ObjectiveTo explore the surgical selection of iliac vein balloon angioplasty, as well as the treatment and management of postoperative complications including restenosis and secondary deep venous thrombosis.MethodsAll 55 enrolled patients received routine telephone follow-up, and imaging reexamination and statistical analysis were only performed on 10 patients complicated with restenosis or secondary thrombosis after balloon angioplasty.ConclusionThis study provides reference basis for the selection of clinical surgical schemes and perioperative management of iliac vein balloon angioplasty in the treatment of iliac vein compression syndrome.
ObjectiveTo quantify changes in popliteal vein haemodynamics after 1 hour of sitting and to determine whether a brief seated stretching protocol can improve venous return while maintaining the seated posture.MethodsIn this prospective repeated-measures study, 34 healthy adults aged 18-30 years (19 men, 15 women) underwent bilateral popliteal vein assessment after 60 minutes of sitting and again after completion of a brief seated stretching protocol comprising heel raises and hamstring/calf stretching. B-mode and triplex Doppler ultrasound were used to measure popliteal vein cross-sectional area (CSA) and time-averaged mean velocity (TAMV). Volume flow rate (VFR) was calculated as CSA × TAMV.ResultsFor the whole cohort, CSA did not change significantly (p = 0.175). In contrast, TAMV increased significantly from 2.40 to 4.04 cm/s (+68.3%, p < 0.001), and VFR increased from 0.77 to 1.62 cm3/s (+110.4%, p < 0.001). No significant sex differences were observed in pre-stretching haemodynamic parameters or in post-stretching VFR (p > 0.05). However, post-stretching CSA was significantly higher in men (0.45 vs 0.31 cm2, p = 0.002), whereas post-stretching TAMV was significantly higher in women (4.31 vs 3.65 cm/s, p = 0.015).ConclusionA brief seated stretching protocol significantly improved popliteal venous return after prolonged sitting, primarily through increased blood flow velocity rather than alteration in venous calibre. This simple, equipment-free intervention may represent a practical strategy for reducing sitting-related venous stasis in sedentary settings. Further studies are required to confirm its clinical value in older and at-risk populations.
BackgroundLong-pulsed Nd: YAG 1064 lasers are the standard of care for superficial vein transcutaneous laser treatment. The current concept suggests that the larger the laser spot size, the deeper the penetration into the skin for two reasons: First, wider spot sizes allow the use of higher pulse energy, as energy density (Fluence) decreases exponentially as the beam area widens. Second, the same pulse energy delivered by a smaller beam will be concentrated in the surface owing to the scattering effect. In this study, we examine the effect on skin penetration by changing the spot size of a long-pulsed Nd: YAG 1064 nm laser.Methods100 different skin samples from 5 human dermolipectomy flaps were shot with 3 consecutive long-pulsed Nd: YAG 1064 nm pulses, one of each with a different spot size (3, 5, and 7 mm), while an energy meter was placed underneath to measure energy. In the first 80 samples, the same total energy (10J) was used for all 240 shots. In the last 20 samples, the same energy density (Fluence) of 100 J/cm2 was used in all 60 shots.ResultsNo variations in mean energy across all spot sizes were observed (3 mm = 3.85 ± 0.89 J, 5 mm = 4.15 ± 0.83 J, 7 mm = 3.96 ± 0.73 J, p = 0.072). Regardless of the spot size, the average pulse energy attenuation was 60.1% with a standard deviation of 8.3%. The average fluence attenuation was 52.3% with a standard deviation of 5.7%. A strong correlation was found in the final energy measured in the same area, regardless of the spot size used.ConclusionIn an ex vivo human skin model, varying the spot size of a long-pulsed Nd: YAG 1064 nm laser did not significantly affect energy transmission to the subdermal tissue.
