vein blood volume.ResultsThe mean femoral vein blood flow was 286 mL/min with active calf movements and 288 mL/min with passive calf movements (p = .929). Flow peaks were produced during dorsiflexion, that is, during stretching of the posterior muscle groups, returning to baseline levels after stopping the movement in both interventions. The mean maximal venous pump capacity measured by photoplethysmography was 3.7% with active calf movements and 3.5% with passive calf movements (p = .141).ConclusionIn this study, passive calf movements were able to promote a mean femoral vein volume flow comparable to the physiological effect produced by active calf movements in healthy adults. This appears to contradict the current understanding of the importance of calf muscle contraction in producing venous return.

The venous system plays a key role in clinical practice but remains underassessed due to the limited accessibility of conventional imaging tools. Near-infrared reflection illumination (NIRI) devices ("vein finders"), though recently introduced to assist venipuncture, have potential for broader vascular assessment. Our aim was to investigate the feasibility of a NIRI device to quantify the morphology of superficial hand veins and evaluate their response to a transient hemodynamic stress induced by suprasystolic limb occlusion. The dorsal hand veins of 14 healthy adults (21.5 ± 4.2 y.o.) were continuously recorded during a procedure consisting of a 5 min baseline, 3 min arm occlusion (200 mmHg), and 3 min recovery phases. Morphological parameters including vein width, branching angles, asymmetry indices, junctional exponent deviation, and optimality ratio, were extracted from three metacarpal veins and their tributaries. Nonparametric statistics were used to compare parameters between phases (p < .05). Occlusion led to a significant increase in the width of both receiving and tributary veins (p < .001), reflecting venous pooling. However, branching geometry remained largely unchanged, suggesting structural resilience. Junctional exponent deviation remained low, in agreement with Murray's law. Near-infrared vein finders enable real-time, non-invasive assessment of superficial venous morphology and compliance. Their sensitivity to dynamic vascular changes, combined with potential for integration with automated analysis tools, supports their broader use in vascular diagnostics, preoperative planning, and bedside monitoring.

BackgroundPelvic venous disorders (PeVD) are a recognized cause of venous origin chronic pelvic pain (VO-CPP) in women. However, the prevalence and management of PeVD in patients with lower extremity varicose veins remain understudied. This study assesses the incidence of PeVD among women with superficial venous insufficiency (SVI) and evaluates the role of transvaginal ultrasound (TVUS) as a screening tool.MethodsA retrospective analysis was conducted on 350 female patients with SVI (CEAP C2-C6) from January 2021 to December 2023. SVI was confirmed by duplex ultrasound (DUS). All patients were evaluated for CPP at the initial visit. In those with CPP, pelvic symptom management preceded any lower limb intervention. Symptomatic patients were assessed using the Pelvic Venous Congestion Symptom Scale (PVCSS), Visual Analog Scale (VAS), and TVUS for features suggestive of PeVD. In confirmed cases, diagnostic venography and ovarian vein embolization were performed, followed by saphenous vein ablation.ResultsPeVD was identified in 11% (37/350) of patients. TVUS revealed pelvic varicosities, ovarian veins dilation >6 mm, and reflux, confirmed by venography. Of the 37 patients, 41% (15/37) underwent embolization, while 59% opted for conservative management. Post-treatment, median PVCSS scores improved from 20 to 2 (p < 0.001), and VAS scores from 8 to 0 (p < 0.001), indicating significant symptom relief. Mean follow-up was 17 months, with assessments at 1, 6, and 12 months. Reintervention-free survival was 86.7%.ConclusionApproximately one in 10 women with SVI have symptomatic PeVD, highlighting the importance of targeted screening. TVUS serves as a useful non-invasive diagnostic tool. Further studies are needed to clarify optimal treatment strategies and long-term outcomes in this population.

