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21 pages, 1034 KB  
Review
Superficial Venous Thrombosis in Non-Varicose Veins: A Narrative Review
by Marco Mangiafico, Francesco Lorenzo Di Pino and Luca Costanzo
J. Clin. Med. 2026, 15(3), 1082; https://doi.org/10.3390/jcm15031082 - 29 Jan 2026
Viewed by 781
Abstract
Background: Superficial venous thrombosis (SVT) is an inflammatory and thrombotic disorder affecting superficial veins. While varicose veins (VVs) are the primary risk factor, SVT occurring in non-varicose veins (NVVs) is a critical clinical finding, often acting as a sentinel marker for severe systemic [...] Read more.
Background: Superficial venous thrombosis (SVT) is an inflammatory and thrombotic disorder affecting superficial veins. While varicose veins (VVs) are the primary risk factor, SVT occurring in non-varicose veins (NVVs) is a critical clinical finding, often acting as a sentinel marker for severe systemic pathologies. Aims: This review aims at examining incidence, mechanisms, underlying causes, and clinical outcomes of SVT within the NVV population. Materials and Methods: We conducted a comprehensive narrative review of the existing medical literature. Results: SVT in NVVs is frequently associated with systemic conditions, including inherited or acquired thrombophilia, visceral or hematologic malignancies (notably Trousseau’s syndrome), vasculitis (e.g., Behçet’s syndrome), and connective tissue disorders. Specific manifestations like migratory SVT or Mondor’s disease provide crucial diagnostic clues. Notably, NVV-SVT carries a significantly higher risk of recurrence and venous thromboembolic events compared to VV-associated cases. Conclusions: A thorough diagnostic work-up is essential for patients with NVV-SVT to ensure early detection of underlying systemic diseases. Although current management does not differentiate between VV and NVV cases, the increased thromboembolic risk in the latter suggests a need for tailored therapeutic approaches. Further prospective studies are required to evaluate differentiated anticoagulant strategies regarding dosage and duration for this high-risk population. Full article
(This article belongs to the Section Vascular Medicine)
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14 pages, 245 KB  
Article
Ultrasonographic Thrombosis Rates Associated with Midline Catheters in Patients with Advanced Chronic Kidney Disease: A Prospective Cohort Study
by Christopher Montoya, Marwan Tabbara, Lea Tordjman, Marie Anne Sosa and Efren Chavez
Kidney Dial. 2026, 6(1), 6; https://doi.org/10.3390/kidneydial6010006 - 7 Jan 2026
Viewed by 998
Abstract
Background: Preserving arm veins is important for arteriovenous fistula (AVF) creation in patients with advanced chronic kidney disease (CKD), as mature AVF is the preferred hemodialysis access. Midline catheters introduced into AVF candidate veins may cause thrombosis, hindering AVF formation. This study [...] Read more.
Background: Preserving arm veins is important for arteriovenous fistula (AVF) creation in patients with advanced chronic kidney disease (CKD), as mature AVF is the preferred hemodialysis access. Midline catheters introduced into AVF candidate veins may cause thrombosis, hindering AVF formation. This study aims to determine ultrasonographic rates of midline-associated upper extremity deep venous thrombosis (UE-DVT) or superficial venous thrombosis (SVT) in patients with advanced CKD. Methods: We conducted a prospective study involving subjects with advanced CKD, who had a point-of-care ultrasound-guided midline placed in an arm vein. Within 35 days of midline insertion, participants underwent routine bilateral UE venous duplex ultrasound. The primary outcome was a composite occurrence of UE-DVT/SVT ipsilateral to the midline. Comparative analyses were performed based on patient demographics and device-specific variables. Results: 49 subjects with advanced CKD received midlines. The median midline catheter dwell time was <6 days for 15/49 patients (30.6%). The primary outcome occurred in 15/49 patients (30.6%), mostly asymptomatic thrombosis. No significant associations were found between outcomes and patient or device characteristics. Conclusions: Our study identified frequent use of midlines with short dwell times in subjects with advanced CKD which calls into question proper device selection. In this cohort, midline-associated arm clots were frequent. Full article
14 pages, 1192 KB  
Article
Global Variations in Surgical Techniques and Postoperative Care for Radial Forearm Free Flap (RFFF) in Head & Neck Surgery: A Cross-Sectional International Survey
by Elena Russo, Andrea Costantino, Giannicola Iannella, Filippo Marchi, Antonio Greco, Luca Calabrese, Antonella Polimeni, Remo Accorona, Armando De Virgilio and RFFFSurv Collaborative
J. Clin. Med. 2025, 14(22), 8023; https://doi.org/10.3390/jcm14228023 - 12 Nov 2025
Viewed by 1167
Abstract
Objective: This cross-sectional survey aimed to comprehensively gather data on radial forearm free flap (RFFF) utilization and practices in head and neck reconstructive surgery. Methods: An online questionnaire was organized into seven sections: demographics, surgeon experience, harvesting techniques, microsurgical considerations, postoperative [...] Read more.
