Diagnosis of pelvic venous disorders (PeVD) is complicated by non-specific symptoms, deep location of the pelvic veins, and low awareness of the disease among clinicians. Aim To study clinical manifestations of PeVD and reveal their determinants by comparing symptomatic and asymptomatic patients. Methods This prospective, cross-sectional, observational study consecutively enrolled 287 females with PeVD verified by duplex ultrasound. Characteristics of the venous-origin chronic pelvic pain (VO-CPP) and other PeVD symptoms and signs, as well as pelvic venous reflux duration and distribution were studied. Results Predictors for symptomatic PeVD were asthenic habitus and body mass index <19 kg/m 2 (OR 5.8, p < 0.05). Clinical manifestations included symptoms of pelvic venous insufficiency (PVI) regardless of the presence of left renal vein (LRVC) or left common iliac vein compression (LCIVC). VO-CPP was identified in 90.5% of patients mostly as a dull, aching pain (60.5%) located in the hypogastrium (51.0%), which increased after load and in the second phase of the menstrual cycle (72.4%) and decreased in the lying position (78.6%). Severe VO-CPP was most prevalent in patients with LCIVC (33.7%). Heaviness in the hypogastrium and dyspareunia were common (60.5% and 56.7% patients) and significantly affected sociopsychological status. Dyspareunia and VO-CPP were associated with type II/III reflux and multi-collector venous lesions. Significant LRVC and LCIVC were predictors for severe PeVD with OR 22.0 and 6.2, respectively (both p < 0.05). Vulvar, gluteal and thigh varicosities were detected in 29% of patients along with internal iliac vein reflux in 79.3% of them. Headaches, orthostatic tachycardia and hypotension were detected in 46.2%, 40.1%, and 32.8% of symptomatic cases. Conclusion Symptomatic course of PeVD is characterized by various clinical manifestations of PVI, with its most common and severe symptom – VO-CPP, and multiple lesions of pelvic and retroperitoneal veins, with prolonged reflux in two or more pelvic venous collectors.
Purpose This study compares radiofrequency ablation (RFA) with versus without high ligation (HL) for treating primary varicose veins of the great saphenous vein, assessing differences in surgical efficacy. Method In this retrospective cohort study, consecutive patients with lower-extremity varicose veins treated at a single vascular center (July 2023–July 2024) were allocated to RFA (n = 65) or RFA ablation with high ligation (RFA + HL, n = 72). Groups were compared for operative time, blood loss, postoperative pain, hospital stay, symptom relief, and 2-year recanalization and recurrence rates. Results Both RFA and RFA + HL demonstrated favorable therapeutic outcomes, with significant symptom improvement observed in all patients postoperatively. The RFA group demonstrated superior perioperative outcomes, including shorter operative time (60.46 ± 7.89 vs. 65.21 ± 8.28 min, p = 0.001), less blood loss (11.92 ± 5.50 vs. 14.46 ± 6.94 mL, p = 0.020), lower postoperative VAS scores at 1d and 3d ( p < 0.01), a shorter hospital stay (2.15 ± 0.67 vs. 2.39 ± 0.64 days, p = 0.037), and a lower incidence of impaired wound healing (0.0% vs. 9.7%, p = 0.014). In contrast, RFA + HL provided better long-term durability, with significantly lower recanalization rates at both 9-month (1.4% vs. 10.8%, p = 0.027) and 12-month (2.8% vs. 12.3%, p = 0.047) follow-ups, as well as at 18-month (2.8% vs. 13.8%, p = 0.017) and 24-month (4.2% vs. 16.9%, p = 0.014) follow-ups. Notably, by 24 months postoperatively, clinical recurrence had occurred in 6 patients (9.2%) in the RFA group but none in the RFA + HL group ( p = 0.010). Conclusion Compared with RFA alone, the combination of RFA and HL for treating GSV incompetence was associated with a longer operative time and a higher risk of incision-related complications in the groin. However, the combined procedure demonstrated a lower venous recanalization rate at the 1-year follow-up, suggesting superior long-term durability of GSV closure.
Background Lymphedema is a chronic condition that commonly develops after cancer treatment and requires long-term multidisciplinary management. As increasing numbers of patients seek health information online, Google Trends provides an opportunity to evaluate online search interest and information-seeking behavior. This study aimed to investigate global online search interest in lymphedema from both surgical and rehabilitation perspectives. Methods This infodemiological observational study analyzed worldwide Google Trends data for the query “lymphedema” from January 2004 to December 2025, with partial January 2026 included in sensitivity analysis. Temporal trends in Relative Search Volume (RSV) were assessed using the modified Mann–Kendall test, Sen’s slope, and calendar-month regression with Newey–West covariance. Geographic distribution, related search queries, and related topics were analyzed descriptively. Results Global search interest in lymphedema demonstrated a significant long-term increasing trend (modified Mann–Kendall Z = 4.39, p < 0.001), with a Sen’s slope of 0.163 RSV units/month. The seasonally adjusted linear slope was 0.167 RSV units/month (95% CI 0.121–0.212). The highest normalized RSV was observed in the United States, followed by the United Kingdom, Australia, Canada, and Ireland. “Lymphedema treatment” was the highest-ranked related query. Related topics included disease-specific and anatomical concepts. Conclusions Relative Google search interest in lymphedema increased over the study period. The findings may help guide online education but do not establish disease burden, patient demand, or public awareness.
