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

{"title":"A novel infrared fluorescence method to identify regions of superficial microvenous reflux in patients with chronic venous disease","authors":"Gregory T. Jones PhD,&nbsp;Kari Clifford PhD,&nbsp;Geraldine B. Hill MSc,&nbsp;Kate N. Thomas PhD,&nbsp;Sarah Lesche MD,&nbsp;Jolanta Krysa MBChB","doi":"10.1016/j.jvsv.2026.102448","DOIUrl":"10.1016/j.jvsv.2026.102448","url":null,"abstract":"<div><h3>Objective</h3><div>Reflux within the superficial microvenous network may play a critical role in the development of skin changes associated with chronic venous insufficiency. This study aimed to extend previous ex vivo observations to determine the in vivo utility of near infrared fluorescence (NIRF) imaging to assess superficial venous reflux in the leg.</div></div><div><h3>Methods</h3><div>A total of 28 limbs were examined in 17 participants. These included limbs with (CEAP C2, n = 6; C3, n = 1; and C4, n = 15) and without (CEAP C0, n = 6) venous disease. Indocyanine green (5 mL at 0.1 mg/mL) was infused via an (antegrade) cannula in the distal great saphenous vein and the medial leg imaged using NIRF. Venous reflux was assessed using the Valsalva maneuver, with or without superficial outflow obstruction (thigh cuff inflated to 50 mmHg).</div></div><div><h3>Results</h3><div>Consistent with our previous ex vivo study, NIRF imaging visualized a wide range of different microvenous reflux patterns in vivo. These included focal and diffuse regions of fluorescence within the skin, the extent of which appeared to be associated with venous disease (CEAP C classification) severity. The observed reflux patterns also appeared to be functional correlates of perforator vein or saphenofemoral junctional incompetence.</div></div><div><h3>Conclusions</h3><div>This preliminary in vivo study provides proof-of-principle observations suggesting a potential novel method for investigating microvenous reflux in superficial venous disease.</div></div><div><h3>Clinical Relevance</h3><div>This study reports the first in vivo use of near-infrared fluorescence (NIRF) imaging with indocyanine green to assess superficial microvenous reflux within intact limbs. This preliminary data suggests that the extent and distribution of skin fluorescence may be associated with venous disease severity (CEAP Clinical classification). It also provides potential mechanistic insight, identifying reflux patterns that appear to be functional correlates of venous incompetence. This study suggests that NIRF imaging could provide a novel tool for investigating microvenous contributions to chronic venous disease and its skin manifestations.</div></div>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"14 3","pages":"Article 102448"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146018972","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":"Clinical Outcomes and Feasibility of Nonthermal, Nontumescent Ablation for Isolated Below-the-Knee Great Saphenous Vein Incompetence.","authors":"Jeeyoung Min, Sang Woo Park, Jin Ho Hwang, Jun Seok Kim, Song Am Lee, Jae Joon Hwang, Hyun Keun Chee, Yun Hak Lee, Woo Young Yang, Yong Wonn Kwon","doi":"10.1016/j.jvsv.2026.102509","DOIUrl":"https://doi.org/10.1016/j.jvsv.2026.102509","url":null,"abstract":"<p><strong>Objective: </strong>To assess feasibility, clinical outcomes, and safety of nonthermal, nontumescent (NTNT) ablation for symptomatic isolated below-the-knee (BTK) great saphenous vein (GSV) incompetence with competent saphenofemoral junction and above-knee GSV.</p><p><strong>Methods: </strong>This multicenter retrospective study included 73 treated BTK-GSV limbs in 50 patients who underwent NTNT ablation (mechanochemical ablation [MOCA] or cyanoacrylate adhesive closure [CAC]) between October 2020 and April 2025. Isolated BTK-GSV incompetence was defined as reflux ≥1.0 second confined to the BTK segment on duplex mapping without junctional or above-knee truncal reflux. Follow-up duplex ultrasound and Venous Clinical Severity Score (VCSS) assessments were performed at 1 week and 1, 3, 6, and 12 months.</p><p><strong>Results: </strong>Immediate post-procedural duplex ultrasound confirmed complete occlusion of the treated BTK-GSV segment in all limbs. No partial or complete recanalization was observed during follow-up. The median VCSS improved significantly from 4 [interquartile range (IQR), 3-4] at baseline (n=73) to 0 [0-1] at 1 week (n=51), 0 [0-1] at 1 month (n=73), 0 [0-1] at 3 months (n=73), 0 [0-0] at 6 months (n=73), and 0 [0-0] at 12 months (n=43) (all P < .001 vs baseline, Wilcoxon signed-rank test). No major adverse events occurred, including deep vein thrombosis, pulmonary embolism, or permanent paresthesia suggestive of saphenous nerve injury. Minor events included superficial phlebitis (8%), ecchymosis (7%), and skin rash related to bandages or compression stockings (7%), all resolving with conservative management.