Superficial vein thrombosis (SVT) is a common vascular pathology that may progress to deep vein thrombosis (DVT) and pulmonary embolism (PE), posing a potential threat to patients' lives. Although current clinical guidelines emphasize conservative management, modern minimally invasive surgical techniques, including endovenous laser ablation (EVLA), are increasingly used and may offer improved outcomes in selected patients. We report the case of a female patient presenting with acute SVT of varicose tributaries of the great saphenous vein (GSV). Duplex ultrasound revealed thrombosis of a dilated tributary with valve incompetence of the GSV. The patient underwent EVLA of the GSV using a 1940-nm radial fiber combined with phlebocentesis of the thrombosed tributary. Early postoperative duplex imaging confirmed complete obliteration of the GSV with preserved patency of deep veins. Clinically, rapid regression of pain, hyperemia, and edema was observed, and the patient recovered without complications. This case highlights the potential benefits of minimally invasive treatment in SVT associated with varicose veins, particularly in the presence of reflux and when thrombotic masses extend near the saphenofemoral junction. EVLA may acceler-ate symptom resolution, reduce inflammation, and decrease recurrence risk compared with conventional treatment. Further research is needed to evaluate long-term outcomes and define optimal patient selection criteria.
BACKGROUND: COVID-19 represents one of the most significant medical challenges in recent years, with thrombotic events being among its most severe manifestations. This study aimed to evaluate the evolution of acute and subacute deep vein thrombosis of the lower limbs in patients with and without COVID-19. METHODS: This retrospective cohort study evaluated 200 consecutive patients diagnosed with acute and subacute deep vein thrombosis of the lower extremities in 2019 (pre-COVID-19 control group) and 200 patients with COVID-19 and the same diagnosis between 2020 and 2021. The primary sites of lower limb venous thrombotic events and demographic and clinical characteristics (sex, age, clinical presentation, and time to diagnosis) were compared between the two groups. The study was approved by the research ethics committee. The data were entered into an Excel spreadsheet and statistical analysis was performed. RESULTS: Statistically significant differences were found in patients infected with COVID-19 presenting with acute deep vein thrombosis. These were associated with male sex, COVID-19-related hospitalization, bilateral lower limb involvement, and the absence of suggestive clinical signs on physical examination, with a predominance of distal deep vein thrombosis and isolated thrombosis of the soleus veins. CONCLUSIONS: A significant shift in the characteristics of lower limb venous thrombosis was observed during the COVID-19 pandemic compared to the pre-pandemic period. In COVID-19 patients, thrombotic events were more frequently bilateral, distal, and involved muscle veins, particularly in the soleus. These cases were predominantly found in male and hospitalized individuals and often lacked suggestive clinical signs on physical examination.
BACKGROUND: The VEINSTEP study aimed to evaluate the effectiveness of conservative treatment in reducing chronic venous disease (CVD) symptoms, signs, and improving quality of life in real-world settings METHODS: The study enrolled 6236 adult outpatients globally, including 496 (8%) from Ukraine, seeking treatment for symptomatic CVD and receiving conservative therapy in routine practice. Symptom severity was measured using a 10-cm Visual Analog Scale (VAS, 4-point scale) and Patient Global Impression of Change (PGIC); signs were assessed with the Venous Clinical Severity Score (VCSS). Quality of life was estimated using the 14-item Chronic Venous Insufficiency Questionnaire (CIVIQ-14). Follow-up visits occurred at weeks 2 and 4, with an optional visit at week 8. RESULTS: The analysis included 485 participants from Ukraine (62% female), aged 52.1 +/- 14.1 years, with a BMI of 27.5 +/- 4.6 kg/m(2). The predominant CEAP classifications were C1 (15.5%), C2 (44.3%), and C3 (21.6%). Conservative therapy primarily comprised oral venoactive drugs (VADs, 97.5% of subjects), mainly micronized purified flavonoid fraction (MPFF, 81.8%), compression (79.8%), and topicals (40.0%). Conservative treatment, particularly MPFF, significantly improved global symptoms (pain, leg heaviness, cramps, swelling sensation), with 76.5% of patients reporting improvement by week 2 and 95% of patients reporting improvement by week 4. There was a notable reduction in global symptom severity (VAS) between weeks 0 and 4:-1.64 +/- 1.31 (P<0.001). Patients receiving MPFF-based therapy reported significant improvement in quality of life at V2 compared to V0 (P<0.001). CONCLUSIONS: This analysis from the Ukrainian VEIN STEP cohort highlights the high prevalence of CVD and frequent lack of prior treatment. Conservative management with MPFF and compression improved symptoms and quality of life. Diagnostics relied mainly on clinical assessment. Updated CEAP C3 criteria are needed for better edema differentiation.
