Gabor Forgo MD , Silvia Cardi MD , Riccardo Fumagalli MD , Tim Sebastian MD , Daniel Périard MD , Stefano Barco MD (Prof) , Nils Kucher MD (Prof) , Rolf P. Engelberger MD
{"title":"Midterm clinical outcomes of mechanical versus rheolytic thrombectomy for iliofemoral or iliocaval deep vein thrombosis","authors":"Gabor Forgo MD , Silvia Cardi MD , Riccardo Fumagalli MD , Tim Sebastian MD , Daniel Périard MD , Stefano Barco MD (Prof) , Nils Kucher MD (Prof) , 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> < .01) and a lower rate of stent placement (70% vs 98%; <em>P</em> < .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}
Arjun Jayaraj MD, Jack Owens BS, Mary Meghan Dickerson BS
{"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, Jack Owens BS, Mary Meghan Dickerson BS","doi":"10.1016/j.jvsv.2026.102445","DOIUrl":"10.1016/j.jvsv.2026.102445","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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 <em>t</em> tests, and regression analysis were used to evaluate the data.</div></div><div><h3>Results</h3><div>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 (<em>r</em> = 0.1-0.3; <em>P</em> > .05), although VSDS had a moderate correlation (<em>r</em> = 0.4; <em>P</em> = .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 (<em>r</em> = 0.4; <em>P</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}
Jackwin Sam Paul MD , Prabhu Premkumar MCh , Sarah Sunil Joseph MPH , Anu Mary Oommen MD , Vinod Joseph Abraham MD
{"title":"Prevalence of chronic venous disorders and its risk factors among rural adults in Tamil Nadu, South India","authors":"Jackwin Sam Paul MD , Prabhu Premkumar MCh , Sarah Sunil Joseph MPH , Anu Mary Oommen MD , 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> < .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}
Yun Sun Lim MBBS , Prajwala S. Prakash MRCSEd , Qiantai Hong FRCSEd , Malcolm Mak FRCSEd , Lawrence Han Hwee Quek FRCR , Uei Pua FRCR , Gavin Lim FRCR , Justin Kwan FRCR , Yi-Wei Wu FRCR , Gabriel Chan FRCR , Glenn Wei Leong Tan FRCSEd , Lester Rhan Chaen Chong FRCSEd , Li Zhang MRCSEd , Enming Yong FRCSEd, MBA
{"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 , Prajwala S. Prakash MRCSEd , Qiantai Hong FRCSEd , Malcolm Mak FRCSEd , Lawrence Han Hwee Quek FRCR , Uei Pua FRCR , Gavin Lim FRCR , Justin Kwan FRCR , Yi-Wei Wu FRCR , Gabriel Chan FRCR , Glenn Wei Leong Tan FRCSEd , Lester Rhan Chaen Chong FRCSEd , Li Zhang MRCSEd , 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 , Takasuke Harada MD , Yuriko Takeuchi MD , Takahiro Mizoguchi MD , Hiroshi Kurazumi MD , Mototsugu Shimokawa MD , 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 <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}
Gregory T. Jones PhD, Kari Clifford PhD, Geraldine B. Hill MSc, Kate N. Thomas PhD, Sarah Lesche MD, Jolanta Krysa MBChB
{"title":"A novel infrared fluorescence method to identify regions of superficial microvenous reflux in patients with chronic venous disease","authors":"Gregory T. Jones PhD, Kari Clifford PhD, Geraldine B. Hill MSc, Kate N. Thomas PhD, Sarah Lesche MD, 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":"Randomized, Open-label Pilot Trial of Clopidogrel vs No Treatment After Iliac Vein Stenting for NIVLs","authors":"Olga Bakayev MD , Iryna Kuzma MD , Enrico Ascher MD , Anil Hingorani MD","doi":"10.1016/j.jvsv.2025.102422","DOIUrl":"10.1016/j.jvsv.2025.102422","url":null,"abstract":"","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"14 2","pages":"Article 102422"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147394104","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":"Events of Interest","authors":"","doi":"10.1016/S2213-333X(26)00013-2","DOIUrl":"10.1016/S2213-333X(26)00013-2","url":null,"abstract":"","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"14 2","pages":"Article 102454"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147394106","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":"Effect of Concomitant Phlebectomy Extent on Outcomes in C2 Disease: A Propensity Score Matching Study","authors":"Kilsoo Yie MD, PhD, Arom Shin MD","doi":"10.1016/j.jvsv.2025.102397","DOIUrl":"10.1016/j.jvsv.2025.102397","url":null,"abstract":"","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"14 2","pages":"Article 102397"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147394779","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}