IntroductionThis study assessed the relationship between venous leg ulcers (VLUs) and overall survival among patients treated for chronic venous insufficiency.MethodsPatients with CEAP C2-C6 disease who underwent superficial venous interventions at a single center from May 2016-April 2024 were identified from the Vascular Quality Initiative Varicose Vein Registry. Demographics, comorbidities, and venous disease severity were recorded at the index database procedure. Mortality was recorded from the electronic health record and Social Security Death Index. Patient characteristics and all-cause mortality were compared between VLU (C5-C6) and non-VLU (C2-C4) cohorts.ResultsAmong 7084 patients, 8.9% (n = 632) had a VLU history. Compared with non-VLU patients, those with a VLU history were older (p < .001) and disproportionately male (p < .001), Black/African American (p < .001), and Medicaid-insured (p = .009). They had greater body mass indices (p < .001), revised venous clinical severity scores (rVCSS) (p < .001), HASTI scores (p = .015), and work/activity limitations (p < .001). Prior venous thromboembolism (p < .001), anticoagulation use (p < .001), previous varicose vein (VV) treatment (p = .042), and deep venous reflux (DVR) (p < .001) were also more common. Mortality was higher among VLU patients than non-VLU patients (3.6% vs 0.7%, p < .001) over a similar mean follow-up (2.8 vs 3.0 years, p = .070). VLU history was associated with worse survival (HR 5.03, 95% CI [2.96-8.53], p < .001), in addition to older age (p < .001), male sex (p = .003), White race (p = .003), no prior VV treatment (p = .026), anticoagulation use (p < .001), higher rVCSS (p < .001), and DVR (p = .016). After adjusting for these latter variables, VLU history remained independently associated with mortality (adjusted HR 2.01, 95% CI [1.00-4.01], p = .049). Compared with C2, only C6 -not C3-C5 -was associated with increased mortality after multivariable adjustment (adjusted HR 3.40, 95% CI [1.08, 10.69], p = .036).ConclusionAmong patients undergoing superficial venous interventions, VLUs were associated with a two-fold hazard of all-cause death. The mechanism driving their increased mortality warrants further study.

BackgroundStiffness is an independent determinant of compression therapy efficacy, beyond compression pressure alone. Three indices - static stiffness index (SSI), dynamic stiffness index (DSI), and walking pressure amplitude (WPA) - quantify stiffness. This study evaluated in vivo stiffness in eight compression stocking models to assess whether those marketed as "strong-elastic" differ significantly from those marketed as "light-elastic".MethodsIn a prospective, open-label pilot study, 10 healthy participants were each fitted with eight off-the-shelf AG II compression stocking models (4 "strong-elastic", 4 "light-elastic"). Continuous pressure monitoring was conducted at four standardized anatomical sites (B, B1, C, D) of the right lower extremity using the Picopress® system. A total of 320 measurement cycles were completed. Data were analyzed by comparing grouped results for "strong" vs. "elastic" stockings.ResultsThe SSI did not differ significantly between "strong-elastic" (stMCS) and "light-elastic" (elMCS) stockings at any site (p > .05). However, stMCS showed significantly higher DSI at sites B (4.55 ± 2.00 mmHg vs 3.90 ± 1.63 mmHg; p = .028), C (5.83 ± 2.28 mmHg vs 5.10 ± 1.82 mmHg; p = .015), and D (2.33 ± 1.16 mmHg vs 1.58 ± 0.87 mmHg; p < .001). For WPA, stMCS exhibited significantly higher stiffness at B1 (6.75 ± 2.26 mmHg vs 6.03 ± 2.27 mmHg; p = .018), C (4.33 ± 2.31 mmHg vs 3.73 ± 2.24 mmHg; p = .020), and D (6.25 ± 2.07 mmHg vs 4.23 ± 1.59 mmHg; p < .001). Mean lower leg circumference increased from 0.50 cm (D) to 1.05 cm (C), depending on movement.ConclusionAt B1, no significant differences in SSI or DSI were found between "strong-elastic" and "light-elastic" stockings, whereas WPA significantly differentiated both groups. Overall stiffness values exceeded previous reports, indicating both stMCS and elMCS possess substantial stiffness and likely improve venous hemodynamics.