BackgroundClinical frailty is an emerging health problem and a risk factor for venous disease and its adverse outcomes. This review and meta-analysis will determine the association of frailty in the development of venous diseases and related adverse outcomes.Materials and methodsA literature review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searches were done in PubMed and Embase, from 1 January 2007 to 1 January 2025. Articles that were not related to frailty and venous disease were excluded. References from review papers were further screened following the same inclusion and exclusion criteria. R studio was used for the meta-analysis of the studies on non-postoperative venous thromboembolism (VTE) and pulmonary embolism (PE).ResultsA total of 1338 articles were retrieved, and 72 papers, involving 6,407,901 patients, were included in the final review. Sixty-one studies assessed frailty and postoperative complications, and 65% reported that frail patients had a higher risk of postoperative VTE (p < 0.05). Spinal, neurosurgical, abdominal, and orthopaedic patients exhibited the highest rates across surgical specialties. Meta-analysis of six studies demonstrated that frailty was associated with an increased risk of non-postoperative VTE (OR 1.91, 95% CI 1.15-3.18, p = 0.012). Three papers showed that high frailty risk was associated with greater odds of mortality in patients with PE (Pooled OR 9.95, 95% CI 6.32-15.67, p < 0.0001). Of the remaining two studies, one found that frail patients were more likely to have ulcer recurrence than non-frail patients (p < 0.001). The other reported that frail patients had a higher risk of varicose veins than non-frail patients (p = 0.01).ConclusionClinical frailty is associated with an increased risk of VTE and adverse outcomes in venous disease, although the certainty of evidence is limited by substantial heterogeneity and methodological differences among studies.
ObjectiveThis study aimed to investigate central sensitization (CS) in individuals with lipedema using pressure pain threshold measurements and to examine its relationship with clinical features, sonographic findings, body composition, and Central Sensitization Inventory (CSI) scores.MethodsA total of 61 female patients with lipedema and 20 healthy controls were included in this cross-sectional study. Pressure pain threshold (PPT) was assessed at the thigh, pretibial region, and forearm using a manual algometer. Sonographic subcutaneous fat thickness was evaluated, and body composition parameters were assessed using bioelectrical impedance analysis. Clinical outcomes related to CS-including the CSI, Visual Analog Scale (VAS), Lower Extremity Functional Scale (LEFS), Short Form-12 (SF-12), and the Extended Nordic Musculoskeletal Questionnaire (NMQ-E)-were recorded. Linear mixed-effects models were used to compare PPT across groups, anatomical sites, and disease stages. Associations between PPT, CSI scores, body composition parameters, sonographic findings, and clinical measures were evaluated using Pearson correlation analyses.ResultsPatients with lipedema exhibited significantly lower PPT values across all anatomical regions, including the forearm, and significantly higher CSI scores compared with healthy controls (p < .001). Sonographic assessment confirmed increased subcutaneous fat thickness in the lower extremities of lipedema patients. Lipedema stage was not associated with overall PPT levels. However, lower forearm PPT and LEFS scores were observed in more advanced stages. Forearm PPT showed significant negative correlations with lean body mass, body fat mass, and total body water (p < .05), while no other significant associations were identified.ConclusionIndividuals with lipedema demonstrate features consistent with CS, characterized by reduced PPTs in both affected and non-affected regions together with elevated CSI scores. These findings suggest that altered pain processing may contribute to the widespread pain and functional limitations observed in lipedema, highlighting the importance of comprehensive assessment of CS in this population.
Cyanoacrylate adhesive closure (CAC) is a non-thermal, nontumescent option for treating saphenous reflux. This study aimed to develop a formal, evidence-based expert consensus on the use of CAC for the management of varicose veins in India. A modified Delphi consensus process was conducted. A panel of 12 experienced Indian interventional radiologists was convened. Consensus was defined as ≥80% agreement, achieved through anonymized voting and iterative discussions. All 12 panelists (100% participation) achieved a unanimous consensus (100% agreement) with the finalization of 29 consensus statements across eight domains. The consensus delineated the role of CAC across the clinical-etiological-anatomical-pathophysiological classes C2-C6 and in saphenous veins with diameters of 4-20 mm. The consensus provides a standardized procedural algorithm detailing specific steps for adhesive delivery, catheter recapture (recapturing the delivery catheter into the blue introducer sheath while intravascular before removal), and compression. CAC is recommended as an outpatient, non-tumescent day procedure using a 7F short introducer sheath; consequently, it is associated with reduced intra-procedural discomfort and reduced post-treatment bruising compared with thermal ablation. Key recommendations include: postprocedural compression stockings are not mandatory, early ambulation is encouraged, and structured follow-up is advised. The consensus also differentiates phlebitis (pain/erythema, absence of itching) from hypersensitivity (itching) to guide management, advises careful patient selection for shallow veins and operator judgment for large-diameter vessels, suggests considering prophylactic NSAID or antihistamine on a case-by-case basis, and recommends avoiding CAC in patients at high risk for immune-mediated reactions.
