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

{"title":"NON-INVASIVE HemodynamicS of Non-Thrombotic Iliac Vein Lesions ARE DISTURBED IN PATIEnTS with A HiSTORY OF Deep Venous Thrombosis.","authors":"Ismael Z Assi, Drew J Braet, Sharika Bamezai, Luciano Delbono, Sonali Verma, David Williams, Thomas Wakefield, Andrea Obi, C Alberto Figueroa","doi":"10.1016/j.jvsv.2026.102644","DOIUrl":"https://doi.org/10.1016/j.jvsv.2026.102644","url":null,"abstract":"<p><strong>Objective: </strong>Non thrombotic iliac vein lesions (NIVL) are thought to be associated with deep vein thrombosis (DVT), yet most individuals with NIVL never develop thrombotic complications. This study assessed whether ultrasound-derived hemodynamic measurements differ between NIVL patients with and without a history of DVT, and whether these hemodynamic measurements better discriminate DVT history than percent stenosis alone.</p><p><strong>Methods: </strong>We performed a retrospective case-control study of patients evaluated at a tertiary academic referral center between 2022 and 2025 who underwent pelvic venous duplex ultrasound imaging. Patients with left common iliac vein stenoses greater than 20 percent were included and categorized by history of left lower extremity DVT. Exclusion criteria included concurrent DVT or prior venous stenting. Ultrasound images were digitized to obtain vessel diameters and spectral Doppler velocities in the iliac veins. Mean velocity, peak velocity, flow rate, shear rate, and ipsilateral and contralateral ratios were calculated. Continuous variables were compared using Welch t tests, with statistical significance defined as p<0.05.</p><p><strong>Results: </strong>45 patients were included, comprising 9 with prior DVT and 36 without. Amongst all metrics, velocity-based metrics at the compressed left common iliac vein showed the strongest associations with a history of prior DVT, including ipsilateral velocity ratio (log2 fold change -1.539, p=0.007), peak velocity (log2 fold change -0.999, p=0.002), and mean velocity (log2 fold change -0.989, p=0.002). Differences in percent stenosis were statistically significant but less discriminative than velocity-based metrics (log2 fold change 0.363, p=0.033). Composite metrics such as flow rate and shear rate demonstrated weaker discrimination. Dimensionality reduction analysis revealed distinct clustering based on multivariate hemodynamic features between patients with and without a history of DVT.</p><p><strong>Conclusions: </strong>Among patients with NIVL, decreased velocity through the left common iliac vein at the compression point was the strongest predictor of prior DVT whereas percent stenosis was less discriminative. This study suggests that ultrasound-derived hemodynamic assessment can potentially provide a functional framework for risk stratification in patients with NIVL, but further prospective studies are needed to validate its clinical utility.</p>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":" ","pages":"102644"},"PeriodicalIF":3.1,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224476","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":"Systematic Review of Devices, Designs, and Trials for the Treatment of Deep Venous Reflux.","authors":"Kwasi Ansere Ofori, Stephanie Li, Alyssa A Grimshaw, Rabih Chaer, Cassius Iyad Ochoa Chaar","doi":"10.1016/j.jvsv.2026.102643","DOIUrl":"https://doi.org/10.1016/j.jvsv.2026.102643","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Chronic venous insufficiency (CVI) is driven primarily by venous reflux and affects nearly one-third of adults. While superficial reflux is effectively treated with ablation, therapeutic options for deep venous reflux (DVR) remain limited. Despite decades of innovation, no prosthetic or bioprosthetic venous valve has achieved U.S. regulatory approval. We systematically reviewed device strategies, clinical and hemodynamic outcomes, complications, and barriers to translation for devices designed to treat DVR.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a PROSPERO-registered systematic review (CRD420251101761) of six databases from inception through February 2026, including in vivo animal and human studies evaluating prosthetic or bioprosthetic devices for DVR. Studies of native valve repair or autotransplantation were excluded. The primary outcome for human studies was clinical improvement, and secondary outcomes included patency, procedural complications, valvular function, and thrombosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 516 records identified, 15 met inclusion criteria: 8 human and 7 animal studies. Two principal strategies were identified: intraluminal valve restoration (VR) and external compression (EC), with approximately 40% of devices delivered percutaneously or endovenously. In human studies, technical