Chronic venous leg ulcers (CVLUs) affect 1%–3% of adults. Standard compression therapy achieves healing in only 40%–70% of cases at 24 weeks. Evidence for hyperbaric oxygen (HBO) therapy remains controversial, with limited sham‐controlled trials. To evaluate whether adjunctive HBO improves healing of refractory CVLUs compared to standard care alone. Single‐centre, open‐label randomised trial of 80 adults with CVLUs that persisted > 3 months despite standard care (defined as < 30% area reduction after 4 weeks of compression therapy). All consecutive eligible patients were randomised to HBO (20 sessions at 2.4 ATA, 90 min) plus standard care ( n = 40) or standard care alone ( n = 40). Primary outcome: percentage ulcer area reduction at day 30. Blinded assessors measured wounds, though participants knew their treatment allocation. HBO group had greater area reduction (62.1% ± 22.1% vs. 41.7% ± 21.5%; mean difference 20.4%, 95% CI: 10.1–30.7, p < 0.001; Cohen's d = 0.95). Complete healing at 90 days occurred in 62.5% vs. 30.0% (NNT = 3). TcPO ₂ increased from 26.1 ± 6.3 to 150.3 ± 45.6 mmHg in HBO group ( p < 0.001). Pain decreased more with HBO (ΔVAS −5.0 vs. −1.5, p < 0.001). Three patients (7.5%) had mild ear barotrauma that resolved spontaneously. Main limitations were lack of sham control and 90‐day follow‐up. In this trial, adjunctive HBO was associated with faster short‐term healing of refractory venous ulcers < 20 cm ² . However, the open‐label design and single‐centre setting limit confidence in these findings. Sham‐controlled multicentre trials with longer follow‐up are needed before recommending routine use.

Deep vein thrombosis (DVT) remains associated with substantial morbidity despite anticoagulation therapy, with 20-30% experiencing recurrence and up to 50% developing post-thrombotic syndrome (PTS). Statins possess anti-inflammatory properties that may benefit DVT outcomes, but evidence for adjunctive use remains limited. We conducted a retrospective cohort study of 255 patients with first-episode proximal DVT diagnosed between January 1^st, 2020 and December 31^st, 2020, with follow-up through December 31^st, 2024. Using multinomial propensity scores, we matched patients 1:1:1 who were receiving rosuvastatin 20 mg (N.=85), rosuvastatin 10 mg (N.=85), or no statin (N.=85) for ≥3 months before DVT diagnosis. All patients received guideline-directed anticoagulation. Primary outcome was composite of DVT recurrence and/or PTS. We used Cox regression for time-to-event analyses and mixed-effects models for biomarker trajectories. After median follow-up of 42 months (IQR 36-48), the primary outcome occurred in 31.8% of rosuvastatin 20-mg group, 38.8% of 10-mg group, and 47.1% of controls (HR=0.67, 95% CI 0.50-0.90, P=0.008 for 20 mg vs. control). Both rosuvastatin groups showed greater reductions in inflammatory markers compared to controls. Complete vein recanalization at 48 months was observed in 74.1%, 65.9%, and 58.8% respectively (overall P=0.045; pairwise 20 mg vs. control P=0.095, Table II). Safety profiles were similar across groups, with no excess bleeding or muscle-related events. In this hypothesis-generating study, rosuvastatin use was associated with reduced DVT complications, with suggestions of dose-dependent effects. These associations require confirmation in prospective randomized trials before clinical recommendations can be made.

Background: Deep vein thrombosis (DVT) is associated with inflammatory response that may contribute to incomplete venous recanalization and post-thrombotic syndrome (PTS). Diosmin, a venoactive flavonoid, may provide additional benefit when combined with standard anticoagulation. Objectives: To evaluate whether adjunctive diosmin therapy reduces inflammation, improves recanalization, enhances quality of life, and decreases PTS severity in acute DVT. Methods: This retrospective cohort study analyzed 612 patients with acute proximal DVT receiving anticoagulation alone (control, n = 298) or anticoagulation plus diosmin 600 mg daily ( n = 314). Propensity score matching (1:1) yielded 230 pairs. C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), and erythrocyte sedimentation rate (ESR) were assessed at baseline and day 30. Recanalization was evaluated by duplex ultrasound at 3 and 12 months. Quality of life was measured using VEINES-QOL, and PTS was assessed using the Villalta scale at 12 months. Results: The diosmin group showed greater reductions in CRP (−13.9 vs −11.8 mg/L; p = 0.038), NLR (−1.72 vs −1.43; p = 0.019), and ESR (−17.2 vs −14.1 mm/hr; p = 0.031) at day 30. Complete recanalization rates were higher with diosmin at 12 months (91.3% vs 76.5%; p < 0.001). VEINES-QOL scores were better in the diosmin group at 12 months (71.8 ± 13.2 vs 66.9 ± 12.6; p = 0.024). While overall PTS incidence was similar (14.9% vs 16.3%; p = 0.72), moderate-to-severe PTS was less frequent with diosmin among PTS patients (21% vs 40%; Fisher’s exact p = 0.062), suggesting a trend that requires confirmation. Conclusions: Adjunctive diosmin was associated with greater inflammatory marker reductions, improved recanalization, and better quality of life. A trend toward reduced PTS severity was observed but should be interpreted cautiously given the small number of events. Prospective randomized trials are needed to confirm these findings.