ObjectiveTo compare the clinical efficacy of two postoperative compression methods at 48 h after endovenous radiofrequency ablation (RFA) of the great saphenous vein on complications, quality of life, return-to-work time, and patient satisfaction.MethodsIn this prospective, single-center randomized controlled trial, 210 patients with duplex ultrasound-confirmed great saphenous vein incompetence (C2-C5) underwent RFA and were randomized to receive either elastic stockings (study group) or multilayer bandage compression (control group) for 48 h postoperatively. Primary outcomes included postoperative complications assessed at 2 h, 1 day, 2 days, 7 days, and 1 month. Secondary outcomes included pain (VAS), quality of life (CIVIQ-14), venous clinical severity score (VCSS), satisfaction (10-point scale), and time to return to normal work. Follow-up rates were 98% at 7 days and 96% at 1 month.ResultsMinor but statistically significant differences were observed in complications such as pain, ecchymosis, edema, and itching between groups. The study group returned to work sooner (2.11 ± 1.19 days) than the control group (4.39 ± 2.55 days, p < 0.01). Patient satisfaction at 1 month and changes in CIVIQ-14 and VCSS scores showed no significant between-group differences.ConclusionElastic stockings worn for 48 h after RFA provided certain advantages over multilayer bandage compression, particularly in reducing early postoperative complications and shortening time to return to work.

BackgroundThis study aimed to develop multiple machine learning (ML) models to predict DVT stability based on clinical and computed tomography (CT) texture features.MethodsA total of 108 patients diagnosed with DVT by clinical examination and ultrasonography in this study. Patients were divided into the DVT with acute pulmonary embolism (APE) (thrombus unstable group) and DVT without APE (thrombus stable group) groups based on whether their computed tomography pulmonary angiography examination was combined with APE. The region of interest was manually delineated on the CT images using the 3D-Slicer software to extract the textural features of the thrombus. The patients were divided into training and validation sets in a ratio of 7:3. The least absolute shrinkage and selection operator and ten-fold cross-validation were applied to obtain texture features with nonzero coefficients in the training set. Clinical data were used as variables to screen for independent risk factors predicting DVT stability using univariate and multivariate logistic regression analyses. Four machine learning algorithms, logistic regression (LR), support vector machine (SVM), K-nearest neighbor (KNN), and extreme gradient boosting (XGBooST), were used to develop a DVT stability prediction model based on a combination of nonzero feature parameters and clinical features. The performance of the models was assessed and compared using the accuracy, precision, recall, F1 score, specificity, positive prediction rate, negative prediction rate, and area under the curve (AUC), calibration curves, and decision curves.ResultsThe combined AUC, calibration curve, decision curve, and other evaluation metrics showed that the LR model outperformed other ML models [AUC: 0.87 (0.73∼0.87), Accuracy: 0.79, Precision: 0.75, F1 Score: 0.77, Recall: 0.80, Specificity: 0.87, Probability of Positive Prediction: 0.82, Probability of Negative Prediction: 0.75], with the best prediction performance.ConclusionsML models based on clinical and CT texture features can be used to predict DVT stability.

BackgroundVaricose veins impact quality of life in patients with chronic venous disease (CVD), and their optimal treatment remains unclear. The Transfixing Endovenous Thermal Ablation(TEThA) technique is a procedure that consists of endovenous laser thermal ablation of varicose tributaries by combining the transfixing technique for endovenous procedure with tumescent anesthesia.ObjectiveTo evaluate the impact of the TEThA technique on quality of life and postoperative complications in patients with varicose veins.MethodsThis Prospective, single-arm study included 22 patients (CEAP C2-C6) treated with the TEThA technique. Quality-of-life and clinical scores (CIVIQ-14, AVVQ, rVCSS, CEAP, Caprini) were assessed at baseline, 6 weeks, and 6 months postoperative.ResultsSignificant improvements were observed in CIVIQ-14 (30.95 to 22.76; p = .013), AVVQ (36.43 to 23.49; p = .012), rVCSS (7.73 to 4.18; p = .014), and CEAP (3.09 to 1.94; p = .002). No significant complications, thrombotic events, or need for reintervention occurred.ConclusionTEThA significantly improved clinical and quality-of-life outcomes in patients with varicose veins, with a favorable safety profile.