success ranged from 87.7%-100%, patency from 67%-100%, and perioperative complication rates from 0%-44%, consisting primarily of bleeding, wound infection, and valve thrombosis. Valve occlusion occurred in up to 28% of animal implants and 18%-22% of select human cohorts. Two perioperative deaths occurred in animal studies; none were reported in human studies. Among human studies, valve competency assessment methods varied substantially. Reported competency ranged from 0%-92%, reflecting heterogeneity in imaging modalities and definitions. Discordance between anatomic patency, duplex-derived reflux reduction, and clinical improvement was frequently observed. In contemporary multicenter trial data, fewer than half of patients met predefined reflux-reduction endpoints despite high device patency and substantial clinical improvement, highlighting discordance between anatomic, hemodynamic, and patient-centered outcomes. By one year, pain had improved in 75%-97% of patients; rVCSS decreased by 37%-81%, with clinically meaningful (≥3-point) improvement in up to 84.6%; and ulcer healing ranged from 67%-100%. Longer follow-up extended to 2 years in animal studies and up to 11 years in human series with various outcomes reported.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Several devices developed for DVR have demonstrated technical feasibility and symptom improvement. However, the risk of thrombosis, the marginal impact on valvular function, and the lack of standardization and selection of adequate endpoints in the measurement of results remain major barriers to regulatory approval. Standardized composite endpoints integrati","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":" ","pages":"102643"},"PeriodicalIF":3.1,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224485","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":"A pilot study of the InVera Infusion Device: Twelve-month outcomes in the treatment of incompetent saphenous veins.","authors":"Imre Bihari, Stephen Madden, Nigel Phelan, Lowell S Kabnick","doi":"10.1016/j.jvsv.2026.102642","DOIUrl":"https://doi.org/10.1016/j.jvsv.2026.102642","url":null,"abstract":"<p><strong>Objective: </strong>The InVera Infusion Device is a novel catheter designed for the delivery of sclerosant agents during non-thermal, non-tumescent (NTNT) ablation of incompetent superficial truncal veins of the lower extremity. This device pilot study aimed to evaluate the technical success, safety, and 12-month clinical outcome.</p><p><strong>Methods: </strong>A single-center, prospective pilot study enrolled 10 patients with primary symptomatic axial reflux who underwent chemical ablation procedures with sclerosant delivery using the InVera Infusion Device. Primary outcomes assessed were technical procedural success, adverse events, Revised Venous Clinical Severity Score (rVCSS), patient-reported outcomes (PROs) based on a HASTI (Heaviness, Achiness, Swelling, Throbbing, Itching) symptom questionnaire and anatomical success rates from duplex ultrasound examination at baseline, 1 week, 8 weeks, 3, 6, and 12 months post procedure. Baseline and 12 months post procedure were compared for both the rVCSS and the HASTI results using a paired t-test and a Wilcoxon signed-rank test respectively RESULTS: Technical procedural success was 100%. There were no device-related adverse events or serious adverse events including no deep vein thrombosis recorded throughout the follow-up period. Clinician assessed rVCSS and patient reported HASTI scores both showed statistically significant reductions from baseline to 12 months (adjusted p = 0.03 for both). Ultrasound-based anatomical assessment at 12 months demonstrated elimination of abnormal reflux and complete or partial occlusion in 90% of patients.</p><p><strong>Conclusions: </strong>The InVera Infusion device provides a safe and effective technique for the delivery of sclerosant agents as part of the management of incompetent saphenous veins, demonstrating favorable 12-month anatomical, clinical and patient reported outcomes in this pilot cohort.</p>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":" ","pages":"102642"},"PeriodicalIF":3.1,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224500","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 \"Pelvic Vein Embolization using different Embolic Agents for the Treatment of Pelvic Venous Insufficiency: A Systematic Review and Meta-Analysis\".","authors":"Romaric Loffroy","doi":"10.1016/j.jvsv.2026.102645","DOIUrl":"https://doi.org/10.1016/j.jvsv.2026.102645","url":null,"abstract":"","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":" ","pages":"102645"},"PeriodicalIF":3.1,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216397","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":"Iliac Vein Stenting With or Without Ovarian Vein Embolisation for May-Thurner Syndrome-Associated Pelvic Venous Disorder in Women: A Received-Treatment Retrospective Cohort Study.","authors":"Tianhong Cai, Rong Zhang, Kai Chen, Jianfeng He, Dianxi Chen, Tenghui Zhan","doi":"10.1016/j.jvsv.2026.102641","DOIUrl":"https://doi.org/10.1016/j.jvsv.2026.102641","url":null,"abstract":"<p><strong>Objective: </strong>To compare clinical outcomes after iliac vein stenting (IVS) alone, simultaneous IVS plus ovarian vein embolisation (OVE), and staged IVS followed by OVE in women with May-Thurner syndrome-associated pelvic venous disorder.