Objective: This cross-sectional survey aimed to comprehensively gather data on radial forearm free flap (RFFF) utilization and practices in head and neck reconstructive surgery. Methods: An online questionnaire was organized into seven sections: demographics, surgeon experience, harvesting techniques, microsurgical considerations, postoperative care, flap monitoring, and outcomes. It was distributed by email to 216 head and neck reconstructive surgeons who attended the International Federation of Head and Neck Oncologic Societies (IFHNOS) congress in Rome (21–25 June 2023) using the congress mailing list. Responses were collected from 54 surgeons (25% response rate), representing 15 countries across Europe, Asia, the Americas, and Oceania, underscoring the international scope of the survey between 5 February and 25 March 2024. The questionnaire was not formally piloted or validated. Missing data were managed on a per-question basis. Descriptive statistics were used, and 95% confidence intervals (CIs) were calculated for key surgical outcomes to indicate estimate precision. Associations between categorical variables were analyzed using Pearson’s χ2 test with Cramér’s V as an effect size, and relationships between continuous variables were examined using Spearman’s rank correlation (ρ) with 95% confidence intervals (CIs). Given the exploratory design and limited sample size, no correction for multiple comparisons was applied, and the risk of both Type I and Type II errors was acknowledged. Results: Variations were observed in harvesting techniques, microsurgical preferences, and postoperative care protocols. Most surgeons initiated flap harvesting concurrently with tumor resection, primarily preserving superficial sensory nerves. Regarding venous outflow, 50% of respondents preferred the cephalic vein, 19% used comitant veins, and 29% utilized both systems when possible. Perioperative antibiotic use was standard practice, though anticoagulant preferences and flap monitoring methods varied. The study achieved a high success rate for RFFF procedures, exceeding 95%, with venous thrombosis identified as the main cause of flap failure. No significant correlations were found between flap failure rate and training method (p = 0.21), specialty (p = 0.37), annual number of RFFF procedures (p = 0.89), surgeon age (p = 0.42), or hospital type (p = 0.48). Effect sizes were small to moderate, indicating weak or negligible associations. Similarly, perioperative factors such as anticoagulant use (p = 0.84), preoperative antibiotics (p = 0.42), surgical instruments (p = 0.61), suture techniques (p = 0.51), and donor vein selection (p = 0.20) showed no statistically significant associations with flap loss. Patient satisfaction assessments were inconsistent, with only 39% of surgeons routinely performing them. Conclusions: The study provides valuable insights into current RFFF practices and outcomes across an international cohort of head and neck surgeons, highlighting patterns and variability in techniques, perioperative care, and monitoring strategies. Full article
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13 pages, 1302 KB  
Review
Venous Manifestations of Gastric Cancer: Bilateral Varicose Veins as a Rare Initial Presentation—A Narrative Review
by Anna Laura Maiozzi, Filomena Botta, Silvia Maccioni, Livia Stanga, Lucretia Marin-Bancila, Ciprian Ilie Rosca, Anca Dinu, Abhinav Sharma and Nilima Rajpal Kundnani
Gastrointest. Disord. 2025, 7(4), 70; https://doi.org/10.3390/gidisord7040070 - 31 Oct 2025
Viewed by 2283
Abstract
Background: Varicose veins (VVs) are an overlying manifestation of chronic venous disease, commonly occurring in the lower extremities. While typically linked to primary venous insufficiency, they can occasionally be secondary to systemic disease, e.g., malignancies, by various mechanisms such as tumor compression, hypercoagulability, [...] Read more.