PurposeTo prospectively characterize peri-procedural changes in thrombin-antithrombin complex (TAT), plasmin-α2-plasmin inhibitor complex (PIC), fibrin/fibrinogen degradation products (FDP), D-dimer, thrombomodulin (TM), and tissue plasminogen activator-inhibitor complex (t-PAIC) in patients with venous malformations (VMs) undergoing percutaneous sclerotherapy.MethodsThis prospective single-center observational study included 68 patients with VMs and 48 healthy controls. Peripheral venous blood was collected 24 h before treatment, immediately after treatment, and on postoperative days 1-3. Local lesional blood was aspirated through the access needle before contrast or sclerosant injection. Biomarker concentrations were compared using paired and repeated-measures analyses. Receiver operating characteristic (ROC) analyses were used only to explore discrimination between VM-associated hemostatic activation and healthy-control values.ResultsLocal lesional samples showed higher TAT, PIC, FDP, and D-dimer concentrations than paired preoperative peripheral samples, whereas TM and t-PAIC did not differ significantly. After sclerotherapy, TAT increased immediately, while D-dimer showed a more prolonged postoperative elevation. At the immediately post-procedure time point, exploratory ROC analysis showed an AUC of 0.9517 for TAT and 0.8931 for D-dimer. The TAT/PIC ratio also increased immediately after treatment, suggesting a transient laboratory shift toward coagulation predominance. No symptomatic venous thromboembolism, pulmonary embolism, overt disseminated intravascular coagulation, or major bleeding was observed during 30-day follow-up.ConclusionIn patients with venous malformations undergoing sclerotherapy, TAT showed an immediate post-procedural increase consistent with acute thrombin generation, whereas D-dimer showed a more sustained postoperative pattern. These findings describe peri-procedural hemostatic activation and support further outcome-based evaluation of TAT and TAT/PIC.
Background Chronic venous insufficiency (CVI) is a progressive condition of the venous system that negatively impacts physical function. Objective To identify and analyze functional assessment instruments used in patients with CVI and map their measurement properties, including reliability, validity, and reported changes over time, recognizing that formal responsiveness was evaluated inconsistently across studies. Methods This scoping review followed the Joanna Briggs Institute recommendations and was reported in accordance with the PRISMA-ScR framework. The study protocol was previously registered on the Open Science Framework ( https://osf.io/dz6u2/overview ), and searches were conducted across MEDLINE, EMBASE, Web of Science, and LILACS, without date or language restrictions. Two independent reviewers performed study selection and data extraction, with discrepancies resolved by a third reviewer. Results From 6342 records identified, 21 studies were included, with 19 instruments identified. Performance-based measures included walking and functional capacity tests (6-min walk test, 10-m walk test, Incremental Shuttle Walk Test), lower-limb functional tests (30-s sit-to-stand, step tests, single-leg stance, SPPB, weight-bearing lunge test), and other performance outcomes (Heel-rise test). Patient-reported outcome measures included physical activity and functioning questionnaires (e.g., IPAQ-SF, HAQ-20, HAP, LEFS, AADL) and symptom-related measures (FSS). Instrumental assessments included goniometry (manual/digital) and hand-held dynamometry. Across studies, measurement evidence most frequently addressed validity (18 instruments), while reliability (2 instruments) and reported changes over time (13 instruments) were less commonly evaluated and inconsistently reported. Conclusion A wide range of functioning and disability measures has been used in CVI, but measurement properties remain incomplete, particularly in reliability and evidence regarding changes over time, limiting confident selection for outcome monitoring.
