BackgroundLipedema is a chronic and progressive disorder of subcutaneous adipose tissue that predominantly affects women and is frequently misdiagnosed as obesity, lymphedema, or venous disease. Increasing evidence indicates that lipedema represents a systemic vascular-lymphatic-inflammatory disorder rather than a cosmetic or metabolic condition. Delayed diagnosis often results in progressive fibrosis, lymphatic dysfunction, chronic pain, and functional impairment.ObjectiveThis review aims to present a structured, clinically applicable framework for the diagnosis and multimodal management of lipedema within phlebology practice, with an emphasis on stage-specific assessment and integrated therapeutic strategies.MethodsA narrative clinical review of peer-reviewed literature in phlebology, vascular medicine, lymphatic disorders, and adipose tissue pathology was conducted. Diagnostic criteria, clinical staging, and differential diagnostic features were synthesized into a practical, stage-based framework. A multilayer therapeutic approach targeting inflammation, lymphatic function, adipose tissue pathology, extracellular matrix remodeling, and post-treatment rehabilitation is proposed.ResultsAccurate diagnosis of lipedema relies primarily on clinical evaluation, including pain assessment, tissue palpation, characteristic fat distribution, and exclusion of lymphedema and simple obesity. Early-stage identification enables effective intervention focused on inflammation control and lymphatic unloading, potentially preventing irreversible fibrosis. Advanced stages require targeted adipose tissue interventions, fibrosis management, and structured rehabilitation to preserve mobility and quality of life.ConclusionLipedema should be recognized as a systemic vascular-lymphatic-inflammatory disorder within phlebology practice. Early diagnosis and implementation of a structured, stage-specific multimodal treatment framework may significantly alter disease progression and reduce the risk of long-term disability.
Endovenous thermal ablation (EVTA) of varicose veins is now the first-line therapy for truncal reflux, yet consensus on peri-procedural pharmacological thromboprophylaxis is lacking. A ten-item, online, anonymized survey was distributed to all 291 members of the Spanish Chapter of Phlebology and Lymphology (CEFyL-SEACV) in February 2024. Items explored respondent demographics, anaesthesia, use, timing, drug choice and duration of pharmacological thromboprophylaxis after EVTA. Results are reported as frequencies. Of 291 surgeons, 120 replied (response rate 41%, 120/291); 110 routinely performed EVTA and formed the analytic sample. Most had >10 years of venous experience (84%, 101/120) and practiced in public (48%, 58/120) or private (44%, 53/120) hospitals. Pharmacological thromboprophylaxis was prescribed by 95.5% (105/110): routinely in 80.9% (89/110) and selectively in 14.5% (16/110). Low-molecular-weight heparin (LMWH) was preferred (92.7%, 102/110); direct oral anticoagulants (DOACs) were rare (6.4%, 7/110). Prophylaxis was initiated immediately post-procedure in 39.1% (41/110), within 1-6 h in 37.1% (39/110) and ≥6 h in 22.9% (24/110). Standard duration was 6-10 days for 69.5% (73/105), whereas patients with pro-thrombotic risk factors frequently received extended courses (≥15 days in 16.2%, 17/105). Spanish vascular surgeons widely adopt pharmacological thromboprophylaxis after EVTA, but timing and duration vary substantially in the absence of definitive guidelines. These findings highlight the need for a national, evidence-based consensus to harmonize practice and optimize patient safety.
Chronic venous disease (CVD) is one of the most common vascular disorders, affecting millions of people worldwide. Owing to the variability of clinical symptoms and the subjective nature of their interpretation, diagnosing CVD at an early stage is complicated, making it crucial for patients to consult a specialist. It was hypothesized that an artificial intelligence (AI) model could accurately classify CVD (C0-C2 Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) clinical class) from lower limb photographs. Therefore, this study aimed to develop and validate such a model. A multicenter cross-sectional study (NCT17122021) was conducted from May 2020 to January 2024 in accordance with the Declaration of Helsinki. A dataset of 10,745 lower limb photographs was collected using smartphones and professional cameras across several Russian clinics, then standardized and anonymized before model training. CEAP clinical class was determined by consensus among three surgeons experienced in phlebology. The AI model IVENUS was developed to automatically assess lower limb photographs and classify early-stage CVD according to the CEAP clinical classification (C0-C2). The model was trained using a deep learning approach based on the Swin Transformer V2 architecture. To improve model robustness and reduce overfitting, Gaussian blurring and color jitter were applied as data augmentation methods during training. The standard performance metrics (sensitivity, recall, specificity, accuracy, and precision) were calculated. The dataset consisted of 673 lower limbs of stage C0, 4445 lower limbs of stage C1, and 5627 lower limbs of stage C2. The overall diagnostic accuracy in the external validation subset of 1622 photographs was 84.8%, with a precision of 84.3%, sensitivity of 84.3%, and specificity of 92.3%. The AI model IVENUS demonstrated high diagnostic value for early-stage CVD, sufficient for its application as a clinical decision support system. Therefore, this model may support patient self-screening and telemedicine triage and may be used by specialists for automated patient routing and tracking of treatment progress.