</p><p><strong>Conclusions: </strong>NTNT ablation appears to be a safe and effective option for symptomatic isolated BTK-GSV reflux, providing significant clinical improvement with durable occlusion and without thermal-related nerve injury.</p>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":" ","pages":"102509"},"PeriodicalIF":2.8,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816408","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 Systematic Review with Meta-Analysis on Racial and Ethnic Disparities in Acute Venous Thromboembolism Diagnosis and Management.","authors":"Megha Anand, Syed Muhammad Saad Jalil, Huaqing Zhao, Riyaz Bashir","doi":"10.1016/j.jvsv.2026.102511","DOIUrl":"https://doi.org/10.1016/j.jvsv.2026.102511","url":null,"abstract":"<p><strong>Objective: </strong>Acute Venous Thromboembolism (VTE), encompassing deep vein thrombosis and pulmonary embolism, is one of the leading causes of cardiovascular mortality. Recent studies have shown racial and ethnic disparities in VTE incidence and outcomes. The objective of this review is to identify racial and ethnic disparities present in the incidence, diagnosis, and management of VTE.</p><p><strong>Methods: </strong>A comprehensive review was conducted in PubMed and ScienceDirect using the following search terms: pulmonary embolism, deep vein thrombosis, race, ethnicity, racial disparities, ethnic disparities, and social determinants. Papers were included if they were published in English and within the years 2004-2024. Papers were excluded if they studied non-US adult populations, if VTE was not a main outcome of interest, or if they focused on surgery or COVID related VTE. The resultant papers (n=52) included randomized clinical trials, systematic reviews, meta-analyses, and observational studies at single-center, multi-center, and national levels. Quantitative data on the use of Catheter-Based Therapies (CBT) by racial and ethnic groups were extracted from a subsect of papers where it was explicitly reported (n=8). Using this data, a meta-analysis was conducted to compare the utilization of catheter-based therapies for pulmonary embolism across different racial and ethnic groups.</p><p><strong>Results: </strong>Significant racial and ethnic disparities in the diagnosis and treatment of VTE were noted. Black patients had the highest disease incidence, severity, mortality, and inpatient complications. Similar inequities may exist among other racial and ethnic groups, though these remain less well-characterized due to limited ethnic representation in current VTE literature and related clinical trials. Genetic factors contribute more to VTE risk in white patients, whereas comorbidities and socioeconomic disparities have a more significant impact on non-white patients. Several studies have noted disparities in access to catheter-directed thrombolysis for non-white patients compared to white patients. Notably, racial disparities in advanced therapy usage are reduced in the context of high-risk PE, though ethnic disparities persist. Initial studies have suggested that PERT implementation may reduce disparities in VTE management, though further research is needed to evaluate its impact on outcomes. Results of the meta-analysis further supported these findings by revealing increased CBT usage in white and non-Hispanic patients compared to black and Hispanic patients respectively.</p><p><strong>Conclusions: </strong>Socioeconomic vulnerability and comorbid conditions account for disparities in VTE incidence in minority populations, and poor outcomes in these groups may be tied to inequalities in access to catheter-based interventions.</p>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":" ","pages":"102511"},"PeriodicalIF":2.8,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815460","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":"Association of Post-Thrombotic Changes with Disease Severity in Patients Presenting with Symptomatic Calf Vein Thrombosis.","authors":"Spiro Koustas, Nicos Labropoulos","doi":"10.1016/j.jvsv.2026.102508","DOIUrl":"https://doi.org/10.1016/j.jvsv.2026.102508","url":null,"abstract":"<p><strong>Background/objectives: </strong>This study was designed to evaluate the development of post-thrombotic signs and symptoms in patients with isolated calf deep vein thrombosis (ICDVT) in relation to changes seen by ultrasound in the affected veins.