</p><p><strong>Methods: </strong>This single-centre retrospective cohort study enrolled 184 women (aged 18-65 years) with imaging-confirmed MTS and haemodynamically significant PeVD at Fujian Maternity and Child Health Hospital (January 2021-May 2025). The primary estimand was treatment received: IVS alone without subsequent OVE (Group A, n=71), simultaneous IVS plus OVE (Group B, n=54), or staged IVS then OVE (Group C, n=59, including 45 planned staged cases and 14 staged-after-IVS reassessment cases). The primary outcome was >=50% reduction in VAS pain score at 12 months. Confounding was addressed using multivariable regression, propensity score matching (PSM), stabilised inverse probability weighting (IPTW), overlap weighting, augmented inverse probability weighting (AIPW), and repeated-measures models. OVE timing analyses were exploratory. Exact-date and time-updated OVE sensitivity analyses were performed, and available follow-up was extended through August 31, 2026.</p><p><strong>Results: </strong>At 12 months, response rates were 54.9% for IVS alone, 74.1% for simultaneous IVS+OVE, and 69.5% for staged IVS+OVE (overall P=0.059). Receipt of OVE was associated with higher adjusted odds of response compared with IVS alone (adjusted OR 2.64, 95% CI 1.21-5.73; P=0.014), supported by IPTW (OR 3.12, bootstrap 95% CI 1.09-6.87). PSM (OR 2.60, 95% CI 0.93-7.29), overlap-weighted (OR 2.42, 95% CI 0.66-8.84), and AIPW estimates were directionally consistent but imprecise. Planned staged and staged-after-IVS reassessment cases had 12-month response rates of 73.3% and 57.1%, respectively. Recorded 30-day events were mostly Grade I; one simultaneous IVS+OVE patient had Grade IIIa coil migration requiring snare retrieval, with no sequelae. Median follow-up was 37.3 months (IQR, 23.7-54.2; maximum, 66.5), with 96.6% stent patency among 29 patients assessed at 60 months.</p><p><strong>Conclusions: </strong>In this received-treatment analysis, adjunctive OVE was associated with higher 12-month symptom-response rates compared with IVS alone. No statistically significant difference was observed between simultaneous and staged OVE, but this exploratory timing comparison should not be interpreted as equivalence. Because residual confounding remains and OVE adds procedure-specific events, these findings support selective consideration of OVE for patients with substantial ovarian vein reflux rather than routine incorporation for all patients.</p>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":" ","pages":"102641"},"PeriodicalIF":3.1,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182771","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":"Corrigendum.","authors":"","doi":"10.1016/j.jvsv.2026.102633","DOIUrl":"https://doi.org/10.1016/j.jvsv.2026.102633","url":null,"abstract":"","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":" ","pages":"102633"},"PeriodicalIF":3.1,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182786","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":"Reflux Extension Index (REXI) as a novel ordinal tool for quantifying saphenous reflux burden in women with CEAP C1-C2 chronic venous disease.","authors":"Claudia Carvalho Sathler de Melo, Fausto Miranda Júnior, Adriana Sanudo, Ronald Luiz Gomes Flumignan","doi":"10.1016/j.jvsv.2026.102640","DOIUrl":"https://doi.org/10.1016/j.jvsv.2026.102640","url":null,"abstract":"<p><strong>Objective: </strong>To describe and quantify saphenous reflux patterns in women with early chronic venous disease (CEAP C1 and C2), to evaluate its discriminative ability between C1 and C2 and to identify if a greater extension of saphenous reflux corresponds to a greater probability of C2 classification.</p><p><strong>Methods: </strong>Cross-sectional study of women ≥ 18 years classified as CEAP C1 or C2 by clinical examination and duplex ultrasonography between January 2019 and July 2023 at a private phlebology clinic. Met inclusion criteria 1,138 (2,276 limbs); all examinations were performed by a single operator. The Number of Zones with Reflux (NZR; 0-12 - Pittaluga's lower-limb mapping) was binned into REXI-0 (0), REXI-1 (1-2), REXI-2 (3-5), REXI-3 (≥ 6). Analyses were conducted at the limb level (n = 2,276) and at the patient level for concordant subgroups (bilateral C1 n = 666; bilateral C2 n = 240; total n = 906). Logistic regression, adjusted for age and family history, was performed in 885 women with complete data. Model discrimination was assessed using the area under the receiver operating characteristic curve (AUROC), monotonic trend within a generalized estimating equations (GEE) framework, and McNemar's test.