Background/Aims: The optimal vascular access strategy for very elderly patients initiating hemodialysis (HD) remains unclear. Arteriovenous fistulas (AVFs) offer long-term benefits but may be limited due to vascular aging. This study evaluated vascular access outcomes in patients aged ≥ 80 years. Methods: We conducted a retrospective cohort study using data from the Korean National Health Insurance Service between 2008 and 2019. Patients aged ≥ 80 years who initiated HD with a newly created AVF or arteriovenous graft (AVG) were included. Primary outcomes were primary, assisted primary, and secondary patency. The secondary outcome was all-cause mortality. Outcomes were compared using Kaplan–Meier analysis and multivariable Cox regression. Results: Among 8,487 patients, 5,124 (60.4%) received AVFs (AVF group) and 3,363 (39.6%) received AVGs (AVG group). AVFs were associated with significantly lower rates of patency loss across all definitions. The adjusted hazard ratios (HRs) for AVG vs. AVF were 1.76 (95% confidence interval [CI], 1.67–1.86) for primary patency loss, 1.90 (95% CI, 1.77–2.03) for assisted primary, and 3.18 (95% CI, 2.81–3.61) for secondary patency loss. All-cause mortality was also higher in the AVG group (adjusted HR, 1.24; 95% CI, 1.17–1.30). Conclusions In this large-scale study, AVF use was associated with superior patency and lower mortality compared with AVG in patients aged ≥ 80 years. These findings suggest that AVF remains a beneficial option for appropriately selected elderly patients and that age alone should not be a primary barrier to its creation.

Purpose: The use of direct oral anticoagulants (DOACs) is challenging in fragile patients, including those with cancer, chronic kidney disease (CKD), and old age. We aimed to compare the safety of DOACs in terms of bleeding complications in these patients. Methods: Using hospital data from 2013 to 2019, we compared the risk of bleeding and major bleeding, including intracranial bleeding, any bleeding requiring transfusion, and all-cause bleeding, in patients with venous thromboembolism (VTE) who were naïve to DOAC (n = 12,369) and warfarin (n = 4,123). Hazard ratios (HRs) for the clinical outcomes were analyzed using Cox regression analysis, with warfarin as a reference. Results: The study included 4,078 eligible patients, predominantly female (54.1%), with a mean age of 62.5 years. DOACs were the primary treatment in 74.1% of the patients. DOAC treatment was associated with lower all-cause mortality compared to warfarin (HR, 0.799; 95% confidence interval [CI], 0.707–0.904). Although rates of recurrent VTE or major bleeding did not significantly differ between the groups, DOAC-treated patients had lower bleeding risk (HR, 0.562; 95% CI, 0.393–0.805; P = 0.002). The individual DOAC drugs did not differ significantly in terms of composite outcomes, recurrence, or bleeding events. Conclusion DOAC showed comparable outcomes with warfarin in the fragile patient population.

Purpose: The use of direct oral anticoagulants (DOACs) is challenging in fragile patients, including those with cancer, chronic kidney disease (CKD), and old age. We aimed to compare the safety of DOACs in terms of bleeding complications in these patients. Methods: Using hospital data from 2013 to 2019, we compared the risk of bleeding and major bleeding, including intracranial bleeding, any bleeding requiring transfusion, and all-cause bleeding, in patients with venous thromboembolism (VTE) who were naïve to DOAC (n = 12,369) and warfarin (n = 4,123). Hazard ratios (HRs) for the clinical outcomes were analyzed using Cox regression analysis, with warfarin as a reference. Results: The study included 4,078 eligible patients, predominantly female (54.1%), with a mean age of 62.5 years. DOACs were the primary treatment in 74.1% of the patients. DOAC treatment was associated with lower all-cause mortality compared to warfarin (HR, 0.799; 95% confidence interval [CI], 0.707–0.904). Although rates of recurrent VTE or major bleeding did not significantly differ between the groups, DOAC-treated patients had lower bleeding risk (HR, 0.562; 95% CI, 0.393–0.805; P = 0.002). The individual DOAC drugs did not differ significantly in terms of composite outcomes, recurrence, or bleeding events. Conclusion DOAC showed comparable outcomes with warfarin in the fragile patient population.

