Phlebology最新文献

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.

BackgroundDespite anticoagulation, 50% of proximal deep vein thrombosis (DVT) cases progress to post-thrombotic syndrome (PTS). While percutaneous mechanical thrombectomy (PMT) reduces thrombotic burden, optimal venous access selection (popliteal vs infrapopliteal) remains unestablished. This study compares long-term outcomes between these approaches.MethodsA retrospective cohort of 56 acute DVT patients (28 per group) underwent propensity score matching for age, sex, symptom duration, and thrombus extent. All received PMT via either infrapopliteal access or popliteal access at a tertiary center (2021-2024). Primary outcomes included PTS incidence and access site complications.ResultsPopliteal access demonstrated shorter establishment time (15 vs 22.5 min, p < .01), while infrapopliteal access preferentially utilized the peroneal vein (69.2%). No intraoperative complications; minor postoperative events occurred in 5.4% (3/56) without intergroup difference. 48 patients (85.7%) completed ultrasound surveillance (mean follow-up: 21.4 ± 12.4 months). PTS rates were significantly lower with infrapopliteal access (12.5% vs 41.7%, p = .023), with a markedly lower incidence of moderate-to-severe PTS (Villalta ≥10) in the infrapopliteal group (4.2% vs 25.0%, p = .097). These benefits were observed despite comparable residual thrombosis (70.8% overall) and DVT recurrence (12.5%).ConclusionInfrapopliteal PMT, with selective adjunct CDT, is associated with a lower risk of PTS compared to popliteal access, likely due to more complete distal thrombus clearance. Despite longer access times, this approach demonstrates favorable long-term outcomes and represents a viable alternative for DVT management.

BackgroundChronic venous disease (CVD) arises from venous obstruction, reflux, or both. Iliac vein stenting is standard for obstructive lesions, but the incremental benefit of concurrently treating deep venous reflux remains uncertain. We evaluated the efficacy of combining iliac vein stent placement with deep venous valve reconstruction in CVD patients presenting with both iliac obstruction and reflux.MethodsFrom October 2015 to May 2025, we retrospectively analyzed a prospectively maintained cohort of 74 patients with lower-limb CVD and iliac vein stenosis and stratified them by reflux pattern: Group 1 (n = 14), iliac obstruction + superficial venous reflux; Group 2 (n = 16), iliac obstruction + deep venous reflux; Group 3 (n = 44), iliac obstruction + both deep and superficial venous reflux. Outcomes included Venous Clinical Severity Score (VCSS), ulcer healing, and complications.ResultsAll groups showed symptomatic improvement with significant VCSS reductions. Patients in Group 3, who received comprehensive management for iliac obstruction and both deep and superficial reflux, showed numerically more favorable outcomes than the other groups. Among 27 patients with active ulcers, the overall healing rate was 85.2%; those undergoing deep venous valve reconstruction had higher healing rates and shorter time to closure. Primary patency of iliac stents was 98.3%, and no major complications were observed.ConclusionsIn CVD with coexisting iliac obstruction and venous reflux, a combined strategy-iliac stenting plus deep venous valve reconstruction-was associated with greater clinical improvement and a shorter time to complete ulcer healing compared with treating obstruction alone. This approach appears safe, maintains high stent patency, and may optimize outcomes in complex CVD.

BackgroundThe issues of diagnosis and treatment strategy for the left renal vein compression (LRVC) have not been fully resolved, and treatment methods vary widely from medical therapy to renal autotransplantation. The aim of this study was to determine the feasibility of isolated interventions on the left ovarian vein in patients with LRVC of varying severity.MethodsThis prospective cohort study included 63 female patients with LRVC (30 symptomatic and 33 asymptomatic), selected out of 266 consecutively examined patients with pelvic venous disorders (PeVD). All participants underwent blood and urine tests, duplex ultrasound studies (DUS) of the renal and pelvic veins, and dynamic renal scintigraphy (DRS). Patients with LRVC and symptoms of pelvic venous insufficiency (PVI) and/or reflux in the left ovarian vein (LOV) further underwent ovarian vein resection or embolization. Follow-up clinical and laboratory evaluations, DUS, and DRS were performed 1 to 12 months after the intervention.ResultsLRVC was diagnosed in 23.6% of patients with PeVD, and was symptomatic in 11.3% and hemodynamically significant, according to DUS, in 4.9% of them. None of patients with LRVC had renal symptoms (pain in the left flank of the abdomen, hematuria) or impaired filtration and secretory dysfunction of the left kidney (LK), according to DRS. Symptomatic LRVC was accompanied by clinical manifestations of PeVD. Ovarian vein interventions were performed in 24 symptomatic patients and resulted in elimination of chronic pelvic pain (CPP) and pelvic venous reflux (PVR) in all cases. Follow-up examinations did not reveal any deterioration in the blood outflow through LRV or disturbances in the LK function after intervention in any patient.ConclusionsLRVC without hematuria does not deteriorate the LK filtration and secretory functions. Patients with symptomatic LRVC without hematuria can undergo isolated interventions on LOV. These interventions are effective in eliminating CPP and do not impair the LK function.