BACKGROUND: Cryosclerosis is a safe, effective, and low-complication technique for the treatment of stage C1 chronic venous insufficiency (CVI) but is not widely used, possibly due to limited published literature. We present the benefits of the technique based on our experience of over three decades. METHODS: In this article we describe the physical and biological phenomena that govern the functioning of the technique. Furthermore, we describe the optimal equipment needed to perform it. RESULTS: The cooling, chemical and osmotic actions of cryosclerosis have a combined effect that have produced excellent results and patient satisfaction. It has the advantage of requiring small doses of sclerosant, which decreases the chance of systemic allergic reactions, or hematuria. CONCLUSIONS: We have presented our experience with the procedure, developed over three decades of use. Provided that the appropriate sclerosant is used and that an ideal temperature is maintained throughout the procedure, the technique is effective and safe. We therefore emphasize the importance of using a cryosyringe, which cools chromated glycerin to temperatures of-45 to-50 degrees C and maintains it cool for 30 minutes.
BACKGROUND: The treatment of deep vein thrombosis (DVT) has significantly advanced in recent years, with direct oral anticoagulants (DOACs), such as rivaroxaban, showing efficacy and safety in managing this condition. This prospective study aimed to evaluate the clinical effectiveness of rivaroxaban in patients diagnosed with DVT, focusing on clinical improvement, thrombus recanalization, and valve function preservation. METHODS: A cohort of patients diagnosed with proximal and distal DVT was treated with rivaroxaban in an outpatient setting. Clinical outcomes, including pain relief, reduction of edema, thrombus recanalization, and valve function preservation, were assessed at two and six months. Data were analyzed in the context of the COVID-19 pandemic, which influenced treatment modalities. RESULTS: A total of 62% of the patients were women, with a median age of 53 years. A rapid clinical improvement was observed, with 91% of patients experiencing relief from pain and heaviness within 72 hours. Patients with distal DVT showed a faster reduction in edema compared to those with proximal DVT. Recanalization rates at two months were 41% for proximal DVT and 21% for distal DVT, with total recanalization observed in 29% of distal cases. Notably, 82% of patients with distal DVT preserved valve function. The most common adverse events were mild gastrointestinal bleeding, mostly attributed to hemorrhoids, which were managed with temporary suspension of rivaroxaban. CONCLUSIONS: Rivaroxaban proved to be an effective and safe treatment for DVT, leading to significant clinical improvement, thrombus re-canalization, and preservation of valve function. These findings support rivaroxaban as a preferred therapeutic option, especially in the outpatient setting, and align with existing evidence in the field. (Cite this article as: Rios JR. Rivaroxaban in deep vein thrombosis: an analysis of results in a clinical case series. Acta Phlebol 2026;27:20-5. DOI: 10.23736/S1593-232X.25.00665-4)
BACKGROUND: In sclerotherapy of C1 disease, the volume of sclerosant might reflect the volume of the diseased veins in skin and subcutaneous levels. A cross sectional study was carried out. METHODS: From July 2023 to September 2024, sclerotherapy efficacy for treatment of C1 disease was studied according to percent decrease of sclerosant volume needed to perform two timely scheduled sessions. Inclusion criteria were every non-pregnant and non-lactating female with C1 disease, normal duplex scan and no vein intervention within the last year. Treatment of total limb was performed by injecting all visible veins and their feeders after taking pre-pictures in different views in standing position with standardized camera and light conditions. Volume of sclerosant was recorded as number of ampoules needed to run the first session. The second session was scheduled 4 months, post pictures, patient satisfaction score out of 100% was taken, the second sclerotherapy session was performed, and the percent decrease in ampoule number was assessed in comparison to the first session. Coded files of pre and post pictures were sent to an independent expert for efficacy assessment out of 100%. Ethical approval was granted. RESULTS: Ninety limbs from 50 patients were studied. Mean time between first and second sessions was 140.77 +/- 60.01 days. Mean patient satisfaction score was 71.92 +/- 21.66%. Mean expert opinion improvement score was 89.70 +/- 5.08%. Percent decrease of sclerosant volume was only 31.79%. CONCLUSIONS: For C1 disease, relying on visual tools to assess efficacy of sclerotherapy sessions might be misleading with a high volume of subcutaneous non-visible residuals and feeders.