Chronic venous disease (CVD) is a prevalent condition that results from venous hypertension and leads to a variety of symptoms including leg pain, swelling, and venous ulcers. The condition significantly impacts quality of life (QoL) and imposes a burden on healthcare systems. Venoactive drugs (VADs) can manage CVD symptoms by improving venous tone, reducing inflammation, and enhancing microcirculation. In this review, six experts from Latin America provide a critical appraisal of the evidence supporting the use of VADs in CVD management. The review evaluates the efficacy of various VADs, including micronized purified flavonoid fraction (MPFF), rutosides, calcium dobesilate, sulodexide, horse chestnut seed extract, and red vine leaf extract. MPFF demonstrated robust efficacy in randomized controlled trials, significantly reducing symptoms such as pain, leg heaviness, and edema, and improving QoL. Other VADs, such as rutosides and calcium dobesilate, showed varying degrees of effectiveness, though the quality of supporting evidence remains inconsistent. This review also highlights variations in international guidelines - some recommending VADs more strongly than others, with MPFF emerging as the preferred option, supported by high-quality evidence. However, further research is necessary to clarify the role of other VADs and provide more definitive guidance on their use in clinical practice. PLAIN LANGUAGE SUMMARY: Chronic venous disease (CVD) is a condition that affects the veins in the legs, causing pain, swelling, and other symptoms like heaviness and cramping. It can also lead to more severe issues such as skin changes and ulcers. CVD is common and can greatly reduce a person's quality of life (QoL). It can also place a significant burden on healthcare systems. Venoactive drugs, or VADs, are medicines that help improve blood flow in the veins, reduce swelling, and ease inflammation. These drugs are used to alleviate CVD symptoms, especially when other conservative treatments, like compression stockings, are insufficient. This review describes the published evidence about different types of VADs and their effectiveness in CVD. Some drugs, like micronized purified flavonoid fraction (MPFF), have been shown to be particularly effective in reducing leg pain, swelling, and heaviness, as well as helping to improve the QoL of people with CVD. Other VADs, including rutosides, calcium dobesilate, and horse chestnut seed extract, have demonstrated clinical efficacy. Different medical guidelines for treating CVD from around the world recommend using VADs, though with some discrepancies on recommendation gradings. While MPFF is referred to in these guidelines as a leading option, further research is needed to better understand how different VADs can be used most effectively in treating CVD.
