Objective: The efficacy of routine inferior vena cava (IVC) filter placement during catheterdirected thrombolysis (CDT) or pharmacomechanical thrombectomy (PMT) for iliofemoral deep vein thrombosis (IF-DVT) remains controversial. This study aimed to evaluate whether routine IVC filter placement improves prevention of pulmonary thromboembolism (PTE) or recurrent venous thromboembolism (VTE) in this population. Methods: We retrospectively reviewed adults with acute IF-DVT treated with CDT/PMT (March 2021–February 2025) and compared outcomes between a filter group (n=17) and no-filter group (n=21). All patients received six months of oral anticoagulation. The primary outcome was incident PTE within six months. Secondary endpoints included the 6-month composite of recurrent VTE (recurrent deep vein thrombosis and/or PTE), inferior vena cava thrombosis, and target-limb stent occlusion. Results: Baseline limb laterality, thrombus extent, and concomitant PTE were similar. Primary outcome: PTE at six months—0/17 (0%) in the filter group vs 1/21 (4.8%) in the nofilter group (p>0.999). Secondary outcomes: recurrent DVT—3/17 (18%) vs 1/21 (4.8%) (p=0.307); IVC thrombosis—1/17 (5.9%) vs 0/21 (0%) (p=0.447); stent occlusion—1/17 (5.9%) vs 2/21 (9.5%) (p>0.999). Event-free survival also did not differ (log-rank p=0.43).Beyond six months, long-term composite events were infrequent with no significant differences. Conclusion In anticoagulated patients undergoing CDT/PMT for acute IF-DVT, routine prophylactic IVC filter placement did not improve short- or long-term outcomes, including prevention of PTE. These data support a selective, rapid-retrieval strategy for highembolic-risk scenarios.

Chronic venous disease (CVD) presents a major public-health burden and is frequently managed via minimally invasive endovenous ablation techniques. Although these modalities have replaced traditional open surgery due to favorable safety and recovery profiles, early complications remain under-reported and may compromise patient outcomes and practitioner trust. In this review we define “early complications” as those occurring intra-operatively or within 24 hours of the procedure and provide a structured overview of the incidence, mechanisms, risk-factors and management strategies across thermal (laser, radiofrequency) and non-thermal (mechanochemical, cyanoacrylate) ablation methods. Thermal ablation carries inherent risks such as skin burns, nerve injury, and hemorrhage/hematoma. Non-thermal technologies reduce thermal damage but introduce distinct complications including adhesive hypersensitivity, phlebitis and thrombotic events. We summarize reported incidence rates, highlight anatomical and procedural risk-factors, and propose a framework for prevention and management of these events. Key practical implications include the need for standardized reporting of early adverse events, informed consent addressing realistic risk profiles, protocolized peri-procedural pathways in venous centers, and close monitoring for postoperative complications is essential. Early complications may be uncommon but are clinically significant—recognition, stratification of risk, prompt diagnosis and intervention are essential to preserve the safety profile of endovenous ablation.

D-dimer testing has long been established as a cornerstone in the diagnostic evaluation of suspected venous thromboembolism (VTE), offering a high negative predictive value when combined with clinical probability assessment. However, its performance and interpretation remain challenging in real-world practice, particularly among patients with high baseline thrombotic risk or a history of previous deep vein thrombosis (DVT). This review summarizes recent advances and practice patterns concerning Ddimer-based diagnostic algorithms, with an emphasis on their application in complex clinical settings. Recent evidence demonstrates that D-dimer retains diagnostic value in low- and intermediate-probability patients but loses specificity in the presence of active malignancy, postoperative inflammation, or chronic vascular disease. In individuals with prior DVT, baseline elevation and residual thrombus often lead to false-positive results, underscoring the need for integrated diagnostic strategies combining D-dimer testing with compression ultrasonography and validated clinical scores. Despite the availability of refined approaches, such as age-adjusted or pretest-probability-adjusted thresholds, their implementation in routine care remains limited. Real-world data reveal frequent test overuse, variable assay interpretation, and inconsistent adherence to guidelinerecommended diagnostic pathways. Understanding these limitations and contextual factors is essential to enhance diagnostic precision and resource utilization. Future directions include improved algorithm adherence through electronic decision-support systems, harmonization of assay reporting standards, and further validation of D-dimer– based models in diverse patient populations.