ObjectiveTo evaluate the educational quality, reliability, and transparency of YouTube™ videos on lipoedema, and to examine associations with uploader type and engagement metrics.MethodsOn 15 May 2025 we searched YouTube™ for "lipoedema," screened the first 200 relevance-ranked items, and included videos ≥60 s with intelligible audio. Advertisements, duplicates and soundless videos were excluded. Two independent physicians in Physical Medicine and Rehabilitation (PM&R) rated eligible videos using DISCERN, the Global Quality Score (GQS), and the Journal of the American Medical Association (JAMA) benchmark criteria; disagreements were discussed and original ratings retained for agreement analyses. We recorded upload date, duration, views, likes, comments, channel subscribers, uploader category, and content domain.ResultsWe analyzed 92 YouTube™ lipoedema videos uploaded between 25 February 2015 and 8 January 2025. Uploader mix: vascular surgeons 39.1% (largest) and PM&R physicians 4.3% (smallest); the most common topic was definition + symptoms + management (26.1%). Mean DISCERN totals were 33.47 ± 9.88 and 33.42 ± 8.68 (both poor); mean GQS 2.18 ± 0.82 and 2.43 ± 0.81; only 6.6% were high quality and none scored 5/5. Views correlated strongly with likes and comments (both p < .001), moderately with duration (p < .01), and weakly with subscribers (p < .05). Inter-rater agreement was strong (r = 0.859/0.663/1.000; all p < .001).ConclusionThe overall quality and transparency of YouTube™ lipoedema videos are suboptimal despite substantial engagement. Increasing expert-authored, evidence-based content-particularly from PM&R- and co-produced patient-clinician videos may better align reliability with reach.

BackgroundThere remains an ongoing controversy in the prevention and management of deep vein thrombosis (DVT) following varicose vein surgery.MethodA 32-question electronic survey was sent out to current Vascular Surgeons and Fellow Phlebologists in Aotearoa New Zealand.ResultsThe response rate was 32.4%. There was a significant difference in the application of pre-operative DVT scoring using the Caprini score between Vascular Surgeons and Phlebologists (p < .001). Variation in prophylactic DVT treatment and duration of compression therapy were seen.ConclusionFurther studies are warranted to address the extensive variation in clinical practice in the management of varicose veins.

BackgroundTo evaluate kinesiophobia and its relationship with disease-related characteristics and quality of life in lipedema patients.MethodsIn this descriptive case-control study, 40 lipedema patients and 40 participants in the control group were included. All participants were evaluated in terms of body mass index (BMI), pain numeric rating scale (NRS) and pain threshold (PT) scores, kinesiophobia (Tampa Scale for Kinesiophobia - TSK), lower extremity functional scores (Lower Extremity Functional Scale - LEFS), and health-related quality of life (Nottingham Health Profile - NHP) scores. Additionally, the lipedema patients were evaluated in terms of extremity volumes, and total and mean lower extremity fat mass by dual-energy X-ray absorptiometry.ResultsHigh kinesiophobia was detected in 78% of the lipedema patients and 55% of the control group (p = .033). TSK (p = .048), NRS (p = .001), and NHP total scores (p = .041) were higher and PT scores (p = .007) were lower in lipedema patients compared to the control group. No difference was found between lipedema patients with high and low kinesiophobia in terms of fat mass or extremity volumes. A positive correlation was found between TSK score, NHP total score (r = 0.356, p = .024), NHP physical activity (ρ = 0.403, p = .010) and NHP energy (ρ = 0.436, p = .005) subscale scores.ConclusionKinesiophobia is highly prevalent in lipedema patients, regardless of disease-related data and affecting the quality of life of the patients, negatively.

ObjectiveThe incidence, risk factors, and clinical presentation of deep venous thrombosis (DVT) vary with age. This study aimed to evaluate the differences in clinical characteristics of DVT among patients of different ages.MethodsWe retrospectively analyzed 938 patients with symptomatic lower extremity DVT admitted to our hospital between January 2020 and January 2024. Patients were categorized into youth (<40 years), middle-aged (40-64 years), and elderly (>65 years) groups. Demographic data, comorbidities, risk factors, clinical presentations, and management approaches were collected and analyzed.ResultsMost participants were middle-aged or elderly, with young patients constituting only 11.19% of the study population. The youth group had a slight female predominance, while the middle-aged and elderly group had a balanced gender distribution. The elderly group were more likely to have comorbidities such as diabetes and malignancies, though they had a lower prevalence of autoimmune diseases compared to younger patients. Congenital risk factors were relatively rare in the overall population, yet were present in 22.86% of young patients, a significantly higher proportion than in the middle-aged and elderly groups. Most patients with DVT were provoked, especially in the elderly group. The prevalence of concurrent congenital and acquired factors was 13.33% in the youth group, compared to only 4.97% in the middle-aged group and 2.88% in the elderly group. Proximal DVT was most frequent in middle-aged patients, while young patients were more likely to seek treatment in the acute phase and undergo surgical intervention. Anticoagulation noncompliance was noted in nearly 40% of elderly patients but only 6.67% of young patients.ConclusionRisk factors and clinical characteristics of DVT vary significantly with age, particularly between young and elderly patients. Young patients were more inclined to seek prompt and effective treatment and demonstrated better adherence to anticoagulation therapy.