Background/Objectives: major open abdominal surgery remains associated with clinically important postoperative pain, delayed gastrointestinal recovery, opioid exposure, and prolonged length of stay. Intravenous lidocaine infusion (IVLI) has biologically plausible analgesic, anti-hyperalgesic, anti-inflammatory, and opioid-sparing effects, but prior evidence syntheses have often combined open and minimally invasive procedures. This systematic review evaluated evidence for perioperative IVLI in adult patients undergoing major open abdominal surgery. Methods: the review was structured according to PRISMA 2020. The final search was run on 15 January 2026 and covered PubMed/MEDLINE, Embase, Cochrane CENTRAL, Scopus, Web of Science Core Collection, ClinicalTrials.gov, and WHO ICTRP from database inception to that date, without language restrictions at the search stage. Eligible studies enrolled adults undergoing elective open abdominal surgery and compared systemic IVLI with placebo, usual care, or active epidural analgesic comparators. Primary outcomes were postoperative opioid consumption and pain intensity. Secondary outcomes included gastrointestinal recovery, postoperative ileus, length of hospital stay, postoperative nausea and vomiting, inflammatory/stress biomarkers, and adverse events. Results: ten randomized trials involving 658 participants were included. Placebo/usual-care trials and active-comparator trials were synthesized separately because they address different clinical questions. IVLI generally reduced opioid consumption compared with placebo, with extractable effects including a 55.9 mg reduction in 72 h morphine use in one abdominal surgery trial and a 13.9 mg reduction in 24 h morphine use after radical prostatectomy. Gastrointestinal recovery favored IVLI in most placebo-controlled studies; for example, first flatus occurred 12.5 h earlier and first bowel movement 28.4 h earlier in one trial. Active-comparator trials suggested comparable early dynamic pain outcomes versus thoracic epidural analgesia in selected settings, although opioid consumption findings were less consistent. No serious lidocaine-related toxicity was reported, but the included trials were underpowered to detect rare local anesthetic systemic toxicity events and did not consistently capture subclinical neurologic symptoms such as perioral numbness or visual disturbance. Conclusions: in adult open abdominal surgery, perioperative IVLI may provide opioid-sparing and recovery benefits, particularly when infusion continues beyond the intraoperative period. However, the certainty of evidence remains limited.
ObjectivesLipedema is a chronic disorder characterized by pain and disproportionate fat distribution, and its diagnosis is frequently overlooked. The aim of this study was to evaluate and compare the responses generated by contemporary artificial intelligence models-ChatGPT-5o, Gemini-3, and Perplexity AI-to structured clinical questions developed in accordance with the 2024 S2k Lipedema Guideline. The models were analyzed in terms of clinical accuracy, readability, and reference reliability to assess their performance in delivering guideline-based medical information.MethodsThis cross-sectional and comparative study was conducted by submitting 30 structured clinical questions, prepared on the basis of the relevant guideline, to three large language models. Responses collected on 10 February 2026, were evaluated using a seven-point Likert scale (reliability) and a five-point scale (accuracy). Text readability was assessed using six established indices, including the Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), and Gunning Fog Index (GFOG). Reference reliability was examined by analyzing hallucination tendencies as defined in the literature.ResultsA statistically significant difference in reliability was observed among the models (p = .041); Perplexity (4.95 ± 1.20) achieved significantly higher scores than ChatGPT-5o (4.38 ± 1.05) (p = .038). In readability analyses, Perplexity (12.80 ± 2.10) required a significantly higher educational level according to FKGL scores compared to both ChatGPT-5o (p = .041) and Gemini-3 (p = .036). Regarding reference reliability, ChatGPT-5o outperformed Perplexity in source verifiability (p = .031), bibliographic precision (p = .044), and total RHS scores (p = .027), emerging as the most robust model in this domain. No statistically significant differences were found among the models in terms of clinical accuracy and usefulness (p > .05). Inter-rater agreement was excellent (Kappa: 0.92-0.97).ConclusionIn this study, ChatGPT-5o distinguished itself in reference quality, whereas Perplexity demonstrated superior reliability. However, the complex linguistic structures accompanying efforts to maintain high medical accuracy may constitute a significant barrier for individuals with limited e-health literacy. Although these systems show strong potential as medical information resources, they cannot yet replace expert physician oversight in terms of patient safety. A balanced approach between technical reliability and patient-centered simplification remains necessary.
The aim of this study was to evaluate differences in radiation exposure across chronic venous obstruction (CVO) classification groups during endovascular recanalisation and stenting of unilateral iliofemoral lesions and to identify clinical and procedural factors influencing radiation dose. This was a retrospective, single centre cohort study of 133 patients with unilateral iliofemoral CVO who underwent successful endovascular recanalisation and stenting with mobile C arm fluoroscopy between February 2017 and January 2023. Lesions were classified using the Jalaie CVO classification system. Radiation parameters included fluoroscopy time (FT), cumulative air kerma (CAK), kerma area product (KAP), entrance skin dose, and effective dose. Procedure data included total stent length and procedure time. Radiation and procedure parameters were recorded systematically in the institutional database and subsequently analysed across classification groups. Statistical analyses involved Mann-Whitney U test, Pearson and Spearman correlation analyses, and multivariable linear regression. Radiation exposure increased with higher CVO classification. Type III and IV lesions were associated with longer FT and higher CAK and KAP than type I lesions (p < .001). Compared with single stent implantation, use of two or three stents was associated with higher CAK (p < .001 and p = .006, respectively) and KAP (p < .001 and p = .008, respectively). In multivariable analysis, FT was independently predicted by total procedure time (p < .001) and body mass index (BMI) (p = .024). CAK and KAP were independently predicted by total procedure time (p < .001), BMI (p < .001), total stent length (p = .035 and p = .015), and type IV obstruction (p = .020 and p = .034). Radiation exposure during unilateral iliofemoral CVO intervention increases with lesion severity. CVO type IV, BMI, total stent length, and procedure time were independently associated with radiation dose.