</p><p><strong>Methods: </strong>117 limbs in 104 patients, with isolated symptomatic calf vein thrombosis were included in the study. These were objectively diagnosed with ultrasound. The distribution and extent of the initial DVT was recorded in detail. Patients with a documented episode of prior DVT or those having thrombus in the popliteal vein or higher were excluded. Follow-up at 3-24 months was performed with clinical examination and ultrasound. Ultrasound examination was done with the patient in the standing position to ensure optimal testing for detecting post-thrombotic changes. Affected venous segments were classified as having an occlusion, complete recanalization, partial re-canalization, with or without reflux.</p><p><strong>Results: </strong>At 1 year, out of 98 limbs studied, most (99%) had recanalization of their calf vein thrombosis; 53% (n=52) had complete, 46% (n=45) had partial, and 1% (n=1) had no recanalization. Ultrasound studies of those limbs showed reflux (R) in 22% (n=22), obstruction (O) in 9% (n=9), R + O in 33% (n=32), and normal findings in 36% (n=35) of limbs. Only 17% of limbs had signs of edema (CEAP 3), 2% had skin changes (CEAP 4) and 0% had any signs of ulcers (CEAP 5,6). Of these findings, only 14 patients experienced persistent symptoms at 1 year.</p><p><strong>Conclusions: </strong>Patients with symptomatic calf vein DVT generally have good clinical outcomes, with most being asymptomatic, and having mild disease. While small deterioration is seen up to 2 years, few limbs developed skin changes. The presence of reflux in calf veins does not appear to be a significant predictor of severe disease development in the medium term.</p>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":" ","pages":"102508"},"PeriodicalIF":2.8,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147775158","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":"Development and validation of the \"IVENUS\" artificial intelligence model for automated CEAP classification of early-stage chronic venous disease using lower-limb photographs.","authors":"V Denisov, M Chistogov, D Averin, D Zabelinskaya, I Bobrov, N Kondratiuk, A Gasnikov, M Galchenko, K Lobastov, D Borsuk","doi":"10.1016/j.jvsv.2026.102503","DOIUrl":"https://doi.org/10.1016/j.jvsv.2026.102503","url":null,"abstract":"<p><strong>Objectives: </strong>Chronic venous disease (CVD) is one of the most common vascular disorders, affecting millions of people worldwide. Due to the variability of clinical symptoms and the subjective nature of their interpretation, diagnosing CVD at an early stage is complicated, making it crucial for patients to consult a specialist. It was hypothesized that an artificial intelligence (AI) model could accurately classify chronic venous disease (C0-C2 CEAP clinical class) from lower-limb photographs. Therefore, this study aimed to develop and validate such a model.</p><p><strong>Methods: </strong>A multicenter cross-sectional study (NCT17122021) was conducted from May 2020 to January 2024 in accordance with the Helsinki Declaration. The dataset of 10745 lower-limb photographs was collected using smartphones and professional cameras across several Russian clinics, then standardized and anonymized prior to model training. The CEAP clinical class was determined by consensus among three surgeons experienced in phlebology. The AI model \"IVENUS\" was developed to automatically assess lower-limb photographs and classify early-stage CVD according to the CEAP clinical classification (C0-C2). The model was trained using a deep learning approach based on the \"Swin Transformer V2\" architecture. To improve model robustness and reduce overfitting, Gaussian blurring and color jitter were applied as data augmentation methods during training. The standard performance metrics (sensitivity, recall, specificity, accuracy, and precision) were calculated.</p><p><strong>Results: </strong>The dataset consisted of 673 lower limbs of C0, 4445 lower limbs of C1, and 5627 lower limbs of C2. The overall diagnostic accuracy in the external validation subset of 1622 photographs was 84.8%, with a precision of 84.3%, sensitivity of 84.3%, and specificity of 92.3%.</p><p><strong>Conclusions: </strong>The AI model \"IVENUS\" demonstrated high diagnostic value for early-stage chronic venous disease, sufficient for its application as a clinical decision-support system. Therefore, this model may support patient self-screening, telemedicine triage, and may be used by specialists for automated patient routing and treatment progress tracking.