BACKGROUND: Fibroadipose vascular anomaly (FAVA), is a recently described entity in the nomenclature of vascular malformations. It is described as an atypical venous malformation which has a significant component of pain and frequently involve the extremities, especially lower limbs. Ultrasonography and MRI play an important role in the diagnosis. Treatment modalities include sclerotherapy, intralesional steroids and alcohol injection, cryo-ablation, and open surgical resection. The aim of this study was to understand the clinical, radiological and histopathology features of the FAVA and to assess the outcome. METHODS: A retrospective study of patients diagnosed with FAVA from August 2016 to December 2023 were included in our study. The clinical, radiological, pathological data, procedures performed, and the outcomes were analyzed. Patients were followed up for minimum of 6 months clinically and with ultrasound if recurrence was suspected. RESULTS: A total of 40 patients biopsy proven were included. The gender distribution was almost equal in number and the age was ranging from 6 years to 63 years. All patients presented with pain and swelling. The lower limbs were involved in 33/40 cases, and upper limb involvement was seen in 7 cases. In the lower limbs, the posterior compartment muscles were predominantly involved (10/40). The overlying skin was involved in two cases. Sclerotherapy was given in 13/40 cases, of these 10 patients subsequently underwent surgical resection as symptoms were persistent. A total of 23 patients underwent surgical resection. No recurrence was noted in the cohort. CONCLUSIONS: FAVA, though recently diagnosed has evolved rapidly and is no longer a rare entity. To our knowledge this is the largest case series reported in English literature. It is best managed in a multi-disciplinary approach involving vascular surgery, diagnostic radiology, interventional radiology, pathology and occupational therapy. Surgical excision appears to be the best form of treatment. In summary, a proper diagnosis based on clinical findings and imaging is crucial which must be followed by appropriate management will improve the outcome. Recent advances like targeting mTOR pathways seem worth exploring.
BACKGROUND: Superficial venous thrombosis is a common disease and includes the formation of thrombotic masses in the system of superficial veins, and this can occur both with the development of an inflammatory process in the surrounding tissues and without it. The aim of our study was to analyze our own results regarding the use of minimally invasive surgical methods in the treatment of patients with superficial vein thrombosis. METHODS: The contingent of the study consisted of 78 patients who were being treated for the period from 2021 to 2024. The first group, numbering 15 people, included patients who underwent conservative treatment of superficial vein thrombosis using anticoagulant therapy in accordance with current clinical protocols and guidelines. The second group, numbering 63 people, included patients who underwent modern minimally invasive surgical techniques for SVT. RESULTS: An important result of our study is the confirmation that no thromboembolic complications were detected in the postoperative period in patients who received conservative anticoagulant therapy and in patients who underwent minimally invasive surgery. Patients who underwent minimally invasive surgery had not only a significantly shorter average duration of treatment (2.1 +/- 2.6 vs. 4.9 +/- 7.2 days, P<0.01), but also a significantly shorter maximum duration inpatient treatment (17 versus 30 days). CONCLUSIONS: The risk of thromboembolic complications in the group of surgical treatment using modern minimally invasive techniques when the thrombotic process spread more than 3 cm from the sapheno-femoral joint and conservative treatment does not differ in both groups of patients, which indicates the effectiveness and safety of surgical minimally invasive approaches. At the same time, the use of surgical treatment methods in this group of patients makes it possible to reduce the length of stay of patients in the hospital and the duration of anticoagulant therapy.
BACKGROUND: Photography has been playing an important role in clinical practice and its use is widespread in specialties such as dermatology and plastic surgery, although it has been extended to more specialties, but, in vascular surgery there are few articles that address this topic. It is increasingly common to receive and share photographs on social networks for academic, and sometimes non-academic, purposes, this generates ethical and legal challenges that we often ignore. The aim was evaluate, by means of a survey, aspects related to the taking, storage and use of medical photography among vascular disease specialists in Latin America, and the gaps in practice. METHODS: A Google Forms (R) survey was conducted and disseminated via WhatsApp (R) to several Latin-American vascular surgery and angiology association chat rooms. RESULTS: A total of 163 valid responses were collected, 44.8% took pictures of their patients most of the time and 86.5% do so with their cell phone, being this (42.3%) and the personal computer (28.2%) the preferred methods for storage. 85.9% ask their patient for permission to take photographs but only 26.4% use written informed consents. CONCLUSIONS: Among the respondents, informality in the practice surrounding the acquisition and storage of clinical photographs is common. It is important to design protocols that are adapted to the laws of each country and to the principles of medical ethics, in order to protect the information, the doctor and the patient.