Background This pooled data analysis aimed to clarify the effectiveness of micronized purified flavonoid fraction (MPFF) in improving quality-of-life (QoL) across the spectrum of chronic venous disease (CVD) in routine clinical practice. Methods Observational studies conducted in Russian populations assessing the effectiveness of MPFF-based therapy as part of the Russian Vein Act Prolonged program were identified. Primary endpoint was change in QoL over time (CIVIQ-14). Secondary endpoints included change in severity of self-assessed symptoms on a visual analog scale (VAS) and change in the proportion of patients with venous reflux. The systematic review protocol for this study was not prospectively registered. Results Five observational studies involving 4091 participants in CEAP classes C1−C4 and C6 were included. MPFF-based conservative therapy was associated with a statistically significant improvement in CIVIQ-14 global index score at the end of the observational period compared with baseline (SMD [95% CI] 1.29 [1.04, 1.55], p < 0.0001). Improvements were also observed in each CIVIQ-14 dimension: pain (1.50 [1.19, 1.82]; p < 0.0001), physical (0.90 [0.59, 1.20]; p < 0.0001), and psychological (1.03 [0.83, 1.23]; p < 0.0001). Analysis of VAS-assessed symptom severity indicated MPFF-based therapy was associated with statistically significant improvements in leg pain ( p < 0.0001), leg itching ( p < 0.0009), and leg heaviness, leg swelling, and night cramps (all p < 0.0001) compared with baseline. MPFF-based therapy was associated with a statistically significant reduction in the odds ratio of reflux in patients with CEAP classes C2–C4 and C6 (OR 0.1; 95% CI 0.0, 0.5; p < 0.01). High heterogeneity of the results was observed for all parameters studied. Conclusions This pooled data analysis indicated that MPFF-based therapy was associated with improvements in overall QoL score as well as the pain, physical and psychosocial dimensions. MPFF treatment was also associated with improvements in leg symptoms and reduced the proportion of patients suffering from venous reflux across the range of CEAP classes.
ObjectivesGenerative artificial intelligence (AI) models capable of producing photorealistic medical images are increasingly proposed for patient education, clinical illustration, and trainee instruction. However, their ability to accurately represent anatomically distinct disease subtypes remains unclear. This study evaluated the diagnostic accuracy of a widely used generative AI model in producing images corresponding to the five anatomical lipedema types defined by the Schmeller classification.MethodsIn this prospective audit, ChatGPT's image-generation interface was prompted to create 60 images for each lipedema type (Types I-V),yielding 300 images. Prompts were standardized and limited to the subtype label without additional descriptors. Two clinicians independently classified each image into one of the five lipedema types or as indeterminate, blinded to the original prompt; disagreements were resolved by a third clinician. Diagnostic performance was assessed using a confusion matrix and per-type sensitivity, specificity, positive predictive value(PPV), negative predictive value (NPV),F1-score,and one-vs-rest receiver operating characteristic area under the curve (ROC AUC). Overall accuracy and Cohen's κ statistics were also calculated.ResultsAll 300 images were evaluable. The model generated anatomically consistent images for Types I,II, and III (sensitivity = 1.00 for each). Specificity was 1.00 for Types I and II but 0.50 for Type III because all images requested as Types IV and V were classified as Type III. Consequently, the model failed to generate any images consistent with Type IV(arm-predominant) or Type V(calf-isolated) lipedema (sensitivity = 0.00 for both). Overall accuracy was 0.600. Unweighted and quadratic-weighted Cohen's κ values were 0.500 and 0.667, respectively. Micro- and macro-averaged ROC AUC were both 0.750.ConclusionThe model reproduces severity gradients within lower-extremity lipedema but systematically collapses anatomically distinct subtypes into the dominant Type III phenotype, failing to depict arm-predominant and calf-isolated disease. Current generative AI systems may therefore encode lipedema as a single visual phenotype rather than a distributed anatomical entity, limiting their reliability for medical education and clinical communication.