Recurrence after open superficial venous surgery occurs in 20% to 60% of patients at 5 years, yet no validated composite preoperative scoring system exists to quantify individual risk. We aimed to develop and internally validate a predictive model and a derived clinical risk score-the Varicose Vein Recurrence (VVR) Score-for 5-year recurrence after open surgery of the superficial venous system. This retrospective single-center cohort study included consecutive patients undergoing saphenofemoral or saphenopopliteal junction ligation with or without trunk stripping and concomitant phlebectomies between January 2006 and December 2025. The primary outcome was duplex-confirmed recurrent reflux with clinically visible recurrent varices at 5 years; reintervention (open, endovenous, or foam) within 5 years served as a prespecified harder secondary end point. The primary analysis was conducted on extremities with complete 5-year outcome ascertainment. We used multivariable logistic regression with cluster-robust standard errors (patient-level clustering) for model development and cluster bootstrap resampling (500 replications) for internal validation. A simplified integer-based score was derived from shrinkage-adjusted coefficients. Prespecified sensitivity analyses included procedure-stratified subgroup models (three mutually exclusive primary subgroups-high ligation + stripping, high ligation alone, and phlebectomy alone-plus an overlapping saphenopopliteal junction-procedure subgroup), continuous calendar-year analyses with time × predictor interactions, treatment choice as a model covariate, inverse probability of censoring weighting, and Cox regression. Reporting followed the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis guidelines (type 1b). Among 12,480 eligible extremities (9210 patients), 10,142 (81.3%) had complete 5-year ascertainment and constituted the primary cohort. The 5-year recurrence rate was 25.1% (2546/10,142); 74.1% of recurrent extremities underwent reintervention (5-year reintervention rate, 18.6%). Six preoperative predictors were retained: anterior saphenous vein (formerly anterior accessory saphenous vein) reflux (odds ratio [OR], 2.33; 95% confidence interval [CI], 2.03-2.67), incompetent perforators (OR, 2.04; 95% CI, 1.77-2.35), body mass index of ≥30 kg/m² (OR, 1.82; 95% CI, 1.60-2.07), deep venous reflux or obstruction (OR, 1.72; 95% CI, 1.44-2.06), Clinical, Etiologic, Anatomic, and Pathophysiologic classification C4-C6 (OR, 1.62; 95% CI, 1.42-1.86), and great saphenous vein diameter ≥7 mm (OR, 1.41; 95% CI, 1.23-1.62). The optimism-corrected C-statistic was 0.744 (95% CI, 0.726-0.762), with a calibration slope of 0.97 (0.924-1.016) and an intercept of -0.02 (-0.06 to 0.02). Model performance was preserved for the harder reintervention end point (C-statistic, 0.73) and across operative subgroups (apparent C-statistics, 0.70-0.74). The derived VVR Score (0-13 points) stratified patients into low (12.8%), moderate (25.2%), high (41.7%), and very high (66.8%) 5-year recurrence-risk categories. Continuous calendar-year analysis showed no significant time × predictor interactions (smallest P = .21). Sensitivity analyses including inverse probability of censoring weighting on all 12,480 extremities, Cox regression, generalized estimating equations, and treatment-choice-adjusted models produced consistent results. The VVR Score provides an internally validated tool for estimating 5-year recurrence risk after open superficial venous surgery using six preoperative clinical and duplex parameters. Performance was preserved across operative subgroups and for the harder reintervention end point. Because the score is derived in an open-surgical population, external validation in geographically diverse open-surgical cohorts and rederivation/recalibration before use in endothermal, nonthermal, or foam-sclerotherapy populations are essential before broader clinical adoption.

Background: Deep vein thrombosis (DVT) is a frequent complication after femoral neck fracture surgery, with reported incidence rates of 6–19% depending on detection methods. Existing risk assessment tools, such as the Caprini score, show limited discrimination (AUC 0.62–0.75) in orthopedic trauma populations. We aimed to develop and temporally validate a clinical prediction score specifically designed for DVT risk stratification in patients undergoing femoral neck fracture surgery. Methods: This retrospective cohort study included 2,241 consecutive patients undergoing femoral neck fracture surgery at a single Serbian center (January 2018–June 2024). The cohort was split temporally into a development set ( n = 1,829; 2018–2023) and a temporal validation set ( n = 412; January–June 2024). The primary endpoint was DVT diagnosed after surgery on scheduled bilateral duplex ultrasonography (24–48 h and day 7) or symptom-triggered imaging during 90-day follow-up. A multivariable logistic model with 12 prespecified predictors was developed and internally validated with 1,000 bootstrap resamples. Performance was assessed by AUC, calibration slope, Brier score, and decision curve analysis. Results: DVT occurred in 269 patients (12.0%). The DVT Risk Score (DVTS) incorporated 12 predictors, including age > 75 years, D-dimer > 500 ng/mL, albumin < 35 g/L, and ASA score ≥ 3. The optimism-corrected development AUC of the shrinkage-adjusted logistic model was 0.80 (95% CI: 0.76–0.84), and its temporal-validation AUC was 0.82 (95% CI: 0.77–0.87). The simplified integer DVTS had an apparent AUC of 0.81 in development and 0.81 (95% CI: 0.76–0.86) in temporal validation. Calibration slope was 0.94 (95% CI: 0.89–0.99) in validation; Brier scores were 0.087 (development) and 0.084 (validation). At the DVTS ≥ 5 threshold in the validation cohort, sensitivity was 85.4% and specificity 41.8%, with a negative predictive value of 95.6%; a higher threshold (≥ 9) yielded specificity of 81.6%. Three risk categories showed DVT incidence of 3.3% (low), 11.7% (moderate), and 29.2% (high) ( p < 0.001 for trend). Conclusion: The shrinkage-adjusted logistic model maintained good discrimination and acceptable calibration in temporal validation, and the simplified integer DVTS retained good discrimination (AUC 0.81) and stratified patients into clinically interpretable risk categories. External validation and prospective impact evaluation are required before clinical implementation.

Background: Baker’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. Methods: We 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. Results: Vascular 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). Conclusions: We 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.