ObjectivesEndovenous radiofrequency ablation (RFA) is an established minimally invasive treatment for saphenous vein insufficiency. This study evaluated 1-year clinical and anatomical outcomes of RFA in a real-world cohort, including staged adjunctive interventions when indicated.MethodsThis retrospective study initially evaluated 99 patients with symptomatic saphenous vein insufficiency. Of these, 84 patients, corresponding to 90 treated limbs, completed follow-up and were included in the final analysis. Among these, 74 patients underwent great saphenous vein (GSV) ablation (including 6 bilateral procedures, totaling 80 limbs), and 10 patients underwent small saphenous vein (SSV) ablation. Clinical outcomes were assessed using the Venous Clinical Severity Score (VCSS), while Clinical-Etiology-Anatomy-Pathophysiology (CEAP) classification was used to describe baseline disease severity.ResultsThe overall occlusion rate across all treated limbs was 88/90 (97.7%). In the GSV subgroup, mean VCSS decreased significantly from 6.0 ± 1.5 at baseline to 2.2 ± 1.2 at 12 months (p < .001). In the SSV subgroup, mean VCSS decreased from 5.5 ± 0.5 to 2.0 ± 1.0, demonstrating comparable clinical improvement. Ten limbs (12.5% of the GSV limbs) required adjunctive sclerotherapy for symptomatic residual tributaries. Minor complications included transient paresthesia in 7 limbs (7.7%), all of which resolved during follow-up. One patient (1.2%) developed Ablation-Related Thrombus Extension (ARTE), which was managed conservatively without sequelae.ConclusionEndovenous RFA provided high occlusion rates, significant clinical improvement, and a favorable safety profile at 1 year. These findings support RFA as an effective treatment option for both GSV and SSV insufficiency in routine clinical practice.
To evaluate the safety and efficacy of Total Endovenous Laser Ablation (TEVLA) in a multicenter cohort. Prospective multicenter non-randomized study including 153 patients (CEAP C2-C6). TEVLA was performed as a single-session procedure treating truncal veins, tributaries, and perforators. Primary endpoint was occlusion rate. Secondary endpoints included complications, pain (VAS), and rVCSS improvement. Occlusion rate was 99.3% at 7 days and 98.3% at 6 months. No DVT or EHIT events were observed. Minor complications included hyperpigmentation (5.9%) and paresthesia (2.6%). Mean rVCSS significantly improved (-3.24 at 1 month; p<0.001). No association was found between LEED and complications. TEVLA is a safe and effective single-step technique with high occlusion rates and low complication profile. Further randomized studies are warranted.