Background: Varicose veins (VVs) are an overlying manifestation of chronic venous disease, commonly occurring in the lower extremities. While typically linked to primary venous insufficiency, they can occasionally be secondary to systemic disease, e.g., malignancies, by various mechanisms such as tumor compression, hypercoagulability, and paraneoplastic syndromes. Bilateral varicose veins, as a presenting symptom of gastric cancer, are extremely rare and poorly documented. Materials and Methods: A comprehensive literature search was conducted to identify reports and studies linking varicose veins and malignancies, with particular focus on gastric cancer. The search was performed using the PubMed, Scopus, and Web of Science databases covering the last 13 years. Results: Literature Review: A review of the literature in the past decade identified publications, mostly case reports, describing associations between varicose-like venous changes and malignancies such as gastric, pancreatic, hepatic, and small-bowel tumors. The predominant mechanisms reported were inferior vena cava obstruction, tumor-related thrombosis, and paraneoplastic migratory superficial thrombophlebitis (Trousseau’s syndrome). Only a few cases involved gastric cancer as the primary site, with venous changes often being the first clinical sign. There is limited experience with gastric cancer that presents alongside bilateral collateral or varicose veins initially. Apart from the various reports having malignancies and varicose veins we also describe the case of a 50-year-old man who had extended history of bilateral lower-limb varicose veins. Severe, unexplained anaemia without obvious bleeding was discovered during examination. A biopsy verified a gastric adenocarcinoma, while upper gastrointestinal endoscopy revealed an ulcerated mass on the stomach’s greater curvature. Peritoneal dissemination was discovered with additional staging. A palliative subtotal gastrectomy was carried out because of the patient’s ongoing anaemia and suspected chronic bleeding caused by the tumour. The venous symptoms preceded any gastrointestinal issues. Conclusions: Although uncommon, malignancy should be considered in the differential diagnosis for atypical or rapidly progressing bilateral varicose veins, especially when accompanied by systemic symptoms or lab results such as unexplained anemia. Increased suspicion may lead to earlier cancer detection in some patients. Full article
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Article
Plantar Vein Thrombosis in a Patient with Hyperhomocysteinemia: A Case Report
by Thomas Saliba, Charlotte Wynants, Dominique Pottier, Karim Abdelkafi and Sanjiva Pather
J. Am. Podiatr. Med. Assoc. 2025, 115(5), 23219; https://doi.org/10.7547/23-219 - 1 Sep 2025
Viewed by 69
Abstract
Hyperhomocysteinemia (HHcy), defined as having over 15 µmol/l of homocysteine in the blood, is a disease that is generally linked to either a metabolic defect or a dietary deficiency. Patients suffering from HHcy are known to have elevated risks of arterial cardiovascular events, [...] Read more.
Hyperhomocysteinemia (HHcy), defined as having over 15 µmol/l of homocysteine in the blood, is a disease that is generally linked to either a metabolic defect or a dietary deficiency. Patients suffering from HHcy are known to have elevated risks of arterial cardiovascular events, neuropsychiatric illness, compromised bone health, and increased risk of vein thrombosis in unusual anatomical locations. We present the case of a 45-year-old woman diagnosed with HHcy, who presented with acute pain on the sole of her right foot. The patient had previously experienced recurrent superficial venous thrombosis in the plantar veins. The patient was referred for an ultrasound, which revealed plantar metatarsal vein thrombosis. With fewer than 50 reported cases of plantar vein thrombosis in the literature, none of which are currently linked to HHcy, this is a very rare form of thromboembolic event. This case underscores the importance of considering thromboembolic events in atypical locations, in patients with HHcy who present with pain, even if these patients lack other major risk factors. Our case contributes to the growing body of literature on venous thrombosis in patients with HHcy and emphasizes the need for heightened clinical awareness in such patients. We further highlight the need to be aware of their propensity to develop thrombosis in unusual anatomical locations. Full article
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14 pages, 3544 KB  
Article
Assessing Endovenous Heat-Induced Thrombosis in Flush Endovenous Laser Ablation: A Study on Incidence, Risk Factors, and Patient Outcomes
by Mihai Cosmin Burta, Adela Avram, Radu Florian Avram, Steven Kristofor Rogers, Frank Lee Bowling, Stefan Ionac and Mihai Edmond Ionac
J. Clin. Med. 2025, 14(17), 6165; https://doi.org/10.3390/jcm14176165 - 31 Aug 2025
Cited by 3 | Viewed by 2277
Abstract
Introduction: The introduction of radial-firing laser fibers has minimized catheter-to-vein distance during endovenous laser ablation (EVLA) for the great saphenous vein (GSV) and anterior saphenous veins (ASVs). This study investigates flush endovenous laser ablation (fEVLA) effectiveness in addressing chronic superficial venous insufficiency (CVI). [...] Read more.
Introduction: The introduction of radial-firing laser fibers has minimized catheter-to-vein distance during endovenous laser ablation (EVLA) for the great saphenous vein (GSV) and anterior saphenous veins (ASVs). This study investigates flush endovenous laser ablation (fEVLA) effectiveness in addressing chronic superficial venous insufficiency (CVI). Materials and methods: This single-center retrospective study analyzed consecutive fEVLA cases with duplex ultrasound follow-up at 1, 4, and 12 weeks. The primary endpoint was clinically significant endovenous heat-induced thrombosis (classes III–IV). Results: Three hundred and twelve patients were recruited (405 affected limbs, 369 GSV, and 36 ASV). CEAP classifications were stratified as follows: C2 in 6.1%, C3 in 34.2%, C4 in 44%, C5 in 2.7%, and C6 in 12.7% of cases. Perforator ligation, phlebectomy, or foam sclerotherapy were carried out in conjunction with EVLA. fEVLA was feasible in all cases. The success rate was 96.78%, defined as EHIT classes 1 and 2, and assessed by ultrasound one week postoperatively. Clinically significant EHIT (2.5% class 3 and 0.2% class 4) was managed with 15 mg rivaroxaban twice daily for 21 days. Follow-up at 4 weeks revealed complete resolution of all EHIT 3–4 cases. No cases of pulmonary embolism or deep vein thrombosis were observed during the study or follow-up period. Conclusions: fEVLA is a safe treatment for superficial CVI across various CEAP classes, and with prompt detection, the minimal complication rate can be completely resolved. Full article
(This article belongs to the Section Vascular Medicine)
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11 pages, 219 KB  
Article
Superficial Vein Thrombosis in Obese Patients
by Lucía Ordieres-Ortega, Rubén Alonso-Beato, Tatiana Pire-García, Sergio Moragón-Ledesma, Marina López-Rubio, Marta-Olimpia Lago-Rodríguez, Luis Antonio Alvarez-Sala Walther, Francisco Galeano-Valle and Pablo Demelo-Rodríguez
J. Clin. Med. 2025, 14(14), 5024; https://doi.org/10.3390/jcm14145024 - 16 Jul 2025
Cited by 1 | Viewed by 1130
Abstract
Background: The optimal anticoagulation strategy for obese patients with superficial vein thrombosis (SVT) remains unclear. This study evaluates the impact of obesity on anticoagulation patterns and clinical outcomes in patients with lower limb SVT. Methods: We conducted a prospective observational study including consecutive [...] Read more.