</p>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":" ","pages":"102503"},"PeriodicalIF":2.8,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147775216","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":"Use of cover stent as treatment of Iatrogenic Iliac Vein Injury: Case Series and Review of the Literature.","authors":"Fanyun Liu, Fuwen Chen, Hailong Luo, Xiaotong Qi, Jianming Sun, Yikuan Chen","doi":"10.1016/j.jvsv.2026.102505","DOIUrl":"https://doi.org/10.1016/j.jvsv.2026.102505","url":null,"abstract":"<p><strong>Objective: </strong>Iatrogenic iliac vein injury is an exceedingly rare complicationis but is associated with high mortality rates. Repair or ligation is the most common treatment and is technically demanding. An alternative technique is endovascular placement of a covered stent grafting across the injured segment. We study a series of patients with iatrogenic iliac vein injury treated with cover stent and review the available literature on this technique.</p><p><strong>Methods: </strong>The PubMed database was systematically searched up to September 2025 for studies focusing on endovascular repair of iatrogenic iliac vein injury. Inclusion criteria were restricted to adult patients (aged > 18 years) with iatrogenic iliac vein injury. Exclusion criteria included studies addressing endovascular repair for traumatic or spontaneous venous rupture, pathologies involving the iliocaval confluence or arteriovenous fistulas, as well as repair procedures utilizing coil embolization, bare-metal stents, or open surgical techniques.Two reviewers independently completed literature screening and data extraction. Data were extracted for the following parameters:Interventional approach, stent type and size, technical success, postprocedural pharmacologic management, complications and surveillance strategy .</p><p><strong>Results: </strong>From the initial search about 5781 records, 16 studies were finally identified for analysis. All reports consisted of case report or case series. A total of 25 patients had been treated with various covered stent grafts and achieved technical success. Three perioperative complications occurred: two acute thrombus formations and one case of stenosis caudal to the stent edge requiring additional stenting. The postoperative anticoagulation strategy was highly heterogeneous. The perioperative mortality rate was 4%. The median follow-up was 5 months (range 0.25-84 months).</p><p><strong>Conclusions: </strong>For iatrogenic iliac vein injuries, covered stent grafts can be an effective method at securing urgent hemostasis and demonstrate excellent short-term patency.</p>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":" ","pages":"102505"},"PeriodicalIF":2.8,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147775258","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 Known, the Unknown and the Covered Stent: Lessons Learned from Iatrogenic Iliac Vein Injuries.","authors":"Ioannis Tsouknidas, Arjun Jayaraj","doi":"10.1016/j.jvsv.2026.102506","DOIUrl":"https://doi.org/10.1016/j.jvsv.2026.102506","url":null,"abstract":"","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":" ","pages":"102506"},"PeriodicalIF":2.8,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147775269","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":"Anatomical Patterns of Pelvic Venous Reflux to the Lower Limbs.","authors":"Joana Storino, Fanilda Barros, Nathalia Cardoso","doi":"10.1016/j.jvsv.2026.102507","DOIUrl":"https://doi.org/10.1016/j.jvsv.2026.102507","url":null,"abstract":"<p><strong>Background: </strong>Pelvic venous insufficiency is an important but frequently overlooked cause of lower limb varicose veins and early recurrence following superficial venous interventions. Understanding the reflux patterns and distribution of lower limb varicose veins with pelvic origin is crucial for preventing recurrence and unsatisfactory outcomes, which may result from incomplete or inadequate investigation.</p><p><strong>Methods: </strong>Data from 49 female patients (62 limbs) with pelvic reflux that connects to the lower limbs through pelvic escape points were analyzed. All patients were examined for reflux in the standing position using duplex ultrasound. Special attention was given to the reflux patterns, distribution, and connections to the saphenous veins, nerves, and lymph nodes.</p><p><strong>Results: </strong>Most patients were classified as CEAP C2 (95%), and 70% reported leg pain. The most frequently observed patterns were varicose veins on the posterior surface of the thigh (19%), veins connected to the great saphenous vein (GSV) along the thigh and leg (29%), and veins running parallel to the great saphenous vein on the medial thigh (26%). Varicose veins confined exclusively to the perineal region were identified in 15% of patients. Less common patterns included varicose veins on the anterior thigh (8%), veins associated with the sciatic nerve (10%), and veins with lymph node connections (8%). Varicose veins connected to the small saphenous vein were the least frequent, accounting for 5% of cases.