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

{"title":"Response.","authors":"Rafael Demarchi Malgor","doi":"10.1016/j.jvsv.2026.102514","DOIUrl":"https://doi.org/10.1016/j.jvsv.2026.102514","url":null,"abstract":"","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":" ","pages":"102514"},"PeriodicalIF":2.8,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856906","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}

{"title":"Letter regarding \"AVF Upper Extremity DVT Clinical Practice Guideline\" Response to the authors of: 'The American Venous Forum Clinical Practice Guideline on the Care of Patients with Upper Extremity Deep Venous Thrombosis'.","authors":"Tjep Hoedemakers, Lara T Mascini, Bart-Jeroen Petri, Gert J de Borst, Eline S van Hattum","doi":"10.1016/j.jvsv.2026.102513","DOIUrl":"https://doi.org/10.1016/j.jvsv.2026.102513","url":null,"abstract":"","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":" ","pages":"102513"},"PeriodicalIF":2.8,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856852","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}

{"title":"Breaking the Blockage by Advancing Treatment Strategies for Upper Extremity Deep Vein Thrombosis.","authors":"Suchit Chidurala, Mira Patel, Evan Farrell, Luke D Perry, Lori L Pounds, Matthew J Sideman, James C Andersen","doi":"10.1016/j.jvsv.2026.102510","DOIUrl":"https://doi.org/10.1016/j.jvsv.2026.102510","url":null,"abstract":"<p><strong>Background: </strong>Catheter-directed thrombolysis (CDT) and percutaneous mechanical thrombectomy (PMT) are established endovascular strategies for the treatment of deep vein thrombosis (DVT). However, comparative outcomes data specific to upper extremity deep vein thrombosis (UEDVT) remain limited. Given that PMT is associated with improved outcomes in lower extremity DVT, we hypothesize that PMT is associated with improved mortality and morbidity compared to CDT in treating UEDVT. This study evaluates outcomes associated with CDT versus PMT for UEDVT and Paget-Schroetter Syndrome (PSS).</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using the TriNetX US Collaborative Network. Patients diagnosed with UEDVT who underwent CDT (n=1,399) or PMT (n=1,406) between 2005 and 2025 were identified. Patients who received both modalities were excluded. Propensity score matching was performed, yielding 1,198 patients in each cohort (n=2,396) balanced across demographics, comorbidities (including malignancy, type 2 diabetes mellitus, hypertension, coagulation disorders, and end-stage renal disease), and medication use. A subgroup analysis was performed for patients with PSS who underwent CDT or PMT, with similar propensity score matching (n=280). Thirty-day and one-year outcomes were compared using odds ratios (ORs).</p><p><strong>Results: </strong>After matching, pulmonary embolism (PE) rates did not differ significantly between groups at 30 days or one year. Compared with PMT, CDT was associated with significantly higher odds ratio of 30-day mortality (OR, 1.82), myocardial infarction (OR, 2.43), ischemic stroke (OR, 9.11), transfusion (OR, 1.95), 30-day readmission (OR, 2.34), and intracranial hemorrhage (OR, 6.59). These differences persisted at one year, with CDT demonstrating significantly higher OR of mortality (OR, 1.56), myocardial infarction (OR, 2.01), ischemic stroke (OR, 6.69), and intracranial hemorrhage (OR, 3.93). Repeat intervention occurred more frequently in the PMT cohort at one year (12.2% versus 7.68%; OR 1.67). Among patients with PSS, one-year mortality was low in both groups. There were no significant differences in PE or subsequent first rib resection between CDT and PMT treated patients. However, repeat intervention occurred more frequently in the PMT cohort (21.4% vs 10.7%; OR 2.27).</p><p><strong>Conclusion: </strong>In this national propensity-matched analysis, CDT for UEDVT was associated with higher 30-day and one-year morbidity and mortality compared with PMT, whereas PMT was associated with a greater need for repeat intervention. In patients with PSS, CDT and PMT demonstrated similar clinical outcomes, although PMT was associated with higher reintervention rates. These findings suggest differential risk profiles between the two treatment strategies and may inform procedural selection in the management of UEDVT.</p>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":" ","pages":"102510"},"PeriodicalIF":2.8,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839456","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}

{"title":"Laparoscopic and robotic extravascular stenting of the left renal vein for anterior nutcracker syndrome in a single-center series","authors":"Shuai Tang MD ,&nbsp;Kai Li MD ,&nbsp;Fan Chang MD ,&nbsp;Song Li MD ,&nbsp;Zheng Lv MD ,&nbsp;Jianghui Zhang MD ,&nbsp;Wensong Wu MD ,&nbsp;Huiyuan Shi MD ,&nbsp;Fangmin Chen MD, PhD","doi":"10.1016/j.jvsv.2026.102459","DOIUrl":"10.1016/j.jvsv.2026.102459","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"14 3","pages":"Article 102459"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146197843","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}