Background: The optimal anticoagulation strategy for obese patients with superficial vein thrombosis (SVT) remains unclear. This study evaluates the impact of obesity on anticoagulation patterns and clinical outcomes in patients with lower limb SVT. Methods: We conducted a prospective observational study including consecutive patients with SVT in a tertiary hospital from 2014 to 2024. Patients with SVT ≥ 5 cm in length and ≥3 cm from the saphenofemoral junction were included. Obese (BMI ≥ 30) and non-obese (BMI < 30) patients were compared. Patients were followed for one year. Outcomes were assessed at 90 and 365 days. The primary outcomes were venous thromboembolism (VTE) recurrence (SVT, deep vein thrombosis [DVT], or pulmonary embolism [PE]). The secondary outcomes were major bleeding and all-cause mortality. Results: Of 136 patients, 58 (42.6%) were obese. Both groups had similar baseline characteristics, except for younger age and higher smoking prevalence in obese patients. Most patients received anticoagulation (91.9%), primarily a prophylactic dose of low molecular weight heparin or a prophylactic dose of fondaparinux. No significant differences were found in VTE recurrence at 90 or 365 days (p = 0.505), and no major bleeding events occurred. Female sex was associated with a higher risk of VTE recurrence (OR 4.33, 95% CI 1.17–15.98, p = 0.028), but obesity did not influence outcomes. Conclusions: Obesity was not associated with increased VTE recurrence in patients with lower limb SVT. No major bleeding events were observed. These findings suggest that standard anticoagulation regimens may be appropriate for obese patients with SVT, but further studies are needed to confirm these results. Full article
(This article belongs to the Section Vascular Medicine)
30 pages, 3837 KB  
Review
Challenges and Opportunities of Direct Oral Anticoagulant (DOAC) Therapy in Complex Clinical Scenarios: A Comprehensive Review and Practical Guide
by Giuseppe Miceli, Anna Maria Ciaccio and Antonino Tuttolomondo
J. Clin. Med. 2025, 14(9), 2914; https://doi.org/10.3390/jcm14092914 - 23 Apr 2025
Cited by 15 | Viewed by 17699
Abstract
Direct oral anticoagulants (DOACs) have emerged as a preferred alternative to vitamin K antagonists (VKAs) for the prevention and treatment of thromboembolic disorders, offering improved safety, predictable pharmacokinetics, and ease of administration. Despite these advantages, their use in complex clinical scenarios presents significant [...] Read more.
Direct oral anticoagulants (DOACs) have emerged as a preferred alternative to vitamin K antagonists (VKAs) for the prevention and treatment of thromboembolic disorders, offering improved safety, predictable pharmacokinetics, and ease of administration. Despite these advantages, their use in complex clinical scenarios presents significant challenges that necessitate individualized therapeutic strategies. This comprehensive review explores the efficacy, safety, and limitations of DOAC therapy in special populations, including patients with renal or hepatic impairment, obesity, cancer-associated thrombosis, and antiphospholipid syndrome. Additionally, we examine their role in uncommon thrombotic conditions such as superficial venous thrombosis, embolic stroke of undetermined source, upper extremity vein thrombosis, inferior vena cava thrombosis, pelvic vein thrombosis, and cerebral vein thrombosis. The pharmacokinetic variability of DOACs in renal and hepatic dysfunction requires caution to balance the bleeding and thrombotic risks. In obesity, altered drug distribution and metabolism raise concerns regarding appropriate dosing and therapeutic efficacy. Cancer-associated thrombosis presents a complex interplay of prothrombotic mechanisms, necessitating careful selection of anticoagulant therapy. Furthermore, the use of DOACs in antiphospholipid syndrome remains controversial due to concerns about recurrent thrombotic events. Finally, in some unusual scenarios like inferior vena cava, pelvic vein, and cerebral vein thrombosis, the use of DOACs has scarce evidence. This review aims to guide clinicians in optimizing anticoagulation management in challenging patient populations by synthesizing current evidence and providing practical recommendations. Full article
(This article belongs to the Special Issue Thromboembolic Disease and Antithrombotic Therapy)
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11 pages, 440 KB  
Review
Topical Heparin and Heparinoid-Containing Products as Treatments for Venous Disorders: Compounds, Effects, Clinical Implications, and Recommendations
by Daniele Bissacco, Chiara Pisani, Gianraffaele Avallone and Ilenia D’Alessio
J. Clin. Med. 2025, 14(6), 1859; https://doi.org/10.3390/jcm14061859 - 10 Mar 2025
Cited by 1 | Viewed by 23184
Abstract
Background: Although considerable data are available on oral venoactive drugs, very little information has been published on the types and outcomes of topical treatments for venous disease (VD). This comprehensive review assesses the efficacy and safety of topical heparin and heparinoid-containing products [...] Read more.