BackgroundEndovenous laser ablation (EVLA) is a guideline-recommended treatment for great saphenous vein (GSV) incompetence. Higher-wavelength lasers (1470 nm, 1940 nm) with radial fibers aim to improve efficacy while reducing postoperative morbidity. Prospective comparisons remain limited.MethodsIn this multicenter, randomized trial, 66 patients (31 women, 35 men; mean age 54.8 ± 13.6 years) with symptomatic GSV reflux (CEAP C2-C5) were assigned to EVLA using a 1940-nm (Group 1; n = 32) or 1470-nm laser (Group 2; n = 34). Procedures employed standardized radial fibers and identical target LEED (160 J/cm for the first 5 cm, 80 J/cm thereafter). The primary endpoint was ultrasound-based vein morphology (diameter, resorption) at 3, 6, and 12 months. Secondary endpoints included occlusion rates, postoperative pain, sensory disturbances, complications, and quality of life. Outcome assessors were blinded during postoperative examinations.ResultsBaseline characteristics were comparable between groups. During follow-up, 4 patients in Group 1 and one in Group 2 discontinued participation. Complete occlusion was achieved in all patients. No significant differences in vein diameter reduction or resorption were observed between groups. Complete vein resorption at 12 months occurred in 67.9% (Group 1) and 48.5% (Group 2; p = .194). Postoperative pain scores were lower in the 1940-nm group at first follow-up in exploratory analyses, and fewer sensory disturbances occured (7.1% vs 24.1%; p = .092), without statistical significance. Interpretation is limited by differences in applied power (1940 nm: 8 W; 1470 nm: including cases treated at 10 W). No deep vein thrombosis or endothermal heat-induced thrombosis occurred.ConclusionIn this randomized study, no significant differences in ultrasound-based morphological outcomes were observed between 1940-nm and 1470-nm EVLA for GSV incompetence. These findings support comparable efficacy between 1940-nm and 1470-nm EVLA; however, larger studies powered for clinical outcomes are required to confirm potential differences in postoperative morbidity.
High-grade serous ovarian cancer (HGSOC) represents the most aggressive subtype of epithelial ovarian cancer and is frequently diagnosed at advanced stages. Increasing evidence suggests that systemic inflammation plays an important role in tumor progression and clinical outcomes. This study aimed to evaluate the association between preoperative systemic inflammatory indices and tumor burden, perioperative outcomes, and recurrence risk in patients with HGSOC undergoing primary debulking surgery. We conducted a retrospective study including 125 patients with histopathologically confirmed HGSOC who underwent primary debulking surgery between January 2020 and December 2025. Preoperative hematological parameters obtained within 24 h before surgery were used to calculate inflammatory indices including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and aggregate index of systemic inflammation (AISI). Associations between inflammatory markers, clinicopathological characteristics, perioperative outcomes, and recurrence were analyzed using non-parametric tests and logistic regression models. The mean patient age was 53.66 ± 9.14 years, and most patients presented with advanced disease (FIGO III-IV: 70.4%). Patients with T3 tumors showed significantly higher monocyte (0.66 vs. 0.50 × 109/L, p = 0.003), neutrophil (5.43 vs. 4.99 × 109/L, p = 0.042), and platelet counts (325 vs. 280 × 109/L, p = 0.006) and lower lymphocyte counts (1.79 vs. 1.96 × 109/L, p = 0.009). Composite inflammatory indices were also increased in advanced disease, including PLR (177 vs. 153, p = 0.009), AISI (492 vs. 341, p = 0.002), and SIRI (1.65 vs. 1.18, p = 0.018). Patients requiring postoperative blood transfusion had higher neutrophil counts (7.65 vs. 4.97 × 109/L, p < 0.001) and elevated SIRI (2.56 vs. 1.55, p < 0.001). Patients with recurrence had significantly higher platelet counts (339 vs. 293 × 109/L, p = 0.001) and SII values (2849 vs. 2586, p = 0.012). In multivariate analysis, SII remained independently associated with recurrence (OR 1.022 per 100-unit increase; 95% CI 1.002-1.043; p = 0.033) together with advanced FIGO stages (OR 2.863; 95% CI 1.011-8.104; p = 0.048). Preoperative systemic inflammatory markers are significantly associated with tumor burden, surgical outcomes, and recurrence risk in HGSOC. An elevated SII appears to be an independent predictor of recurrence and may represent a practical biomarker for improving preoperative risk stratification and postoperative surveillance.
BackgroundThis study aims to systematically evaluate the current landscape of artificial intelligence (AI) and machine learning applications in lymphedema research by employing bibliometric and altmetric analyses. The goal is to identify major trends, research focuses, and influential contributors in this rapidly evolving field.MethodA total of 43 AI-related articles on lymphedema published between 1975 and 2025 were retrieved from the Web of Science Core Collection. Bibliometric indicators such as publication years, journals, countries, authorship, and citation metrics were analyzed. Altmetric scores were also assessed. Each study was classified by study type and thematic focus.ResultOriginal research articles constituted the majority (n = 26), with clinical studies being the most common subtype. The United States and China led in publication output. Most studies were published in Q1-Q2 journals, indicating high scientific quality. Scientific Reports was the most productive journal. General AI applications and risk prediction emerged as dominant themes. A moderate positive correlation was found between average annual citations and altmetric scores (r = 0.470, p = 0.039), suggesting consistency between academic impact and online visibility.ConclusionThis is the first study to comprehensively map AI-based research in the field of lymphedema using bibliometric and altmetric methods. The findings reveal increasing global interest and high-impact publications, particularly in the domains of risk prediction and early diagnosis. These insights may guide future methodological frameworks and interdisciplinary collaborations in this emerging field.
