Availability of a Suitable Single-Segment Great Saphenous Vein in Patients with Severe Peripheral Arterial Disease.

BackgroundEndothermal ablation (ETA) is a well-established treatment for chronic venous insufficiency (CVI). However, its effectiveness in patients with concomitant lipedema remains poorly described. Given the distinct pathophysiological features and symptom burden of lipedema, outcomes may differ in this subgroup.MethodsWe conducted a prospective cohort study of patients with CVI alone and those with CVI plus lipedema. All patients underwent ETA, with adjunctive phlebectomies as indicated. Quality of life (QoL) was assessed using the EQ-5D-VAS and CIVIQ-20 questionnaires before surgery and at 3 months postoperatively. Demographic and clinical variables included age, body mass index (BMI), waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), and symptom profile. The primary outcome was the change in CIVIQ-20 score at 3 months. Secondary outcomes included changes in EQ-5D-VAS and postoperative complications (hematoma, paresthesia, superficial and deep vein thrombosis).ResultsA total of 48 patients were included (32 with CVI alone, 16 with CVI and lipedema). Preoperative QoL impairment was significantly greater in the lipedema cohort (median CIVIQ-20: 61.0 [49.5-69.5]) compared with CVI alone (46.0 [33.0-56.0], p = .001). At 3 months, both groups demonstrated significant improvement (p < .001 for within-group change). However, the magnitude of improvement was greater in CVI alone (median reduction: -13.5 [-19.5 to -5.0]) than in CVI plus lipedema (-4.0 [-7.0 to -1.5]; p = .012). Multivariable regression identified higher baseline CIVIQ-20 (β = 0.60; SE = 0.09; p < .001) and lipedema status (β = 12.44; SE = 2.43; p < .001) as independent predictors of poorer postoperative CIVIQ-20 outcomes. Paresthesia was more frequent in lipedema patients (25.0% vs 18.8% at 1 month; 12.5% vs 6.2% at 3 months).ConclusionWhile ETA significantly improves QoL in patients with CVI, those with concomitant lipedema experience smaller gains and a higher rate of postoperative paresthesia. These findings highlight the importance of setting realistic expectations and counseling lipedema patients regarding potential outcomes of venous interventions.

Objective: To determine the frequency of different causes of inherited thrombophilia and evaluate clinical presentations in patients presenting with documented venous or arterial thrombosis. Study Design: Cross-sectional study. Place and Duration of Study: Armed Forces Institute of Pathology Rawalpindi, Pakistan from Jan to Jun 2022. Methodology: One hundred and seven patients who fulfilled the selection criteria and gave informed consent in written form were enrolled. Clinical presentations were noted down and patients were assessed for inherited thrombophilia. Polymerase chain reaction was used for the detection of factor V Leiden mutation and prothrombin gene mutation. Pro C global clotting based screening test was used to determine the anticoagulatory capacity of protein C and S. Quantitative determination of the functional activity of antithrombin was performed on CS5100 automated coagulation analyzer. Results: The mean age of the patients was 29.31±14.17 years. Inherited thrombophilia was present in 26(24.3%) patients. Factor V Leiden mutation was present in 14(53.8%), antithrombin deficiency in 6(23.1%), protein C deficiency in 3(11.5%), protein S deficiency in 2(7.7%) and prothrombin gene mutation in 1(3.9%) patient. Commonest clinical presentation was deep venous thrombosis in 10(38.5%) patients followed by pulmonary embolism in 5(19.2%), portal vein thrombosis in 3(11.5%), superficial venous thrombosis in 3(11.5%). Conclusion: The commonest inherited cause of thrombophilia was factor V Leiden mutation and the commonest presenting complaint was deep venous thrombosis.