ObjectivesThis study aimed to analyze the complex components of pain in lipedema and to evaluate correlations among key pain-related parameters, including intensity, hypersensitivity, catastrophizing, central sensitization, and neuropathic pain.MethodsThis prospective study was conducted between June 2025 and September 2025. Patients aged 18 or older with a diagnosis of lipedema were included. Demographic/clinical characteristics were recorded. Pain intensity, hypersensitivity, pain catastrophizing, central sensitization, and neuropathic pain were assessed using the Numeric Rating Scale (NRS), a 0-3 verbal rating scale, the Pain Catastrophizing Scale, the Central Sensitization Inventory, and the painDETECT questionnaire, respectively.ResultsA total of 85 patients were included in the study. Patients had a median age of 44 years, a median Body Mass Index of 29.24 kg/m², and most were classified as stage 2 lipedema (50.6%). Pain intensity was moderate, with a median NRS score of 5, while hypersensitivity levels were moderate (41.2%) to high (34.1%) in most patients. Pain catastrophizing, central sensitization, and neuropathic pain were present in 35.1%, 83.5%, and 27.1% of the patients, respectively. Pain intensity was significantly positively correlated with hypersensitivity, pain catastrophizing, central sensitization, and neuropathic pain (p < 0.05). All parameters were significantly correlated with each other (p < 0.05).ConclusionCentral sensitization may be observed in patients with lipedema and is associated with other pain parameters. The findings highlight significant interrelationships among pain intensity, hypersensitivity, pain catastrophizing, and central sensitization. Pain needs to be assessed in detail in patients with lipedema.

IntroductionLymphedema is a chronic and progressive condition resulting from impaired lymphatic drainage, leading to protein-rich fluid accumulation, tissue remodeling, and fibrosis. It represents a relevant public health issue worldwide, with substantial functional and psychosocial impact. This pictorial essay aims to illustrate the role of ultrasound in the assessment of lymphedema and to describe sonographic features that assist in distinguishing early from advanced disease stages.MethodsThis exploratory pictorial essay is based on representative cases of upper- and lower-limb lymphedema examined in routine clinical practice. High-frequency ultrasound probes (18-21 MHz) were used with B-mode imaging, colour Doppler, power Doppler, micro-flow presets, elastosonography, and AI-assisted image optimisation. The examination focused on skin, subcutaneous tissue, lymphatic channels, and their dynamic behaviour during provocation manoeuvres. No quantitative measurements or statistical analyses were performed.ResultsDistinct patterns of oedema distribution were observed on ultrasound. Mild lymphedema was characterised by predominantly vertical diffusion of fluid from the dermis toward the superficial fascial plane, whereas moderate to severe forms showed horizontal expansion within the subcutaneous compartment, frequently associated with dilated lymphatic lacunae. Lymphatic channels were identifiable as thin-walled, non-compressible structures without inducible flow on colour or power Doppler, even after distal manual compression. Advanced high-frequency imaging enabled visualisation of isoechoic intraluminal material consistent with fibrin deposition in chronically obstructed lymphatic pathways. Elastosonography demonstrated increased stiffness of the deep dermal and subdermal layers in chronic disease.ConclusionUltrasound provides a non-invasive and detailed visual assessment of lymphatic vessels and soft-tissue alterations in lymphedema. When combined with elastosonography and AI-assisted imaging, it facilitates recognition of disease stage and chronicity and supports its role as a valuable tool in the comprehensive evaluation of lymphedema.