Phlebolymphatic stasis is a pathological condition characterized by a slowing or obstruction of the normal flow of venous blood and lymph in the lower limbs. This phenomenon can originate from dysfunctions of the venous circulation or the lymphatic system, or from an interaction of both, and represents a very widespread problem that can lead to a series of significant clinical complications. Several trials and reviews have suggested how venoactive drugs have significant beneficial effects on edema and may have benefits on some other signs and symptoms of CVD compared to placebo. Various substances with phlebotonic, vasoactive, antioxidant and anti-inflammatory action have been used in the treatment of this condition. Among those that have demonstrated greater efficacy and safety bioflavonoids and coumarin were included. We report three clinical cases of phlebolymphatic stasis complicated by cellulite treated with a combination of Bioflavonoids and Coumarin and topical applications of Micronized Zinc Oxide. The synergistic effects of these molecules could be of great help in the treatment of this condition, as also reported in the clinical cases presented.
A constant grow in artificial intelligence (AI) use has been proposed in the different professional fields, including medicine. Although currently performing just in a narrow specialized mode and conducting its activity in a manner diverse from the human thinking, at present, AI is already demonstrating a powerful analytic-synthetic capacity, which in some respects surpasses human capabilities, especially once unstructured real time Big Data streams are explored. However, there is a crucial uncertainty related to the accuracy and precision of diagnostics and treatment plans generated autonomously by AI, and related potential major issues in the patients' population exposed to the phenomenon. These issues need special attention in the very demanding framework of medicine because any AI generated bias may affect human health and wellbeing, while fostering the commercial interests of technology companies. concept reviews reliable prospective and retrospective methods to investigate outcomes generated autonomously by AI. The prospective mode refers to conducting large scale triple-blind studies, in line with the approach from the validated double-blind trial protocols regarding the introduction of new pharmaceutical products. At the same time, our retrospective test proposal describes an opportunity that any clinician or clinical team may independently deploy to test AI's autonomous informational production. Importantly, both methods are universal for any type of medical AI no matter whether it is based on Computer Vision, Natural Language Processing, AI intermodal performance, etc. Moreover, both suggested modes of testing do not violate any ethical code, due to being 100% non-risky for patients, because in both cases of the proposed experimentation, patients receive traditional, entirely human-provided health care. Finally, the standardization and reproducibility of the assessment methodology provide the possibility of large-scale meta-analysis on the topic.
BACKGROUND: The maneuver is useful to increase the result of ultrasound guided foam sclerotherapy for large varicosities. It consists of performing vigorous rubbing on the skin overlying the varicosities selectively, using the knuckles of the fingers of the right hand. Baraldi's Maneuver causes locally an initial and progressive increase in the pain evoked on the patient which favors increasing and complete action/adhesion of the sclerosing agent on the venous endothelium, partially damaged by the physical trauma. This is significant because this new maneuver allows treatment of varicose veins of long extension in a single time, reducing the impact to the patient. This study assessed the outcomes and impact on the Baraldi's maneuver following one-step outpatient ultrasound guided foam sclerotherapy (UGFS) for large varicosities of tributary saphenous veins and extrasaphenous veins. METHODS: The study is retrospective on 1800 symptomatic patients (1083 women, 717 men) having reflux in the saphenous tributaries varicosities (CEAP C3 to C6) and extrasaphenous veins were treated with UGFS (with Polidocanol 0.5-1.0%), in a single-step procedure, from September 2015 to December 2023. The patients were divided into two homogeneous groups: the first group (A) treated with UGFS and Baraldi's Maneuver, the second group (B) treated with UGFS without any maneuver. All patients were treated by UGFS of the varicose veins at the thigh and leg by practicing Baraldi's Maneuver, which consists of performing vigorous rubbing on the skin overlying the varicosities selectively, using the knuckles of the fingers of the right hand. Baraldi's maneuver causes locally an initial and