Telangiectatic matting is commonly described as a transient complication following sclerotherapy and other vascular interventions. Its occurrence after permanent body fillers has not been clearly established. We report the case of a 27-year-old woman who developed persistent telangiectatic matting in the gluteal region several months after polymethylmethacrylate (PMMA) injection for cosmetic augmentation, without prior sclerotherapy in the affected area. A multimodal therapeutic approach was employed, including transdermal Nd:YAG laser and sclerotherapy, resulting in partial clinical improvement. This case suggests a possible association between permanent fillers and delayed microvascular alterations, highlighting the importance of long-term surveillance after aesthetic procedures.
Chronic venous disease affects > 40% of adults. The effectiveness of cyanoacrylate closure for the treatment of saphenous vein reflux compared with current global standard modalities remains unclear. The objective of this study was to assess patient centric and traditional venous outcomes comparing cyanoacrylate closure with surgical stripping and endothermal ablation, two global standards of care. VenaSeal Spectrum randomised controlled trials (RCTs) are prospective, global, multicentre, 1:1 randomised studies evaluating the VenaSeal cyanoacrylate closure system for patients with chronic venous disease. Participants were enrolled in 23 centres across four continents. In the first RCT, 106 participants were randomly assigned to receive cyanoacrylate closure or surgical stripping. In the second RCT, 275 participants were randomly assigned to receive cyanoacrylate closure or endothermal ablation. The primary outcomes were patient satisfaction through 30 days using the periprocedural and postprocedural Venous Treatment Satisfaction Questionnaire (VenousTSQ), and proportion of saphenous reflux treated in each target vein. Adverse events were adjudicated by an independent committee and reported through 6 months. Traditional venous outcomes are evaluated as secondary outcomes. In both studies, baseline characteristics were similar between groups. Periprocedural patient satisfaction at 30 days was greater in participants randomised to cyanoacrylate closure compared with surgical stripping (venous treatment satisfaction score 29.3 ± 4.94 vs. 25.0 ± 6.24, p = .001), but postprocedure patient satisfaction at 30 days and proportion of superficial truncal reflux treated were similar. There was no statistical difference detected in the three primary endpoints comparing cyanoacrylate closure and endothermal ablation. Overall adverse event rates were low, with the most common adverse events following cyanoacrylate being mild to moderate hypersensitivity, which was self limiting. Cyanoacrylate closure for treatment of saphenous reflux resulted in superior periprocedural patient treatment satisfaction compared with surgical stripping. Patient satisfaction and proportion of superficial reflux treated after cyanoacrylate closure were comparable with endothermal ablation. https://www. gov, unique identifier NCT03820947.
BackgroundBaker's cysts can cause significant vascular complications including popliteal vein compression and deep vein thrombosis (DVT), yet no validated tool exists to predict which patients are at highest risk. We aimed to develop and internally validate a clinical nomogram for predicting vascular complications in patients with Baker's cysts.MethodsWe conducted a retrospective cohort study of 1,364 consecutive patients diagnosed with Baker's cysts between January 2015 and December 2024 at a single tertiary center. The primary outcome was a composite of vascular complications (symptomatic popliteal vein compression >50%, DVT involving the popliteal vein, pseudothrombophlebitis, or popliteal artery compression). Multivariate logistic regression identified independent predictors, which were incorporated into a nomogram. Internal validation was performed using 1,000 bootstrap resamples and 10-fold cross-validation.ResultsVascular complications occurred in 137 patients (10.0%). Of the total cohort, 923 (67.7%) presented with symptomatic cysts, while 441 (32.3%) were incidental findings. Five independent predictors were identified: cyst size >40 mm (adjusted OR 2.78, 95% CI 1.86-4.15), rheumatoid arthritis (aOR 2.24, 1.46-3.43), venous insufficiency (aOR 2.42, 1.52-3.86), anticoagulant therapy (aOR 1.86, 1.19-2.91), and age >65 years (aOR 1.72, 1.16-2.56). The nomogram demonstrated good discrimination (AUC 0.83, 95% CI 0.79-0.87) and calibration (Hosmer-Lemeshow p = .66). Risk stratification identified low-risk (2.6%), intermediate-risk (12.5%), and high-risk (35.7%) groups. The median time to complication was 14.2 months overall, with significantly earlier occurrence in high-risk patients (8.3 months).ConclusionsWe developed and internally validated a clinical nomogram based on five readily available variables that can stratify patients with Baker's cysts into risk groups for vascular complications. This tool may help tailor surveillance intensity and timing of intervention. External validation in independent cohorts is required before broad clinical implementation.