Background: Although considerable data are available on oral venoactive drugs, very little information has been published on the types and outcomes of topical treatments for venous disease (VD). This comprehensive review assesses the efficacy and safety of topical heparin and heparinoid-containing products (HCPs) for VD treatment. Methods: This narrative review adhered to established methodologies and standards, utilizing the Scale for the Assessment of Narrative Review Articles (SANRA) for quality assessment. A comprehensive literature search was conducted across MEDLINE (PubMed), Scopus, and Web of Science, covering publications from January 1, 1950, to December 1, 2024. Findings were presented in a narrative format, following structured recommendations to ensure clarity and coherence. Results: Topical heparin and HCPs provide anticoagulation, enhance microcirculation, and regulate skin permeability, with effects influenced by the concentration and formulation. While they effectively improve skin microcirculation in healthy individuals, research on their intracellular effects is limited. Mucopolysaccharide polysulfate (MPS) in heparinoids offers similar vascular benefits and promotes antithrombotic and anti-inflammatory actions. Moisture and gentle abrasion enhance heparin absorption. Topical heparin and HCPs effectively treat superficial vein thrombosis (SVT) and varicose veins (VVs). Products like Hirudoid significantly alleviate SVT symptoms, including pain and swelling. Clinical trials demonstrate substantial symptom improvement with heparin gel (1000 IU/g). For varicose veins, Xioglican cream stabilizes symptoms and improves quality of life, while other formulations like Essaven Gel and Venoruton enhance microcirculation. Conclusions: Managing VD with topical treatments is complicated by the outdated literature and inconsistent methodologies. There is a clear need for systematic research to establish guidelines on the administration, dosage, and frequency of topical treatments. The recommendations in this review aim to provide a foundation for future studies to improve the management of SVT and VVs disease. Full article
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10 pages, 226 KB  
Article
The Effects of Syphilis Infection on Total Knee Arthroplasty Outcomes: A Retrospective Cohort Study
by Paul Gudmundsson, Marc Gadda, Aruni Areti and Senthil Sambandam
J. Clin. Med. 2024, 13(23), 7116; https://doi.org/10.3390/jcm13237116 - 25 Nov 2024
Viewed by 1955
Abstract
Objective: This study investigated the impact of recent syphilis infection on postoperative outcomes following total knee arthroplasty (TKA). We hypothesized that patients with a documented history of syphilis infection would experience a higher rate of postoperative complications compared to those without such a [...] Read more.