Background. Recurrent varicose vein disease (RVVD) remains a frequent problem after surgery or endovenous ablation (≈13-65 %). Mechanisms include residual reflux, de novo varicosities, and neovascularization. When RVVD is complicated by superficial vein thrombosis (SVT), treatment becomes challenging because current guidelines focus mainly on anticoagulation and rarely address reflux correction. Aim. To evaluate the feasibility, safety, and effectiveness of combined minimally invasive therapy for RVVD complicated by SVT. Materials and Methods. This single-center cohort included 31 patients (24 women, 7 men; mean age 55±13 years) with duplex-verified SVT and RVVD (CEAP C2r–C6r) treated between 2013 and 2025. Interventions comprised endovenous laser or radiofrequency ablation (EVLA/RFA), ultrasound-guided foam sclerotherapy (UGFS), and miniphlebectomy (MF), individually or in combination. Short-term rivaroxaban (15-20 mg/day for 20-45 days) was prescribed for SVT. Primary endpoints: segment occlusion, reflux elimination, thrombus regression, recurrence, and complications (EHIT/DVT/PE). Secondary endpoints: changes in VCSS, CIVIQ-14, VDS, and VDSS. Results. Great saphenous vein (GSV) reflux occurred in 20 (65 %) patients, small saphenous vein (SSV) reflux in 15 (48 %) patients, and perforator incompetence in 23 (74 %). Neovascularization at the SFJ/SPJ was detected in 10 (32 %), confirming true recurrence. EVLA was performed in 29/31 patients, usually with UGFS ± MF. Clinical improvement was significant: mean VCSS decreased from 5.5 to 2.1, and CIVIQ-14 from 35.2 to 22.2 (p&lt;0.001). No EHIT ≥ II, DVT, or PE occurred. Duplex confirmed thrombus regression in 94 % of cases. Conclusions. Combined minimally invasive treatment (EVLA/RFA + UGF±MF) is a feasible, safe, and effective option for RVVD complicated by SVT. This reflux-directed, office-based approach ensures durable anatomic success, rapid recovery, and meaningful quality-of-life improvement.

Upper extremity venous thrombosis (UEVT), encompassing upper extremity deep vein thrombosis (UEDVT) and superficial vein thrombosis (UESVT), is increasingly recognized due to invasive procedures and advanced diagnostics. This study characterizes the 5-year outcomes and etiological factors of UEVT in a large cohort. We conducted a retrospective cohort study of 304 consecutive adult patients with acute UEVT (2019-2025) at a tertiary care center in Türkiye. Demographics, medical history, thrombosis characteristics, treatments, and outcomes-including thrombosis resolution, pulmonary embolism, and mortality-were analyzed. Statistical analyses were performed using chi-square tests, multivariate logistic regression, and random forest models. Among the 304 patients, 4 (1.32%) had primary UEDVT, 115 (37.8%) had secondary UEDVT, 112 (36.8%) had nonfistula UESVT, and 73 (24.0%) had fistula-related UESVT. UEDVT was associated with malignancy (38.3%, n = 44), central venous catheters (25.2%, n = 29), rheumatologic disorders (n = 15), and coagulopathies (n = 10). Nonfistula UESVT was linked to local factors (e.g., IV contrast, n = 14; IV drug use, n = 12), with no pulmonary embolism (PE) or mortality. Fistula-related UESVT had a 1.4% PE and mortality rate. UEDVT showed higher PE (29.6% vs. 1.1%, p < 0.001) and mortality (23.5% vs. 0.5%, p < 0.001) than UESVT. Multivariate analysis identified UEDVT (OR = 36.50, 95% CI: 8.58%-155.31%), cancer (OR = 2.80), and heart failure (OR = 3.15) as PE predictors, while UEDVT (OR = 58.76), cancer (OR = 9.50), and age (OR = 1.05) were predictors of mortality (all p < 0.05). UEDVT, driven by systemic factors, carries a higher risk of PE and mortality than UESVT, influenced by local factors. Thorough etiological evaluation and tailored interventions (e.g., catheter removal, multidisciplinary management) are critical to mitigate complications.

Pain Unmasked: Revealing the Impact of Superficial Vein Thrombosis on Daily Life.

Possibilities of using active surgical tactics in the treatment of patients with cvd of the lower extremities complicated by superficial vein thrombosis

Impact of skull base cisterns invasion and extent of resection on the management of skull base intracranial epidermoid tumors.

Proximal tumescence during treatment of saphenous veins with polidocanol endovenous microfoam provides successful ablation of larger veins and predicts reduced microfoam volume

Mondor’s disease is a rare condition (less than 400 cases in literature) characterized by superficial thrombophlebitis of thoracoabdominal veins. It typically presents with pain and a cord-like induration of the chest wall. The pathophysiology of Mondor Disease is incompletely understood. Risk factors: trauma, breast cancer, infectious disease, coagulopathies or idiopathic forms can play a role.