</p><p><strong>Results: </strong>At the limb level, C2 prevalence increased monotonically with REXI category. At the patient level, adjusted odds ratios for bilateral C2 versus REXI-0 were 5.26 (95% CI 3.34-8.29), 14.93 (9.31-23.95), and 51.97 (25.53-105.81) for REXI-1 to -3 (all p < 0.001; McFadden pseudo-R² = 0.280). Discrimination was good and improved with adjustment: crude AUROC 0.815 (0.783-0.847), adjusted 0.837 (0.805-0.868); Δ AUROC = +0.022, p = 0.001. The adjusted probability of C2 crossed 50% between REXI-1 and REXI-2 (56.6%, 48.3-64.9). A left-sided C2 predominance was observed (McNemar OR 1.34, 1.04-1.74; p = 0.026). Of 240 women with bilateral C2, 101 (42.1%) had a REXI-0/REXI-1 profile - minimal or no saphenous reflux.</p><p><strong>Conclusions: </strong>REXI is a simple, quantitative, and clinically applicable ordinal framework for measuring saphenous reflux extension in women with early chronic venous disease. Prospective multicentre validation and interventional outcome studies are the necessary next steps.</p>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":" ","pages":"102640"},"PeriodicalIF":3.1,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164370","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":"Ultra-High-Frequency Ultrasound-Detected Lymphatic Structural Transition Points Are Located Central to Early Dermal Backflow Transition Points on Indocyanine Green Lymphography.","authors":"Shinsuke Akita, Yushi Suzuki, Hisashi Sakuma, Toko Umamoto, Haruka Maei, Yoshihisa Yamaji, Koichi Nagao, Nobuyuki Mitsukawa","doi":"10.1016/j.jvsv.2026.102638","DOIUrl":"https://doi.org/10.1016/j.jvsv.2026.102638","url":null,"abstract":"<p><strong>Background: </strong>In lymphaticovenular anastomosis (LVA), discrepancies between functional assessment of lymphatic flow using indocyanine green (ICG) lymphography and structural evaluation using ultrasound remain a challenge. This study aimed to clarify the spatial relationship between the early dermal backflow transition point (eDBF-TP) identified by ICG and lymphatic structural transition points (LSTPs) detected by ultra-high-frequency ultrasound (UHFUS).</p><p><strong>Methods: </strong>This prospective observational study included 60 sites in patients with secondary limb lymphedema. After identifying eDBF-TP using ICG lymphography, UHFUS was performed within ±50 mm from the reference point (0 mm). LSTPs were defined as obstruction, luminal narrowing, or tortuous segments, and their spatial relationships relative to eDBF-TP were analyzed.</p><p><strong>Results: </strong>LSTPs were identified in 93.3% of sites and were predominantly located central to the eDBF-TP. Obstruction and severe narrowing were mainly found centrally, whereas tortuous segments were more frequently observed peripherally. Only 35% of LSTPs were located within ±5 mm of the eDBF-TP, indicating a spatial discrepancy between functional and structural abnormalities. Confluence points were consistently located peripheral to LSTPs. Intraoperatively, dilated lymphatic vessels peripheral to LSTPs were suitable for anastomosis in all cases and demonstrated favorable washout flow.</p><p><strong>Conclusions: </strong>Functional lymphatic failure may occur peripheral to structural abnormalities. For LVA, selecting dilated lymphatic vessels located peripheral to structural transition points-rather than directly at the eDBF-TP-may represent a rational and effective strategy for determining optimal incision sites.</p>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":" ","pages":"102638"},"PeriodicalIF":3.1,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169919","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":"A Comparison of Aspiration Thrombectomy to Catheter-Directed Thrombolysis in Management of Paget-Schroetter Syndrome.","authors":"Lara Sak, Thomas Munro, Jesus Ulloa, Hugh A Gelabert","doi":"10.1016/j.jvsv.2026.102637","DOIUrl":"https://doi.org/10.1016/j.jvsv.2026.102637","url":null,"abstract":"<p><strong>Objective: </strong>Acute subclavian vein thrombosis secondary to thoracic outlet (Paget Schroetter Syndrome-PSS) may involve prompt clearing of thrombus from the subclavian vein by catheter directed thrombolysis (CDT) or aspiration thrombectomy (ASP). Our goal is to systematically compare the outcomes of CDT and ASP in the management of PSS.