Objective: This study investigated the impact of recent syphilis infection on postoperative outcomes following total knee arthroplasty (TKA). We hypothesized that patients with a documented history of syphilis infection would experience a higher rate of postoperative complications compared to those without such a history. Methods: We conducted a retrospective cohort analysis using a national insurance claims database. Our study population included 237,360 patients who underwent primary TKA between 2005 and 2024. Patients were classified into two groups based on the presence (+Syph) or absence (−Syph) of a syphilis diagnosis within one year prior to the TKA. We evaluated the rates of several postoperative complications at 30 days postsurgery, including infection, hematologic issues, and cardiac events. Statistical analyses between groups was performed using chi-squared tests and Fisher’s exact tests. Routine demographic data such as age, sex, race, and comorbidities were also analyzed. Results: Among the 237,360 TKA patients, we identified 71 with a history of syphilis within one year of their surgery. The +Syph group exhibited significantly higher rates of periprosthetic infection (4.23% vs. 0.81%, p = 0.001), need for manipulation under anesthesia (MUA) at four months (7.04% vs. 2.82%, p = 0.032), deep venous thrombosis (4.23% vs. 1.27%, p = 0.026), periprosthetic fracture (2.82% vs. 0.23%, p < 0.001), and pneumonia (2.82% vs. 0.62%, p = 0.019) within 30 days postTKA. No significant differences were observed in 30-day mortality, deep or superficial surgical site infections, wound dehiscence, blood loss anemia, or transfusion requirements. Additionally, rates of acute renal failure, pulmonary embolism, and cardiac events did not differ significantly between groups. Demographically, patients in the syphilis cohort had a higher prevalence of smoking and diabetes preoperatively within one year of their surgical date. Conclusions: A documented syphilis diagnosis within one year of TKA significantly affects postoperative outcomes, increasing the rates of prosthetic joint infection, MUA, deep venous thrombosis, periprosthetic fracture, and pneumonia. These findings underscore the need for heightened vigilance in the pre- and postoperative management of patients with a history of syphilis infection undergoing TKA. Further research is warranted to explore the relationship between prior syphilis infection and TKA outcomes, as well as to develop strategies to mitigate this increased risk. Full article
(This article belongs to the Special Issue Arthroplasty: Advances in Surgical Techniques and Patient Outcomes)
16 pages, 1663 KB  
Review
Current Diagnostic and Therapeutic Challenges in Superficial Venous Thrombosis
by Ana-Maria Balahura, Adrian-Gabriel Florescu, Teodora-Maria Barboi, Emma Weiss, Daniela Miricescu, Ciprian Jurcuț, Mariana Jinga and Silviu Stanciu
Medicina 2024, 60(9), 1466; https://doi.org/10.3390/medicina60091466 - 6 Sep 2024
Cited by 3 | Viewed by 13253
Abstract
Superficial venous thrombosis (SVT) is a fairly common disorder, characterized by the formation of thrombi inside superficial veins, with or without an associated inflammatory reaction. Its evolution is frequently self-limited. However, serious complications may change this clinical course with extension to deep vein [...] Read more.
Superficial venous thrombosis (SVT) is a fairly common disorder, characterized by the formation of thrombi inside superficial veins, with or without an associated inflammatory reaction. Its evolution is frequently self-limited. However, serious complications may change this clinical course with extension to deep vein thrombosis (DVT) and pulmonary embolism (PE). SVT shares similar risk factors with DVT and is frequently associated with the presence of varicose veins. However, the occurrence of non-varicose veins could conceal risk factors such as malignancies, thrombophilia, or Buerger’s disease. While the clinical diagnosis is generally straightforward, additional diagnostic evaluations are often necessary. Duplex ultrasound (DUS) is an invaluable tool that provides the location of SVT, the proximity to the sapheno–femoral junction, and the clot length, all of which influence the decision for optimal management. The treatment of SVT should be symptomatic, pathogenic (limiting the extension of thrombosis), and prognostic (to prevent complications). There are several guidelines that provide recommendations, and despite the need for more consensus and for further studies, the treatment of SVT should be mainly medical, including anticoagulation in specific clinical situations and symptom relief, with invasive treatment in a minority of cases. Initiation, intensity, and length of anticoagulant treatment should be based on the eventual risk of progression to DVT or PE, which can be high, intermediate, or low, based on the location of SVT and the clot length. Our review summarizes the evaluation and proper management of SVT and highlights the importance of a shared decision within the heart team regarding this condition in order to prevent further complications. Full article
(This article belongs to the Special Issue The Challenges and Prospects in Clinical Cardiology and Angiology)
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20 pages, 2420 KB  
Case Report
Superficial Vein Thrombosis in an Asymptomatic Case of Cholangiocarcinoma with Recent History of COVID-19
by Mihai-Lucian Ciobica, Bianca-Andreea Sandulescu, Mihai Alexandru Sotcan, Lucian-Marius-Florin Dumitrescu, Lucian-George Eftimie, Cezar-Ionut Calin, Mihaela Iordache, Dragos Cuzino, Mara Carsote, Claudiu Nistor and Ana-Maria Radu
Life 2024, 14(9), 1095; https://doi.org/10.3390/life14091095 - 30 Aug 2024
Cited by 1 | Viewed by 2931
Abstract
The COVID-19 pandemic brought into prominence several emergent medical and surgical entities, but, also, it served as trigger and contributor for numerous apparently unrelated ailments such as arterial and venous thromboembolic complications. Additional risk factors for these thrombotic traits may be concurrent (known [...] Read more.