ObjectivesThere is a deficiency in awareness and knowledge of lipedema disease among the general public and healthcare professionals. This situation may lead patients to waste time on getting the correct diagnosis and treatment. Currently, information regarding women's awareness and knowledge level of lipedema in Turkey is limited. This study aims to examine women's awareness, knowledge level, and desire for information concerning lipedema in Turkey.MethodsA total of 502 volunteer women participated in this online cross-sectional survey study. The survey, constructed by the authors of the study with the assistance of guidelines, systematic reviews, and current literature, consisted of sections aimed at determining demographic data, lipedema awareness, knowledge level, lipedema symptoms and suspicion, as well as individuals' health behavior and desire for information. The primary outcome of the study was lipedema awareness, which was defined by having previously heard the term lipedema.ResultsDespite 76.1% of participants reporting awareness of lipedema, the average knowledge score about the condition was a low-to-moderate level of knowledge. The vast majority of participants (71.3%) indicated that they were willing to learn more about lipedema, and their preferred source of information was healthcare professionals (80.3%). Yet, only 19 participants (3.8%) think that lipedema is sufficiently regarded within the healthcare system.ConclusionThis study reveals that, despite relatively high awareness of lipedema among women in Turkey, the level of knowledge remains limited. The strong willingness to receive further knowledge and the preference for healthcare professionals as the principal source of information garner attention. However, the low confidence in the recognition of lipedema within the healthcare system may suggest that healthcare professionals have insufficient knowledge or do not prioritize this issue. Improving awareness and knowledge of lipedema among the public and healthcare professionals might facilitate early identification and minimize treatment delays.
ObjectivesThis study aimed to analyze the patients with saphenous vein aneurysm (SVA) close to the junction treated with endovenous vacuum-assisted laser ablation (VALA).MethodsThis was a retrospective analysis the patients with great saphenous vein aneurysm close to the junction involving a terminal valve and varicose veins who underwent VALA from March 2021 to October 2025. Sclerotherapy of the tributaries were performed during the same treatment session. All patients were examined clinically and with duplex ultrasound (DUS) in the standing position.ResultsTen patients with a median diameter of the great SVA 23.8 mm (IQR 21.6 - 28.9) were included in the study. At 6 months follow up saphenous aneurysms were absent and clinical outcome was improved in all of the patients. At the early postoperative visits there were no patients with symptoms of pulmonary embolism (PE), two cases of endothermal heat-induced thrombosis (EHIT) 1, and one case EHIT 2, which required the prescription of an anticoagulant therapeutic dose. No other adverse events were observed.ConclusionSonographic and clinical 6-months follow-up showed that VALA is an effective procedure with excellent technical result for the treatment of great SVA close to the Junction. However, the best thromboprophylaxis strategy in this case remains to be debatable.
Background and aimsVascular complications in kidney transplant recipients, although uncommon, may pose risks to graft function and patient outcomes. This study investigated the prevalence and characteristics of saphenofemoral junction (SFJ) reflux and lower-limb venous diameters in kidney transplant recipients.MethodsIn this cross-sectional study, patients with a history of kidney transplantation referred to Sina Hospital in Tehran, Iran, from January 2022 to 2024 were included. Duplex ultrasound was used to assess the presence of SFJ reflux, SFJ reflux time, and the diameters of the great saphenous vein (GSV), common iliac vein, external iliac vein, and common femoral vein.ResultsA total of 280 patients were evaluated, with a mean age of 39.52 ± 10.18 years; 227 patients were male (81.1%). The transplanted kidney was located on the right side in 192 patients (68.6%). SFJ reflux was identified in 30 patients (10.7%), of whom 56.7% had bilateral reflux. There was no significant relationship between SFJ reflux and the side of the transplanted kidney (p = 0.273). The GSV diameter was increased in 29.3% of patients on the transplant side and in 24.6% on the contralateral side. The diameters of the common iliac veins were normal in all patients. External iliac vein diameter was increased in 14.3% of patients on the transplant side and in 16.8% on the contralateral side.ConclusionSFJ reflux was observed in 10.7% of kidney transplant recipients. No significant association was found between SFJ reflux and the side of the transplanted kidney. Lower-limb venous diameter parameters did not differ significantly between the transplant side and the contralateral side.