An international multi-disciplinary initiative resulted in the development of 2023 ACR/EULAR Antiphospholipid Syndrome (APS) Classification Criteria to identify patients with high likelihood of APS for research. Phase I/II resulted in 27 candidate criteria organized into six clinical and laboratory domains. Here, we summarize early Phase III efforts to better define and structure candidate criteria within clinical and laboratory domains. Using comprehensive literature reviews and expert consensus, domain subcommittees developed definitions for candidate criteria. Prevalence information was incorporated when available. Definitions were finalized and approved by the Steering Committee for future use during real-world case collection (derivation cohort), multi-criteria decision analysis, and validation. Clinical domain items defined were: (a) macrovascular thrombosis (venous thromboembolism including superficial venous thrombosis, arterial thrombosis, and transient ischemic attack) and associated provoking risk factors; (b) microvascular disease (livedo racemosa, livedoid vasculopathy, antiphospholipid-antibody-nephropathy, diffuse alveolar hemorrhage, cardiac microthrombosis, adrenal hemorrhage, and acute ischemic encephalopathy); (c) pregnancy morbidity (pre-fetal death, fetal death, and pre-eclampsia and placental insufficiency with severe features); (d) cardiac valve disease (thickening or vegetation); and (e) thrombocytopenia. Laboratory domain items defined were coagulation-based functional assay (lupus anticoagulant) and solid phase-based assays (anticardiolipin antibody IgG/M and anti-β2-Glycoportein-I antibody IgG/M). Based on comprehensive literature review and Steering Committee consensus, we defined and structured APS clinical and laboratory domains. Preliminary definitions were subsequently evaluated and confirmed in late Phase III using the derivation cohort and multicriteria decision analysis prior to validation the 2023 ACR/EULAR APS Classification Criteria.

According to international and Russian guidelines, superficial vein thrombosis treatment should be comprehensive and include systemic drug therapy (i.e. anticoagulant therapy), elastic compression and topical preparations. At the same time, local preparations can be self-administered, if the length of blocked portion of the vein is short and a risk of clot breaking off and travelling to the deep veins is low. The effectiveness of topical preparations has been proven to depend, among other things, on the dosage forms, and gels are characterized by more effective transdermal delivery as compared to ointments. Also, the efficacy of the active substance is affected not only by its initial concentration in the drug, but also by the extent to which the concentration is maintained after penetration into the dermis and hypodermis. The current local therapy for superficial vein thrombosis includes heparin gels and nonsteroidal anti-inflammatory drugs, as well as local cooling. The local drug therapy has an anti-inflammatory and analgesic action, and hypothermia enhances analgetic effects. Reduction in the severity of inflammatory process improves the patients' quality of life and increases their commitment to other complex treatments.

Although arterial inflow considerations dominate microsurgical planning, venous outflow is equally vital for flap survival. Patients requiring free tissue transfer (FTT) for lower extremity (LE) reconstruction frequently present with occult preoperative venous thrombosis (VT), yet there are little data guiding perioperative management in this setting. This study examines the prevalence and clinical characteristics of patients with preoperative venous thrombosis (VT) undergoing LE FTT, as well as postoperative outcomes, to evaluate the feasibility of successful microsurgery in this high-risk cohort.A retrospective review of patients with preoperative VT undergoing LE FTT at a single institution was conducted.Among 279 patients, 43 (15.4%) were positive for VT. The overall deep VT (DVT) incidence in this population was 5.7% (n = 16/279) and the superficial VT (SVT) incidence was 10.0% (n = 28/279). Most thromboses were chronic (67.8%). There were two cases of takeback (4.7%) due to thrombosis (one arterial and one venous), of which one flap was salvaged. By a median follow-up duration of 9.7 months, a limb salvage rate of 88.4% was achieved.Preoperative VT is common in microsurgical candidates for limb salvage; however, it is not a contraindication to FTT if proper adjustments are made perioperatively. Considerations include (1) routine use of venous ultrasound to identify VT; (2) perioperative anticoagulation management, including IVC filter placement when indicated; (3) selection of recipient veins that are unaffected by VT; (4) prioritizing the use of two deep veins for anastomosis when feasible; and (5) incorporating implantable devices to monitor venous outflow.