Purpose: The use of direct oral anticoagulants (DOACs) is challenging in fragile patients, including those with cancer, chronic kidney disease (CKD), and old age. We aimed to compare the safety of DOACs in terms of bleeding complications in these patients. Methods: Using hospital data from 2013 to 2019, we compared the risk of bleeding and major bleeding, including intracranial bleeding, any bleeding requiring transfusion, and all-cause bleeding, in patients with venous thromboembolism (VTE) who were naïve to DOAC (n = 12,369) and warfarin (n = 4,123). Hazard ratios (HRs) for the clinical outcomes were analyzed using Cox regression analysis, with warfarin as a reference. Results: The study included 4,078 eligible patients, predominantly female (54.1%), with a mean age of 62.5 years. DOACs were the primary treatment in 74.1% of the patients. DOAC treatment was associated with lower all-cause mortality compared to warfarin (HR, 0.799; 95% confidence interval [CI], 0.707–0.904). Although rates of recurrent VTE or major bleeding did not significantly differ between the groups, DOAC-treated patients had lower bleeding risk (HR, 0.562; 95% CI, 0.393–0.805; P = 0.002). The individual DOAC drugs did not differ significantly in terms of composite outcomes, recurrence, or bleeding events. Conclusion DOAC showed comparable outcomes with warfarin in the fragile patient population.

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.

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.

Varicosities of the vulva are a frequent but often underrecognized sign of venous disease and are rarely written about. However, they may reflect complex pathophysiologic mechanisms, including pregnancy-related hormonal and hemodynamic changes, intricate pelvic venous anatomy, and altered intra-abdominal pressure dynamics. This narrative review summarizes current evidence on the epidemiology, anatomical pathways, etiologic factors, diagnostic modalities, and therapeutic strategies relevant to vulvar varicosities. Accurate identification of the underlying venous pathology—whether due to reflux, anatomic variation, or pelvic outflow obstruction—is essential to guide appropriate treatment selection. Duplex ultrasonography and cross-sectional imaging play a pivotal role in this diagnostic process, while selective venography should be reserved for carefully selected cases in which noninvasive imaging is inconclusive or intervention is being planned. Management strategies range from conservative observation, particularly during pregnancy, to targeted interventions such as sclerotherapy, surgical excision, and endovascular embolization. The presence of pelvic congestion syndrome must be recognized and addressed to ensure durable symptom control and prevent recurrence. Clinical decision-making benefits from a multidisciplinary framework involving vascular surgery, interventional radiology, and gynecology. By providing a comprehensive overview of this often-overlooked condition, the present review aims to promote earlier recognition, improve diagnostic precision, and support individualized treatment planning in women affected by vulvar varicosities.

Purpose: Aortoiliac occlusive disease (AIOD) is widely prevalent and leads to severe claudication or chronic limb-threatening ischemia. Stent placement for AIOD demonstrated excellent outcomes in terms of long-term patency. However, iliac artery rupture is the most fearful complication during the aortoiliac stenting (AIS). This study aimed to evaluate the incidence and risk factors of iliac artery rupture during AIS. Materials and Methods: A retrospective review of consecutive patients with AIOD treated with AIS from 2009 to 2021 was completed. We excluded patients with instent restenosis. All types of stents, including self-expanding stent (SES), balloonexpandable stent (BES), or balloon-expandable covered stent (CS), were used.Angiographic characteristics and procedural outcomes were analyzed. Procedural success was defined as the residual stenosis <30%. Results: A total of 242 patients (86.8% male; mean age 68.8±10.0 years) with de novo AIOD were treated with AIS. The procedural success rate was 100%. Rupture occurred in six patients (2.5%) and all ruptures were occurred in the external iliac artery (EIA). Stenting of the EIA and less calcified lesion were risk factors for iliac rupture (P=0.028). All cases of iliac artery rupture were successfully treated with the CSs. Overall primary patency rates were 98.0% and 93.4% at 12 and 36 months, respectively. Primary patency rates of SES, BES, and CS were 87.7%, 88.4%, and 100% at 36 months, respectively. Conclusion The incidence of iliac artery rupture during AIS was 2.5%. Stent placement in the less calcified lesion and EIA was a risk factor for rupture during AIS. Placement of the CS can be the straightforward solution in case of iliac artery rupture during AIS.

Non-thermal, non-tumescent (NTNT) techniques for varicose vein treatment have gained significant attention as alternatives to traditional thermal ablation methods, providing less invasive options with fewer complications and less downtime. This review examines the efficacy, safety, and patient outcomes associated with NTNT modalities such as cyanoacrylate adhesive closure, mechanochemical ablation (MOCA), and polidocanol endovenous microfoam (PEM). Recent trials suggest these NTNT methods achieve closure rates comparable to thermal methods, with lower complication rates and improved patient satisfaction. Key metrics from recent studies, including technical success, recurrence rates, and complication profiles, underscore the promise of NTNT techniques as first-line therapies. Findings also indicate variability in recurrence rates and complication profiles depending on vein anatomy and patient characteristics. In conclusion, NTNT approaches represent a promising evolution in varicose vein treatment, warranting further studies to standardize outcomes and optimize patient selection.