progressive increase in the pain evoked on the patient which favors increasing and complete action/adhesion of the sclerosing agent on the venous endothelium. Selective compression, which is done using spiral-curled cotton gauze, was performed after US check, after treatment and each patient remained in the clinostatic position for at least ten minutes. All 1800 patients were followed up at 1 week, 1, 3, 6 months and 1 year. Clinical outcomes, changes in the quality of life (QoL) questionnaires, Venous Clinical Severity Score (VCSS) and Aberdeen Varicose Vein Questionnaire (AVVQ), evolutive vein occlusion rates were assessed by duplex ultrasound. RESULTS: In both groups, the diameter of the treated vessels ranged from 7-12 mm. Baraldi's Maneuver from the study performed is effective on all patients, immediately promoting obliteration of the vessel, allowing to have better sclerofoam action/adhesion determining mechanical damage, added to chemical damage, evidenced at the ultrasound check performed immediately after the maneuver itself and prior to selective compression. No major adverse event was observed, and the postoperative minor adverse event rates were similar between the two groups. A significant improvement was observed in VCSS and AVVQ from the preoperative levels to the third month, six months and one-year follow-up. The entire sample had a significant increase in all groups but in group A the overall first week occlusion rate was 97.9% and 96.7% at the 1-year follow-up. Group B differently showed from the first week an occlusion rate of 80,1% and 77.9% at 1-year follow-up. No skin complications such as burning or eschar occurred on all patients; only 2 patients of group A and 3 of group B required evacuation of an endovascular thrombus at the first postoperative checkup. Inflammatory-based hyperpigmentation (dermatitis) occurred on only 12 patients, four on group A, eight on group B). CONCLUSIONS: Exclusively outpatient, Baraldi's maneuver from the study performed is safe and feasible with no major adverse events, despite the large diameters of the veins treated; indeed, particularly in the group A the Baraldi's maneuver is effective on all patients, immediately promoting obliteration of the vessel, checked by US. Within 1 year, it showed an improvement in all QoL parameters and satisfactory veins occlusion.
BACKGROUND: Deep vein thrombosis (DVT) is a frequent complication after total hip and knee arthroplasty. Graduated compression stockings (GCS) are commonly used to reduce this risk, but adherence and comfort can limit effectiveness. METHODS: This retrospective study evaluated the efficacy and tolerability of a novel GCS featuring a silicone-based soft-touch self-supporting system in a retrospective cohort of 250 patients undergoing hip or knee arthroplasty between January and December 2024. All patients received standard pharmacologic prophylaxis and wore the novel GCS. Color Doppler ultrasound was used on postoperative days 5 and 30 to detect DVT. Statistical analysis of obtained data was performed. RESULTS: No symptomatic DVTs were observed; asymptomatic DVT occurred in five patients (2.0%). Compliance was high (93.6%), with no skin irritation or slippage reported. Patients rated comfort highly (mean score 7.7/10). CONCLUSIONS: The innovative GCS with silicone support was safe, well-tolerated, and effective in DVT prevention. Further controlled studies are warranted.
BACKGROUND: The aim of this study was to assess the technical and clinical outcomes of endovascular treatment of hemorrhoids with foam sclerotherapy (EndoTHeF) in patients diagnosed with hemorrhoids of grades I-IV, using an Automated Microfoam Preparation System (AMPS, Varixio (R), VB Devices, Barcelona, Spain). METHODS: A retrospective analysis was conducted, recruiting patients who underwent EndoTHeF with AMPS between May 2008 and May 2024. Sclerotherapy treatment followed international recommendations. The primary endpoint was hemorrhoidal prolapse or bleeding during the follow-up. RESULTS: Two hundred eighteen patients treated with AMPS were included (23.9%, 41.7%, 33.9% and 0.5% with grade I, II, III and IV, respectively). More than half of the patients (54.6%) experienced proctorrhagia. Each patient received an average of 2 foam injection during the procedure. No major complications occurred, with 100% complete intraoperative exclusion of hemorrhoids. The mean follow-up duration was 25 +/- 3 months. The recurrent hemorrhoidal prolapse or bleeding rate was 1.7%, 5.6%, 10.2%, and 20.0% at 6, 12, 24 and 36 months after the treatment, respectively. Grades I and II had lower hemorrhoidal relapse rates compared with Grades III and IV. CONCLUSIONS: The AMPS showed acceptable results when used for EndoTHeF, achieving optimal foam standardization and both operative and follow-up outcomes.