Objectives To investigate the associations of disease-related parameters with physical activity, general health status, functional capacity, and lower-extremity function in patients with chronic venous insufficiency (CVI). Methods This cross-sectional study included 54 patients with Clinical, Etiological, Anatomical, and Pathophysiological (CEAP) C2–C3 CVI. Assessments included Venous Clinical Severity Score (VCSS), selected vein diameter, venous reflux time (VRT), International Physical Activity Questionnaire–Short Form (IPAQ-SF), daily step count, Nottingham Health Profile (NHP), 6-minute walk distance (6MWD), and Lower Extremity Functional Scale (LEFS). Spearman correlation and univariable and age- and body mass index-adjusted multivariable linear regression analyses were performed. Sensitivity analyses used binary VRT (≤6 vs >6 seconds). Results Mean age was 48.81 ± 8.25 years; 45 patients (83.3%) were women and 49 (90.7%) had CEAP C3 disease. VCSS correlated negatively with IPAQ-SF (r = −0.341; p = .012), daily step count (r = −0.438; p < .001), percentage of predicted 6MWD (r = −0.340; p = .012), 6MWD (r = −0.358; p = .008), and LEFS (r = −0.341; p = .012), but not significantly with NHP (r = −0.244; p = .075). In adjusted models, VCSS was negatively associated with IPAQ-SF (B = −60.422; 95% confidence interval [CI], −110.305 to −10.540; p = .019), daily step count (B = −411.843; 95% CI, −678.825 to −144.862; p = .003), percentage of predicted 6MWD (B = −2.765; 95% CI, −4.624 to −0.907; p = .004), and LEFS (B = −4.470; 95% CI, −6.996 to −1.945; p < .001). Selected vein diameter showed no significant adjusted associations. VRT was positively associated only with LEFS (B = 3.643; 95% CI, 1.406 to 5.879; p = .002). With binary VRT, the negative VCSS associations with daily step count, percentage of predicted 6MWD, and LEFS remained significant, whereas the IPAQ-SF association did not (p = .053); the positive VRT–LEFS association remained significant ( p = .041). Conclusions In patients with CEAP C2–C3 CVI, predominantly C3, higher VCSS was associated with fewer daily steps, reduced walking capacity, and poorer lower-extremity function. A multidimensional assessment integrating VCSS, physical activity, functional capacity, and lower-extremity function may provide a more comprehensive clinical evaluation.
Background The optimal management of chronic venous disease with saphenous reflux remains debated. While truncal ablation is commonly recommended, haemodynamically oriented and saphenous-sparing strategies have emerged, possibly challenging the necessity of routine treatment of the saphenous vein in all patients. Objective To evaluate clinical and haemodynamic outcomes following functional phlebectomy in patients with symptomatic varicose veins and saphenous reflux, and to assess the need for subsequent truncal intervention. Methods A retrospective cohort study was conducted including 759 consecutive patients with CEAP C2 disease and duplex-confirmed saphenous reflux, treated between 2008 and 2019. All patients underwent functional phlebectomy targeting refluxing tributaries without routine saphenous ablation. Follow-up was performed up to 36 months with clinical assessment and duplex ultrasound. Outcomes were reported descriptively as absolute numbers and percentages as collected at 36 months. Secondary staged treatment with foam sclerotherapy was performed in patients with persistent symptomatic reflux. Results After functional phlebectomy, absence of reflux was observed in 24.9% of patients, while 49.5% presented persistence of reflux without symptoms and 24.9% persistence with symptoms. Saphenous vein thrombosis occurred in 0.6% of cases. Among patients undergoing secondary sclerotherapy (n = 189), absence of reflux was achieved in 10.05%, while 39.6% became asymptomatic despite persistent reflux. Overall, only a minority of patients required subsequent treatment of the saphenous vein. Saphenous vein diameter appeared to influence treatment outcomes, with preservation observed in all cases with diameters ≤6 mm and increasing need for truncal intervention in larger veins. Conclusions Functional phlebectomy, applied within a haemodynamically guided framework, is associated with favourable clinical outcomes in the majority of patients with saphenous reflux, without the need for routine truncal ablation. These findings support a selective, stepwise approach to treatment and contribute to the evolving paradigm of personalised management in chronic venous disease.