The COVID-19 pandemic brought into prominence several emergent medical and surgical entities, but, also, it served as trigger and contributor for numerous apparently unrelated ailments such as arterial and venous thromboembolic complications. Additional risk factors for these thrombotic traits may be concurrent (known or unknown) malignancies, including at hepatic level. Among these, cholangiocarcinoma (CCA), a rare cancer of intra- and extra-hepatic biliary ducts, represents a very aggressive condition that typically associates local and distant advanced stages on first presentation requiring a prompt diagnosis and a stratified management. This neoplasia has been reported to present a large spectrum of paraneoplastic syndromes in terms of dermatologic, renal, systemic, neurologic, endocrine, and cardiovascular settings, that, overall, are exceptional in their epidemiologic impact when compared to other cancers. Our aim was to introduce a most unusual case of CCA-associated distant thrombosis in a male adult who initially was considered to experience COVID-19-related thrombotic features while having a history of obesity and bariatric surgery. This is a hybrid type of paper: this clinical vignette is accompanied by two distinct sample-focused analyses as a basis for discussion; they each had different methods depending on their current level of statistical evidence. We only included English-published articles in PubMed, as follows: Firstly, we conducted a search of reports similar to the present case, regarding distant vein thrombosis in CCA, from inception until the present time. We performed a literature search using the keywords “cholangiocarcinoma”, “thrombosis”, and “Trousseau’s syndrome” and identified 20 cases across 19 original papers; hence, the current level of evidence remains very low Secondly, we searched for the highest level of statistical evidence concerning the diagnosis of venous thrombosis/thromboembolism in patients who underwent COVID-19 infection (key search terms were “COVID-19”, alternatively, “coronavirus”, and “SARS-CoV-2”, and “thrombosis”, alternatively, “thromboembolism”) and included the most recent systematic reviews and meta-analyses that were published in 2024 (from 1 January 2024 until 8 July 2024). After excluding data on vaccination against coronavirus or long COVID-19 syndrome, we identified six such articles. To conclude, we presented a probably unique case of malignancy with an initial manifestation consisting of recurrent superficial vein thrombosis under anticoagulation therapy, with no gastrointestinal manifestations, in a patient with a notable history for multiple episodes of SARS-CoV-2 infection and a prior endocrine (gastric) surgery. To our knowledge, this is the first identification of a CCA under these specific circumstances. Full article
(This article belongs to the Special Issue Novel Diagnosis and Treatment of Gastrointestinal Disease)
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10 pages, 514 KB  
Review
Dual-Mobility Cups in Patients Undergoing Primary Total Hip Arthroplasty with Prior Lumbar Spine Fusion: A Systematic Review
by Tariq Ziad Issa, Adam Pearl, Emelia Moore, Hannan Ahmad Maqsood and Khaled J. Saleh
Surgeries 2024, 5(2), 125-134; https://doi.org/10.3390/surgeries5020014 - 25 Mar 2024
Cited by 1 | Viewed by 4703
Abstract
Spine and hip abnormalities frequently occur together in most of the orthopedic population; therefore, both of these abnormalities impact the outcomes of the modalities that are being used. Few studies have reported reduced dislocation and revision rates with the use of dual-mobility cups [...] Read more.
Spine and hip abnormalities frequently occur together in most of the orthopedic population; therefore, both of these abnormalities impact the outcomes of the modalities that are being used. Few studies have reported reduced dislocation and revision rates with the use of dual-mobility cups (DMCs) in high-risk lumbar spine fusion (LSF) patients undergoing primary total hip arthroplasty (THA). This study aims to clarify the relationship between pre-existing lumbar spinal fusion and the outcomes of THA with dual-mobility constructs. We systematically reviewed the current literature through several online databases following PRISMA protocol and the Cochrane Handbook for Systematic Reviews of Interventions. We used the methodological index for non-randomized studies (MINORS) to evaluate the methodological quality of the included trials. Four studies examined the feasibility and effectiveness of dual-mobility cups in patients undergoing primary THA with prior LSF. Two studies were conducted in the United States, while the other two originated in Finland and France, respectively. The included studies enrolled 284 patients. Most of these patients had instrumented fusions. Seventy-eight percent of patients received one- or two-level fusions. The average age across the studies was 68.22 and the mean body mass index was 28. No cases of postoperative DMC implant dislocations were identified. The incidence of postoperative complications was 6% (10/173), including deep venous thrombosis, periprosthetic loosening, infection, and fracture, greater trochanteric fracture, and superficial wound infections. Most included studies had some methodological limitations, with an average MINORS score of 10.5 ± 5.8. The use of dual-mobility cups in these high-risk patients undergoing total hip arthroplasty may lead to reduced dislocation rates and postoperative complications. Further long-term follow-up studies are warranted to support these findings. Full article
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16 pages, 512 KB  
Review
Superficial Venous Thrombosis: A Comprehensive Review
by Marco Mangiafico and Luca Costanzo
Healthcare 2024, 12(4), 500; https://doi.org/10.3390/healthcare12040500 - 19 Feb 2024
Cited by 17 | Viewed by 13920
Abstract
Superficial venous thrombosis (SVT), an inflammatory–thrombotic process of a superficial vein, is a relatively common event that may have several different underlying causes. This phenomenon has been generally considered benign, and its prevalence has been historically underestimated; the estimated incidence ranges from about [...] Read more.