Objectives: The aim of this study was to evaluate the level of knowledge of obstetricians and gynecologists about deep vein thrombosis (DVT) in pregnancy. Methods: A cross-sectional questionnaire comprising 12 items was administered to obstetricians and gynecologists employed at a tertiary care hospital between January 2024 and March 2024. Following a reliability analysis, a DVT questionnaire scale was developed, which was subsequently evaluated across three sub-dimensions: (1) General Disease Knowledge (F1), (2) Medical Treatment Knowledge (General) (F2), and (3) Anticoagulant Knowledge Level (F3). Results: A total of 163 participants were evaluated in the study, with a mean age of 32.33±5.75 years. Among these individuals, 107 (65.6%) were female and 56 (34.3%) were male. Additionally, 72 (44.2%) of the participants were classified as resident physicians. The scores for the sub-dimensions of the DVT scale were as follows: 2.25±1.03 for (F1), 1.33±0.72 for (F2), and 2.53±1.09 for (F3). Notably, (F3) of the resident physicians was found to be significantly lower than that of the specialist/faculty member group, with a P-value of less than 0.017. Conclusions: The study demonstrated that the knowledge levels of obstetricians and gynecologists fell below the established proficiency threshold. This deficiency is believed to stem from inadequate understanding of the differentiation between superficial and deep vein thrombosis, the management of anticoagulant therapy during pregnancy, and post-thrombotic syndrome. Enhancing awareness in these areas may improve patient outcomes, reduce reliance on cardiovascular surgery consultations, and alleviate clinical workload.

Paradoxical coronary embolism (CE) causes an estimated 4-13% of ST-segment-elevation myocardial infarction (STEMI) presentations. A thromboembolism can originate in the venous system and cross into systemic circulation via an intracardiac or intrapulmonary shunt, resulting in a variety of clinical presentations. Patent foramen ovale (PFO) is the most common intracardiac shunt, found in nearly 30% of the general population. A 72-year-old male with a history of prior pulmonary embolism and severe degenerative disc disease was admitted to the hospital for elective cervical laminectomy and decompression of C3-T1. His hospital course was complicated by aspiration pneumonia with resultant Streptococcus salivarius bacteremia and new onset atrial fibrillation and spontaneous conversion to sinus rhythm. Transthoracic echocardiogram and subsequent transesophageal echocardiogram after conversion to sinus rhythm demonstrated normal left ventricular systolic function, no evidence of endocarditis nor left atrial appendage thrombus, and a large PFO demonstrating bidirectional shunting. Later, he was noted to have new ST-segment elevations on telemetry, prompting an electrocardiogram which confirmed anterior and lateral ST-segment elevations. Emergent coronary angiography revealed mild coronary artery disease with no evidence of plaque rupture; however, thrombotic occlusions of the distal left anterior descending artery and distal second obtuse marginal artery were most consistent with a thromboembolic event. Bilateral upper and lower extremity duplexes revealed a superficial vein thrombosis in the right cephalic vein. Clinical suspicion was high for paradoxical CE related to his PFO; closure was pursued with transcatheter placement of an occluder device. Paradoxical CE is underdiagnosed, and subsequent evaluation for common culprits should include thrombus of aortic or mitral prosthetic valves, atrial fibrillation, endocarditis, PFO, neoplasm, and hypercoagulable disorders. The incidence of PFO related CE is unknown but suggested to be &lt;4% of STEMI. Current guidelines give conditional recommendations for closure in paradoxical CE, owing to limited literature. As in our case, we would recommend closure of PFO once a paradoxical embolus occurs given risk for recurrent events and data suggesting a higher mortality rate despite lower cardiovascular risk.

Heparin-induced thrombocytopenia after percutaneous coronary intervention complicated by hemothorax and pulmonary thromboembolism: The scylla and charybdis of hematology

Pain and Health Related Quality of Life in Patients with Superficial Vein Thrombosis: A Post Hoc Analysis of the Multicentre INSIGHTS-SVT Study.