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.
BackgroundLipedema is an adipose disorder associated with multiple impairments. Conservative treatments remain the mainstay of management, yet evidence regarding the effects of physical therapies on clinical, imaging, and body composition outcomes is limited. Radial extracorporeal shock wave therapy (rESWT) has been proposed as a non-invasive therapeutic option, although its impact is not fully established.MethodsThis was a prospective, longitudinal, within-patient study conducted in women with clinically diagnosed lipedema. One lower limb was treated with radial extracorporeal shock wave therapy (rESWT), whereas the contralateral limb served as an internal control. A total of 16 patients were initially assessed, of whom 12 completed the full follow-up and were included in the final analysis. rESWT was applied over six sessions (two sessions per week) using standardized parameters. Clinical outcomes (LEFS, EQ-5D, SF-36 Physical Function, and IPAQ) were assessed at baseline, 6 weeks, and 3 months. Ultrasound and elastography were used to evaluate subcutaneous tissue thickness and stiffness at predefined leg and thigh sites, while segmental bioimpedance analysis assessed body composition and fluid distribution. Longitudinal changes were analyzed using mixed-effects models.ResultsSignificant improvements were observed in functional capacity, quality of life, and physical activity levels at both 6 weeks and 3 months compared with baseline (p < .05). In contrast, no statistically significant changes were detected in ultrasound-derived tissue thickness, elastography measurements, or bioimpedance parameters over time, and no significant differences were detected between treated and control limbs within the constraints of the available sample size.ConclusionsrESWT was associated with meaningful clinical and functional improvements in patients with lipedema, despite the absence of detectable changes in tissue thickness, stiffness, or body composition. These findings suggest that the benefits of rESWT may be mediated through symptom modulation and functional adaptation rather than structural tissue modification, supporting its role as part of conservative, symptom-oriented treatment strategies in lipedema.
Acute cholecystitis, a leading cause of urgent surgical intervention, poses challenges in predicting severity and operative complexity. This study characterized the immuno-inflammatory profile distinguishing acute from chronic cholecystitis and assessed whether blood-derived ratios-neutrophil-to-lymphocyte (NLR), monocyte-to-lymphocyte (MLR), and platelet-to-lymphocyte (PLR)-correlate with histologic severity and surgical difficulty. The study retrospectively analyzed 759 patients undergoing cholecystectomy from 2016 to 2024. Inflammatory indices from preoperative bloodwork were compared across histopathologic subtypes (catarrhal, phlegmonous, gangrenous), clinical features, and surgical outcomes, including conversion to open procedure. Logistic regression and ROC analyses identified predictors of acute inflammation and conversion. Acute cholecystitis patients showed elevated NLR (7.0 vs. 3.1), MLR (0.44 vs. 0.26), and PLR (194 vs. 142; all p < 0.001). NLR was the only independent predictor of acute disease (OR = 1.29, 95% CI 1.203-1.390, p < 0.001), with superior discrimination (AUC = 0.806, cut-off = 3.56; sensitivity 73.1%, specificity 80.4%). NLR and PLR rose progressively from catarrhal to phlegmonous and gangrenous subtypes (p < 0.05), mirroring conversion rates (0% catarrhal, 3.2% phlegmonous, 10.5% gangrenous; p = 0.001). Routine hematologic ratios capture systemic immune activation in acute cholecystitis, reflecting histologic severity and operative risk. NLR, integrating innate and adaptive immune dynamics, offers a practical biomarker for preoperative risk stratification in acute care surgery.