</p><p><strong>Conclusions: </strong>Although the GSV is often involved in patients with pelvic venous insufficiency and escape points, non-saphenous varices appear to play a more prominent role in the reflux pattern. These findings support the concept that pelvic-origin reflux manifests as distinct patterns of lower limb varicose veins through defined pelvic escape points, underscoring the importance of thoroughly assessing the connection between pelvic and lower limb venous territories. A better understanding of the distribution of non-saphenous reflux during venous mapping is essential for optimizing treatment strategies and reducing the risk of recurrence.</p>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":" ","pages":"102507"},"PeriodicalIF":2.8,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147775218","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":"Recovery Behavior Patterns After Varicose Vein Procedures: A Critical Reappraisal.","authors":"Shyam Sundar Sah, Abhishek Kumbhalwar","doi":"10.1016/j.jvsv.2026.102504","DOIUrl":"https://doi.org/10.1016/j.jvsv.2026.102504","url":null,"abstract":"","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":" ","pages":"102504"},"PeriodicalIF":2.8,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147775223","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 systematic review of contemporary randomized controlled trials for treatment of lower extremity lymphedema by intermittent pneumatic compression devices.","authors":"Thomas F O'Donnell, Alexander Tedesco, John Fish","doi":"10.1016/j.jvsv.2026.102500","DOIUrl":"10.1016/j.jvsv.2026.102500","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Observational trials have suggested that intermittent pneumatic compression (IPC) devices reduce lymphedema (LED) volume and improve patient-reported outcomes, but this type of trial is subject to bias. Systematic reviews (SRs) of randomized controlled trials (RCTs) provide the highest evidentiary strength for examining the impact of a therapeutic intervention and are important for evidence-based clinical practice guidelines. Few existing SRs, however, include recent RCTs and only a smaller number address LED of the lower extremities (LELED). Therefore, we conducted a SR based on PICO questions to identify RCTs that examined the effect of IPC on LELED for a clinical practice guideline.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;For this SR, English-language RCTs in CINAHL, Embase, and MEDLINE published between January 1, 2010, and January 31, 2025, were searched and the PRISMA reporting method was used. Both intragroup and intergroup comparisons of the specified outcome measures were examined for statistical significance. The evidentiary quality of the RCTs and risk of bias were assessed using GRADE and the Cochrane risk of bias tool, respectively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In the PRISMA analysis, 141 articles were identified through a search of the databases and an additional 4 articles were discovered through other sources, for a total of 145 eligible RCTs. Twenty-one RCTs addressed upper extremity LED and seven LELED RCTs met the criteria for inclusion: adults ≥18 years with unilateral or bilateral chronic LELED and present for ≥6 months and in the maintenance phase of treatment. The patient must have an ankle-brachial index of ≥0.8, have no active infection or acute venous thrombosis, and be able to use the study device and comply with daily therapy. The average total number of patients per RCT was 54, and the mean patient age was 55 years. Female gender predominated (67%). The majority of RCTs were composed of secondary LED, but three series included a segment of primary LED. Chronic venous insufficiency was the most common etiology in the seven RCTs. Five RCTs had two arms, and two had three arms. The experimental arm used an advanced pneumatic compression device in five RCTs, but complex decongestive therapy was combined in this arm with IPC in three. The control comparator arm was complex decongestive therapy in three, a simple IPC in one, and an advanced pneumatic compression device using a different mode in another. Circumferential measurement of limb girth by tape was the most common method to determine volume changes. Five of seven RCTs used a daily treatment regimen, with four using twice daily sessions. Study length varied with 4 weeks in three, 5 weeks in one, and 8 months in another. An a priori power calculation was carried out in three of the seven RCTs. Reduced limb volume was the outcome measure used in all seven studies and all seven showed statistically significant reductions in limb volume when com","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":" ","pages":"102500"},"PeriodicalIF":2.8,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147717145","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}