Introduction. Previous studies have revealed that measuring thrombus echogenicity could be useful in managing patients with deep vein thrombosis of lower limbs. Our study aimed to analyse the echogenicity of thrombi in subjects with superficial vein thrombosis (SVT) and varicose veins. Materials and methods. Duplex ultrasound was performed in 50 patients with varicose veins and SVT of both the trunk of the great saphenous vein and the subcutaneous tributaries. A series of images of the thrombi from the trunk and varicose tributaries were captured and analyzed in Adobe Photoshop®, CS6.0 (Adobe Systems, USA), and the grey scale median (GSM) thrombus echogenicity was determined using the "lasso tool" and "histogram". Results. Varicose tributary thrombus had a significantly higher echogenicity compared to saphenous trunk thrombus: 69.2±17.2 (95% CI 64.4-74.2) vs. 46.4±14.8 (95% CI 42.2-50.6) GSM units, pless than0.0001. GSM values in varicose branches demonstrated a strong positive correlation (r=0.79 [95%CI 0.65-0.87], pless than0.0001) with the time since the onset of SVT, while the echogenicity of the thrombus in the trunk had only a moderate correlation (r=0.42 [95%CI 0.16-0.63], pless than0.01). In the linear regression model, assessing the dynamics of echogenicity depending on the duration of SVT, the R2 coefficient was three times higher for the tributaries - 0.54 vs. 0.18 for the trunk. Thrombus echogenicity increased with each day from the onset of the disease: by +3.4±0.4 GSM units in tributaries (pless than0.0001) and by +1.7±0.5 GSM units in the trunk (pless than0.01). There were no significant differences in GSM values in patients of different gender, age and body mass. Conclusion. Significantly higher echogenicity of the thrombotic masses in the subcutaneous varicose tributary compared with that of the saphenous thrombus, as well as the strong positive correlation of echogenicity with SVT duration, point to the secondary character of involvement of the superficial vein trunks and centripetal progression of thrombosis.

Intermittent pneumatic compression can reduce the incidence of upper extremity venous thrombosis after peripherally inserted central catheter placement in traumatic brain injury patients: A randomised controlled trial.

Background and Aims: Peripherally inserted central catheters (PICCs) and midline catheters (MCs) are essential for administering intravenous therapies. PICCs, which extend from peripheral veins to the central venous system, are effective for high-volume infusions but are associated with significant complications, including venous thromboembolism (VTE) and catheter-related bloodstream infections. In contrast, MCs (terminating in peripheral veins) could present a different thrombotic risk, although current evidence remains conflicting. This systematic review and meta-analysis was conducted to compare VTE rates between these two devices and clarify their safety profiles. Methods: A systematic literature search was performed across PubMed, Embase, Scopus, Web of Science, and The Cochrane Library following the PRISMA 2020 guidelines. Studies were eligible if they reported VTE outcomes (deep vein thrombosis, superficial venous thrombosis, pulmonary embolism) for both MCs and PICCs in adult patients, with a minimum of 15 catheters per type. Risk of bias was assessed using the Cochrane RoB2 tool for randomized controlled trials and the ROBINS-E tool for non-randomized studies. Subgroup and sensitivity analyses were also performed to explore potential sources of variability. Results: After screening 2878 records, 15 studies were included, encompassing 11,496 MCs and 13,344 PICCs. Among these, 2 were randomized controlled trials and 13 were cohort studies (12 retrospective and 1 prospective). Thrombotic events were observed in 468 MC cases (4.1%) and in 549 PICC cases (4.1%). The random-effects model revealed no significant difference in the risk of venous thromboembolism between MCs and PICCs (OR 1.06; 95% CI 0.81–1.38) (Figure 1). These findings remained consistent after excluding high risk-of-bias studies and in the leave-one-out sensitivity analysis. Subgroup analyses based on ICU setting, placement year, and hospitalization status yielded similar results to the overall analysis. However, when examining placement methods, there was an increased VTE risk for MCs compared to PICCs ECG-guided techniques and echo-guided techniques were used for placement (OR 1.57; 95% CI 1.25–1.97). Moreover, when the analysis has been restricted to catheter related thrombosis (CRT) events only (available in seven studies) we reported a non significant increased risk for MCs compared to PICCs (OR 1.30; 95% 0.88 – 1.82). Overall, the quality of the included studies was moderate to low regarding our outcome of interest. Conclusions: In summary, the overall rates of VTE were similar between MCs and PICCs across most analyzed sub populations. However, when advanced placement techniques were utilized, MCs were associated with an increased risk of VTE. Further high-quality studies are warranted to strengthen these findings.