Abstract
Post-thrombotic syndrome morbidity in mechanical thrombectomy versus pharmacomechanical catheter-directed thrombolysis of iliofemoral deep venous thrombosis
Donohue JK, Li K, Tang A, Kann RJ, Vodovotz L, Abou Ali AN, Chaer RA, Sridharan ND. Ann Vasc Surg. 2025 Feb:111:55-62. doi: 10.1016/j.avsg.2024.11.007. Epub 2024 Nov 22.
In this retrospective study, the authors compared outcomes of pharmacomechanical catheter-directed thrombolysis (PCDT) and large-bore mechanical thrombectomy (MT) in 349 patients with acute iliofemoral deep venous thrombosis. Post-thrombotic syndrome (PTS) occurred in 19.1% of patients, with no significant difference between treatment groups in PTS rates, vessel patency, or mortality. MT was associated with fewer operating room visits and shorter ICU stays. MT was not an independent predictor of PTS. Risk factors for PTS included infrainguinal DVT extension, prior DVT, and hypercoagulable state.
The authors concluded that these findings support MT as a safe and efficient treatment option without increasing PTS risk.
Endovascular exclusion of a refluxing segment of femoral vein in post-thrombotic syndrome, characterized by a vicious shunt with the main upward draining pathway
Zamboni P, Baldazzi G, Galeotti R. J Endovasc Ther. 2025 Mar 21:15266028251326767. doi: 10.1177/15266028251326767.
In this study, the authors introduce a novel, minimally invasive endovascular technique to treat ilio-femoral vein reflux in patients with post-thrombotic syndrome (PTS). The method involves identifying a refluxing segment of the femoral vein (FV)—often associated with vein duplication or abnormal collaterals—using Doppler ultrasound and ascending/descending venography. Once the refluxing segment is confirmed, the team performs scleroembolization below the shunt point to exclude the problematic section of the FV from circulation. In a small case series of four patients, three had successful elimination of reflux, and one was not treated. Follow-up Doppler scans (mean: 6.5 months) showed sustained reflux resolution, with significant improvement in Villalta scores (p = .0087).
The authors concluded that this technique offers promise as a targeted intervention for PTS patients who currently lack effective surgical options, and further validation through multicenter trials is recommended.
Standard- versus extended-duration anticoagulation for primary venous thromboembolism prophylaxis in acutely ill medical patients
Kolkailah AA, Abdelghaffar B, Elshafeey F, Magdy R, Kamel M, Abuelnaga Y, Nabhan AF, Piazza G. Cochrane Database Syst Rev. 2024 Dec 4;12(12):CD014541. doi: 10.1002/14651858.CD014541. pub2.
In this review, the authors analyzed seven randomized controlled trials involving over 40,000 acutely ill medical patients to compare standard- versus extended-duration anticoagulation for primary prevention of venous thromboembolism (VTE). Extended-duration anticoagulation significantly reduced the risk of symptomatic and total VTE, as well as serious vascular events, but was associated with a higher risk of major bleeding. It did not impact all-cause mortality or VTE-related mortality.
The authors concluded that overall, while extended prophylaxis offers some protective benefits, these are counterbalanced by increased bleeding risks, and further research is needed to determine the optimal duration and choice of anticoagulant.
Low-dose aspirin versus placebo in postpartum venous thromboembolism: A multi-national, pilot, randomised, placebo-controlled trial
Skeith L, Malinowski AK, El-Chaâr D, Chan WS, Donnelly J, Chauleur C, Ganzevoort W, Wood S, Dubois S, McCarthy C, Buchmuller A, Wiegers H, Gibson PS, Ní Áinle F, Middeldorp S, Duffett L, Bates SM, Garven A, Baxter J, Lethebe BC, Rodger MA; Pilot PARTUM Group. Lancet Haematol. 2025 Feb;12(2):e109-e119. doi: 10.1016/S2352-3026(24)00338-7.
This pilot study (PARTUM trial) evaluated the feasibility of conducting a larger, double-blind, randomized trial of low-dose aspirin versus placebo for postpartum thromboprophylaxis in women at moderate risk of venous thromboembolism (VTE). Conducted across seven centers in four countries, 257 participants were enrolled and randomized within 48 hours after delivery. The recruitment rate met feasibility goals, and no major safety concerns were observed—there were no VTE events in the aspirin group and only one in the placebo group, with minimal non-major bleeding.
The authors concluded that the findings support the feasibility and safety of a larger trial to assess aspirin as a potential low-cost strategy for postpartum VTE prevention.
Venous malformations in children: Comparison between magnetic resonance imaging and histopathological findings
Tofanelli L, Napolitano M, Baraldini V, Moneghini L. Pediatr Radiol 2024 Aug;54(9):1497-1506.
In this study the authors compared magnetic resonance imaging (MRI) and histopathological findings of venous malformations in children to understand the limitations of MRI. They found that in the retrospective review of 26 patients, MRI identified micro shunts, phleboliths, and macro shunts.
The authors concluded that MRI was also found to be accurate with identifying adipose tissue and lymphatic components with accuracy and good to excellent interobserver agreement.
Risk of developing post thrombotic syndrome after deep vein thrombosis with different anticoagulant regimens: A systematic review and pooled analysis
Brown C , Tokessy L, Delluc A , Carrier M. Thromb Res. 2024 Aug:240:109057. doi: 10.1016/j.thromres.2024.109057. Epub 2024 Jun 3.
The authors conducted a literature search to understand the incidence rates of post thrombotic syndrome (PTS) in patients with DVT. The authors found that the incidence of PTS in 4342 patients treated with Vitamin K antagonists, direct oral anticoagulant (DOAC), and low molecular weight heparin were 15.1, 18.2, 24.6 respectively.
The authors concluded that the development of PTS is similar with the three anticoagulant classes, but that severe PTS is lower in patients treated with DOAC.
Use of microcirculatory parameters to evaluate foam sclerotherapy treatment of superficial chronic venous disease, associated or not with venotonic drug: Randomized, double-blind trial
Vieira JM, Porto CL, Hara WY, Oliveira BF, Bouskela E. Int Angiol 2025 Apr;44(2):83-93. doi: 10.23736/S0392-9590.25.05223-X. Epub 2025 Mar 18.
The authors studied 50 patients with CEAP 2 and CEAP 3 diseases. Patients were randomly assigned to two groups. One group received foam sclerotherapy with micronized purified flavonoid fraction (MPFF), and the other group received foam sclerotherapy with placebo. The microcirculation was evaluated using Sidestream Dark Field techniques. The VCSS scores were performed pre- and post-treatment. Both groups had improvement in the VCSS scores. The MPFF group had a greater reduction in the diameters of dermal papilla. This was not statistically significant. Additionally, capillary bulk and capillary limb also had a higher decrease in the MPFF group.
The authors concluded that foam sclerotherapy decreases venous hypertension and improves microcirculation.
The ultrasonographic diagnosis of lymph node varicose veins in the groin - an overlooked missing link in chronic venous disease?
Dulgheriu IT, Solomon C, Ciuce C, Dudea SM. Med Ultrason 2024 Sep 16;26(3):270-276. doi: 10.11152/mu-4390. Epub 2024 Jun 6.
The authors studied 183 patients who underwent doppler ultrasound of the venous circulation of the lower extremities for chronic venous disease. The authors found a statistically significant association between the presence of intranodal varicies and great saphenous vein reflux. They found a moderate to high positive correlation between chronic venous disease stage and the presence of intranodal varices.
The authors concluded that patients with more advanced chronic venous insufficiency will have a higher probability of intranodal varices.