{"title":"Midterm clinical outcomes of mechanical versus rheolytic thrombectomy for iliofemoral or iliocaval deep vein thrombosis","authors":"Gabor Forgo MD ,&nbsp;Silvia Cardi MD ,&nbsp;Riccardo Fumagalli MD ,&nbsp;Tim Sebastian MD ,&nbsp;Daniel Périard MD ,&nbsp;Stefano Barco MD (Prof) ,&nbsp;Nils Kucher MD (Prof) ,&nbsp;Rolf P. Engelberger MD","doi":"10.1016/j.jvsv.2026.102457","DOIUrl":"10.1016/j.jvsv.2026.102457","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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%; <em>P</em> &lt; .01) and a lower rate of stent placement (70% vs 98%; <em>P</em> &lt; .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%).</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"14 3","pages":"Article 102457"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146137528","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}

{"title":"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","authors":"Tao Kang MD ,&nbsp;Song Han MD ,&nbsp;Yao-Liang Lu MD ,&nbsp;Xiao-Qiang Li MD, PhD","doi":"10.1016/j.jvsv.2026.102450","DOIUrl":"10.1016/j.jvsv.2026.102450","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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; <em>P</em> = .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; <em>P</em> = .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; <em>P</em> = .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; <em>P</em> &lt; .001), without a significant increase in major bleeding events (2.3% vs 7.4%; <em>P</em> = .096).</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"14 3","pages":"Article 102450"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146119420","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}

{"title":"Relation between clinical findings and diagnostic parameters in patients undergoing superficial venous intervention for symptomatic chronic venous disease due to isolated venous reflux","authors":"Arjun Jayaraj MD,&nbsp;Jack Owens BS,&nbsp;Mary Meghan Dickerson BS","doi":"10.1016/j.jvsv.2026.102445","DOIUrl":"10.1016/j.jvsv.2026.102445","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;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 &lt;em&gt;t&lt;/em&gt; tests, and regression analysis were used to evaluate the data.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;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 (&lt;em&gt;r&lt;/em&gt; = 0.1-0.3; &lt;em&gt;P&lt;/em&gt; &gt; .05), although VSDS had a moderate correlation (&lt;em&gt;r&lt;/em&gt; = 0.4; &lt;em&gt;P&lt;/em&gt; = .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 (&lt;em&gt;r&lt;/em&gt; = 0.4; &lt;em&gt;P&lt;/em","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"14 3","pages":"Article 102445"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145949029","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}

{"title":"Prevalence of chronic venous disorders and its risk factors among rural adults in Tamil Nadu, South India","authors":"Jackwin Sam Paul MD ,&nbsp;Prabhu Premkumar MCh ,&nbsp;Sarah Sunil Joseph MPH ,&nbsp;Anu Mary Oommen MD ,&nbsp;Vinod Joseph Abraham MD","doi":"10.1016/j.jvsv.2026.102447","DOIUrl":"10.1016/j.jvsv.2026.102447","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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; <em>P</em> = .010) and daily fruit consumption (aOR, 0.26; 95% CI, 0.14-0.49; <em>P</em> &lt; .001) as factors independently associated with lower odds of CVD.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"14 3","pages":"Article 102447"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145952469","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}

{"title":"Long-term efficacy following venous stenting for symptomatic iliofemoral venous obstruction: 5 year clinical and stent outcomes in a Southeast Asian population","authors":"Yun Sun Lim MBBS ,&nbsp;Prajwala S. Prakash MRCSEd ,&nbsp;Qiantai Hong FRCSEd ,&nbsp;Malcolm Mak FRCSEd ,&nbsp;Lawrence Han Hwee Quek FRCR ,&nbsp;Uei Pua FRCR ,&nbsp;Gavin Lim FRCR ,&nbsp;Justin Kwan FRCR ,&nbsp;Yi-Wei Wu FRCR ,&nbsp;Gabriel Chan FRCR ,&nbsp;Glenn Wei Leong Tan FRCSEd ,&nbsp;Lester Rhan Chaen Chong FRCSEd ,&nbsp;Li Zhang MRCSEd ,&nbsp;Enming Yong FRCSEd, MBA","doi":"10.1016/j.jvsv.2026.102449","DOIUrl":"10.1016/j.jvsv.2026.102449","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"14 3","pages":"Article 102449"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146093272","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}

{"title":"The effect of prolonged complex decongestive therapy for lower limb secondary lymphedema","authors":"Kotaro Suehiro MD ,&nbsp;Takasuke Harada MD ,&nbsp;Yuriko Takeuchi MD ,&nbsp;Takahiro Mizoguchi MD ,&nbsp;Hiroshi Kurazumi MD ,&nbsp;Mototsugu Shimokawa MD ,&nbsp;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 &lt;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}