</p><p><strong>Methods: </strong>Consecutive PSS cases at a single institution from 2020 through 2025 were reviewed for management with CDT or ASP. Venograms were assessed for patency, stenosis, and subclavian post-thrombotic changes (PTC). PTC were graded by degree of luminal encroachment, and vessel irregularity: mild (less than 10%), moderate (10-50%) and severe (50-99%). Interventions were assessed: (1) within 1 week of procedure, (2) before subclavian vein decompression, (3) 2 weeks after subclavian vein decompression, and (4) patency at last venogram. Standardized outcomes were assessed.</p><p><strong>Results: </strong>110 patients with PSS were treated over 5 years. 54 met inclusion criteria: 28 CDT and 26 ASP. 1 week following procedure, re-thrombosis occurred in 1 (3.6%) CDT and 6 (23.1%) ASP (p<0.5). Failure to clear thrombosis occurred in 13.8%) ASP case. Composite of early thrombosis and procedural failure was higher in the ASP cohort. Prior to PSS surgery, occlusion was noted in 1 (3.6%) CDT and 8 (30.8%) ASP (p<0.05). PTC mild in 13 (46.4%) CDT and 5 (19.2%) ASP (p<0.05); moderate in 5 (17.9%) CDT and 5 (19.2%) ASP, severe in 9 (32.1%) CDT and 8 (30.8) ASP. At early follow up after PSS surgery, PTC was mild in 10 (43.5%) CDT and 4 (23.5) ASP; moderate in 2 (8.7%) CDT and 1 (5.9%) ASP, severe in 9(39.1%) CDT and 6 (35.3%) ASP. Occlusion was noted in 2 (8.7%) CDT and 6 (35%) ASP. Recanalization resulted in final patency of 22 (95%) CDT and 15 (88%) ASP.</p><p><strong>Conclusion: </strong>ASP and CDT may both be employed for clearing thrombus in PSS, however, they differ on early efficacy, PTC, and patency. While often more rapid and convenient, our results suggest ASP may be inferior to CAT in management of PSS.</p>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":" ","pages":"102637"},"PeriodicalIF":3.1,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147249","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":"Post thrombotic syndrome after thrombotic venous thoracic outlet syndrome.","authors":"Samy Benhalima, Giovanni Gautier, Frédéric Douane, Alban Fouasson-Chailloux, Guillaume Gadbled, Benjamin Espinasse, Blandine Maurel, Marie Morard, Olivier Espitia","doi":"10.1016/j.jvsv.2026.102639","DOIUrl":"https://doi.org/10.1016/j.jvsv.2026.102639","url":null,"abstract":"<p><strong>Background: </strong>Thrombotic venous thoracic outlet syndrome (T-vTOS) including Paget-Schrotter syndrom is a rare form of upper extremity deep vein thrombosis (UEDVT) that mainly affects young, active individuals. Its optimal management remains debated and medium-term outcomes are poorly documented.</p><p><strong>Methods: </strong>Consecutive patients from the vascular medicine department of a university hospital with T-vTOS between 2014 and 2024 were included in a retrospective study. Patients were stratified according to the presence of post-thrombotic syndrome with the modified Villalta score at last follow-up (<5 vs ≥5). Clinical characteristics, therapeutic strategies and outcomes were systematically assessed through a standardized consultation performed by the same physician. Univariable and multivariable logistic regression analyses, using Firth's penalized-likelihood method to account for the limited number of events, were performed to identify factors associated with post-thrombotic syndrome.</p><p><strong>Results: </strong>Fifty patients were included: 28 with a Villalta score <5 and 22 with a Villalta score ≥5 at last follow-up. Patients with Villalta <5 achieved higher rates of complete subclavian vein recanalization at follow-up (63% vs 32%, p=0.045) and were less likely to have persistent subclavian vein occlusion (26% vs 59%, p=0.023). Villalta ≥ 5 patients more often required prolonged anticoagulation (73% vs 29%, p=0.004) and more frequently underwent acute-phase endovascular treatment (36% vs 4%, p=0.007). In multivariable analysis endovascular treatment alone without thoracic outlet surgery was associated with PTS (OR 10.6, 95% CI 1.15; 98.09) (p=0.037), whereas there was no association between PTS and patients who had undergone both endovascular treatment and TOS surgery: OR 1.3 (95% CI 0.26; 6.87) (p=0.736).</p><p><strong>Conclusion: </strong>This study highlights the central role of venous patency in the clinical course of T-vTOS, with persistent subclavian vein occlusion associated with post-thrombotic syndrome. The association observed between acute-phase endovascular treatment alone and post-thrombotic syndrome does not support a clear benefit of this strategy. However, endovascular therapy in conjunction with surgical decompression of the thoracic outlet may reduce the risk of post-thrombotic syndrome.</p>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":" ","pages":"102639"},"PeriodicalIF":3.1,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148425","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}