Venous leg ulcers (VLUs) represent the most advanced manifestation of chronic venous disease and arise from sustained ambulatory venous hypertension due to superficial reflux, deep venous obstruction, or both. Accurate etiologic assessment is essential, with duplex ultrasound serving as the primary tool to identify axial reflux, perforator incompetence, and signs of proximal outflow obstruction in accordance with contemporary ESVS and SVS/AVF guidelines. Compression therapy remains the foundation of treatment, with inelastic or adjustable compression systems providing the most effective pressure reduction and edema control. Optimal wound care—including moisturebalancing dressings, debridement, and judicious use of antimicrobials—supports timely epithelialization. Adjunctive pharmacologic agents such as micronized purified flavonoid fraction, pentoxifylline, and sulodexide may further enhance healing. Early correction of superficial reflux accelerates healing and reduces recurrence, as demonstrated in the Early Venous Reflux Ablation trial. Iliac venous obstruction should be considered in nonhealing or recurrent ulcers, with IVUS-guided stenting appropriate when significant stenosis is confirmed. Integrating guideline-directed venous intervention, optimized compression, and structured wound care is central to improving long-term outcomes in VLU management.

Mechanochemical ablation is one of the non-thermal, non-tumescent endovenous occlusion techniques for truncal venous reflux of varicose veins. Clarivein TM and Flebogrif TMare the two mechanochemical ablation devices currently used in Korea. Despite the advantages of mechanochemical ablation, some disadvantages are hurdles to broader recommendation and use. The pros and cons of mechanochemical ablation have been compared with those of other ablation techniques in many recent clinical studies. The degree of mechanical disruption, the volume of the sclerosant, and the simplicity of device structure are important factors for using mechanochemical ablation safely and effectively.

Venous thromboembolism (VTE), encompassing deep vein thrombosis and pulmonary embolism, remains a major cause of morbidity and mortality. In carefully selected patients, evaluation for inherited or acquired thrombophilia can offer valuable insights for individualized management and recurrence prevention. Current international guidelines recommend targeted thrombophilia testing only in cases of unprovoked or recurrent VTE, early-onset disease, strong family history, or thrombosis at unusual sites.Clinically relevant tests include Factor V Leiden, Prothrombin G20210A, and deficiencies of antithrombin, protein C, and protein S, as well as antiphospholipid antibodies. The prevalence and clinical impact of inherited thrombophilias differ across populations;mutations such as Factor V Leiden and Prothrombin G20210A are rare in East Asians, whereas natural anticoagulant deficiencies and antiphospholipid syndrome are more significant. Thrombophilia testing should therefore be individualized and guided by clinical context, ensuring that results meaningfully influence management decisions.Recognition of ethnic variation and adherence to evidence-based diagnostic strategies can enhance precision in the prevention and treatment of VTE.

Choosing the appropriate treatment for varicose veins depends on the individual patient’s condition, preferences, and needs. Radiofrequency ablation and endovenous laser ablation offer quick recovery and effective vein closure with some risk of recurrence and side effects. Non-tumescent non-thermal methods like cyanoacrylate and mechanochemical ablation provide immediate vein closure without the risks associated with thermal energy but may involve their own set of complications. Clinical guidelines support the use of these treatments, each with specific recommendations for patient suitability.

Compression therapy has been widely used as a symptomatic treatment, providing venous support and symptom relief across all disease stages of chronic venous insufficiency. However, the recent Society for Vascular Surgery guidelines downgraded its recommendation, influenced by a Cochrane review highlighting inconsistent trial data.This Cochrane review, however, had methodological flaws, including patient variability and short follow-up periods, potentially underestimating compression therapy’s benefits. However recent studies reaffirm the efficacy of compression therapy, particularly in advanced cases. There is a lack of strong scientific evidence to evaluate the effectiveness of compression therapy based on conflicting data.