Superficial venous thrombosis (SVT), an inflammatory–thrombotic process of a superficial vein, is a relatively common event that may have several different underlying causes. This phenomenon has been generally considered benign, and its prevalence has been historically underestimated; the estimated incidence ranges from about 0.3 to 1.5 event per 1000 person-years, while the prevalence is approximately 3 to 11%, with different reports depending on the population studied. However, such pathology is not free of complications; indeed, it could extend to the deep circulation and embolize to pulmonary circulation. For this reason, an ultrasound examination is recommended to evaluate the extension of SVT and to exclude the involvement of deep circulation. Also, SVT may be costly, especially in the case of recurrence. Therefore, accurate management is necessary to prevent sequelae and costs related to the disease. This review aims to analyse the epidemiology of SVT, its complications, optimal medical treatment, and open questions with future perspectives. Full article
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Article
Factors Associated with the Evolution of Superficial Vein Thrombosis and Its Impact on the Quality of Life: Results from a Prospective, Unicentric Study
by Blanca Ros Gómez, Javier Gómez-López, Manuel Quintana-Díaz, Sheila Victoria Calvo Sevilla, Pablo Rodríguez-Fuertes, Fabian Tejeda-Jurado, Paula Berrocal-Espinosa, Juan Francisco Martínez-Ballester, Sonia Rodríguez-Roca, María Angélica Rivera Núñez, Ana M. Martínez Virto, Alberto Martín-Vega, Carmen Fernández-Capitán, Giorgina Salgueiro-Origlia, Raquel Marín-Baselga, Alicia Lorenzo Hernández, Teresa Sancho Bueso, Ramón Puchades Rincón de Arellano, Belén Gutiérrez-Sancerni, Alejandro Díez-Vidal, Sergio Carrasco-Molina and Yale Tung-Chenadd Show full author list remove Hide full author list
J. Vasc. Dis. 2024, 3(1), 1-10; https://doi.org/10.3390/jvd3010001 - 2 Jan 2024
Cited by 1 | Viewed by 3985
Abstract
Background: Superficial venous thrombosis (SVT) is a common clinical condition caused by inflammation and the presence of a thrombus inside a superficial vein. It has traditionally been considered a benign and banal disorder, although it can progress or can be associated with thromboembolic [...] Read more.
Background: Superficial venous thrombosis (SVT) is a common clinical condition caused by inflammation and the presence of a thrombus inside a superficial vein. It has traditionally been considered a benign and banal disorder, although it can progress or can be associated with thromboembolic disease of deep territories in up to 20%, asymptomatic or symptomatic pulmonary embolism (PE), especially if it affects the main trunk of the internal saphenous vein. The impact of deep vein thrombosis on the quality of life and its sequelae have long been described in the literature; however, they have not been studied in superficial vein thrombosis. Objectives: We aimed to evaluate the risk factors, management, and complications of SVT and its impact on the quality of life of our patients. Methods: Observational, prospective, single-center study to evaluate the management of SVT. The ultrasound (US) was performed initially on symptomatic patients, during treatment with low-molecular-weight heparin (LMWH), at a follow-up, and at the end of 45 days of treatment. A quality-of-life questionnaire was administered to determine the risk factors, management, and complications of SVT at the moment of diagnosis and at the end of treatment. We included patients referred from the emergency department to a monographic consultation for thromboembolic disease, over 18 years of age with a diagnosis of acute SVT symptomatic, without contraindication to initiate anticoagulation. Results: In total, 63 patients were evaluated between October 2020 and April 2022. The mean age was 65.8 years (SD 13.5), of which 35 were women (55.6%), 39 presented cardiovascular risk factors (61.9%), 25 had a history of previous personal venous thromboembolism (VTE) (39.7%), and 10 had obesity (15.9%), 47 had chronic venous insufficiency or varicose veins (74.9%). During follow-up with ultrasound, 39.7% had partial revascularization, and at discharge, 63.5% had permeabilized the thrombosis against 19% who had residual thrombosis or progression of thrombosis. There was a positive correlation between mobility parameters and improvement in the performance of daily activities (rho = 0.35; p = 0.012) and with improvement in pain/discomfort (rho = 0.37; p = 0.007). An improvement in pain parameters was statistically significantly related to a global assessment health perception (rho = 0.48; p < 0.001). Anxiety and depression parameters were related to a global assessment health perception (rho = 0.462; p = 0.001) and to an overall improvement at 12 months (rho = 0.45; p = 0.001). CONCLUSIONS: Superficial venous thrombosis (SVT) is a highly prevalent disease, which is traditionally considered banal and has good evolution, with heterogeneous management in clinical practice and limited information on patient selection for therapies, current treatment routes, and drug use, as well as outcomes. In recent years, the importance of this entity has become evident due to its frequency in clinical practice, its risk of complications, and the impact it has on the quality of life. This study’s results emphasize the importance of the diagnosis, treatment, and follow-up of superficial venous thrombosis. Full article
(This article belongs to the Section Peripheral Vascular Diseases)
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