Venous thromboembolism (VTE), a severe condition comprising deep vein thrombosis and pulmonary embolism, requires prompt treatment. Traditional therapies include heparin, low-molecular-weight heparin, and warfarin. Direct oral anticoagulants (DOACs) such as dabigatran, rivaroxaban, apixaban, and edoxaban has revolutionized VTE management. Clinical trials show that DOACs are as effective as traditional anticoagulants in preventing recurrent VTE, with similar or lower rates of major bleeding. However, DOAC use is complex in vulnerable populations—those with comorbidities, chronic kidney disease, cancer, and advanced age—due to higher VTE and bleeding risks from polypharmacy and altered pharmacokinetics. Trials have shown promising results for DOACs, but these studies often include few patients from these high-risk groups. Moreover, while DOACs are validated for atrial fibrillation, these findings may not apply directly to patients with VTE due to different dosing. In this study, we aimed to address this gap by reviewing the literature on the efficacy and safety of DOACs in these vulnerable populations.

Central venous catheter (CVC) is commonly used and is a relatively safe procedure for patients who require intravascular volume replacement, pressure monitoring and infusion of various medications including total parenteral nutrition (TPN). Immediate complications include vascular injury, arterial puncture, bleeding, iatrogenic pneumothorax and catheter malposition. Delayed complications include catheter dislodgement, thrombosis and catheter related blood stream infection. Vascular erosion by CVC and subsequent extravasation resulting in hydrothorax, hydromediastinum is one of the delayed complication of CVC insertion. TPN is established nutritional support method for patients who cannot tolerate enteral nutrition in various disease state. Due to its’ hypertonicity, central venous access is mandatory for TPN infusion. Extravasation of TPN via CVC is rare, but may carry significant morbidity and mortality. In this brief review, we will discuss incidence, mechanism of vascular erosion, clinical manifestations, and management of this rare complication of central venous extravasation of TPN.

Treatment of deep vein thrombosis has evolved based on advances in medical technology and understanding of vascular pathophysiology. Initially, anticoagulation therapy was attempted to remove thrombus, and dramatic changes occurred with the introduction of catheter-based technology. Recently, the development of mechanical thrombectomy devices has further advanced the treatment. These devices can remove thrombus in a minimally invasive manner, reducing risks and increasing efficacy compared to conventional anticoagulation therapy or catheter-directed thrombolysis alone. We reviewed recent studies on devices that have been introduced in Korea and devices that are scheduled to be introduced soon, and highlighted their respective efficacy, safety, and role in the treatment of deep vein thrombosis.

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.

Varicose veins are a prevalent vascular disorder affecting a significant portion of the global population, leading to reduced quality of life and potential health risks if left untreated. Traditional treatments, while effective, are often invasive and associated with complications and prolonged recovery times. To provide a comprehensive review of High-Intensity Focused Ultrasound (HIFU) as a non-invasive treatment modality for varicose veins, discussing its mechanism of action, clinical applications, efficacy, advantages, limitations, and future prospects. A systematic literature review was conducted using databases such as PubMed, Scopus, and Web of Science, focusing on studies published up to October 2023 that evaluated the use of HIFU in varicose vein treatment. HIFU demonstrates high efficacy in vein closure rates, comparable to traditional endovenous therapies, with the added benefits of being completely non-invasive, minimizing patient discomfort, and reducing recovery times. Clinical studies report closure rates exceeding 95% with low complication rates. Limitations include longer treatment durations and limited availability due to high costs. HIFU emerges as a promising noninvasive alternative for the treatment of varicose veins, offering significant advantages over traditional therapies. Further advancements and broader accessibility may position HIFU as a standard treatment option in the future. Additionally, we discuss the potential application of HIFU for treating superficial venous lesions such as telangiectasia.

In the treatment of varicose veins, accurate diagnosis through ultrasound examination is very important. Recently, major academic societies have previously reported guidelines for ultrasound examination of varicose veins and have been continuously revising and publishing them. Referring to these major reports, domestic academic societies in the Republic of Korea related to the treatment of varicose veins have also published guidelines for ultrasound examination of lower extremity insufficiency and varicose veins. In addition, various related academic societies and institutions in the United States and Europe have made detailed recommendations on the technical aspects of ultrasound examination of lower extremity venous insufficiency and varicose veins. Medical technician associations related to ultrasound examination have also established their own guidelines for examination methods, etc. If an accurate diagnosis is made based on these guidelines, better treatment results for lower extremity varicose veins can be expected.

The representative conservative modality for venous insufficiency in lower extremities is the application of elastic compression stockings. Typically, wearing these stockings is used as an alternative treatment to surgery or interventions, or after surgery and/or interventions. The effective and efficient outcomes would be anticipated when the patient wear elastic compression stockings in a proper way for the optimal purpose. Despite the controversy surrounding the use of compression stockings, several major academic societies and experts around the world have published guidelines and evidence on the indications and effectiveness of this method. Recent guidelines and research findings were reviewed and appropriate applications for wearing compression stockings were considered.

In the patient with chronic venous disease, venous hypertension occur which result in inability of calf pumps and conduits in the venous system to maintain a normal pressure and normal flow towards the heart. Venous hypertension is caused by venous reflux, obstruction, a combination of reflux and obstruction or arterio-venous fistula. Compensation for obstruction are the development of collateral vein circulation and lymphatic drainage. The clinical symptoms and signs are a result of the venous hypertension and the lack of compensation. Inability to quantitate these factors in individual patients contributes to an incomplete understanding of the pathophysiology, leading to controversies and significant challenges in managing chronic venous disease.

Compression stockings are widely utilized for various purposes in the management of patients with varicose veins. Their primary applications include alleviating swelling and edema, preventing the progression of varicose veins, minimizing post-operative bleeding, and occluding veins following surgical interventions. Various compression devices, such as compression bandages, elastic or non-elastic stockings, are also commonly employed. Graduated compression stockings are particularly favored both pre- and post-operatively for varicose vein treatment. These stockings exert higher pressure in the ankle and calf regions, with gradually diminishing pressure towards the thigh. However, concerns remain regarding the efficacy of this reduced pressure in adequately compressing veins in the thigh region. Moreover, silicone band products designed to prevent slipping often induce significant skin side effects, suggesting their avoidance in clinical practice. For these reasons, below-knee compression stockings may be recommended, as they enhance the calf muscle pump function and improve wearing comfort. In cases where thigh-high stockings are necessary, the addition of targeted pads to the affected vein areas may be beneficial in increasing localized pressure to occlude target vein.

Objective Flebogrif^® is a new mechanochemical ablation (MOCA) technique for treating chronic venous disorders (CVD), with limited studies available. This study provides early clinical outcomes from its use in South Korea.
Methods A retrospective analysis was conducted on 55 patients treated with Flebogrif^® at a Charm Vascular Clinic in Seoul. Mechanical injury combined with foam sclerosant (2% STS and CO₂) was applied to 113 saphenous veins. Primary outcomes were anatomical success at 1 and 3 months, with secondary outcomes included adverse events, pain scores, rVCSS score, CIVIQ14 score, time to return to normal activities and foam sclerosant dosages.
Results The anatomical success rate were analyzed as 97.3% at 1 month and 96.9% at 3 months. Adverse events were mild, with no occurrences of severe events such as paresthesia or deep vein thrombosis (DVT). The mean time returned to normal activities was 1.07±0.42 days. Notably, Flebogrif^® allowed treatment of multiple veins without increased risk, averaging a foam sclerosant volume of 15.85±5.71 cc per procedure. rVCSS and CIVIQ14 scores showed a statistically significant decrease from the initial scores.
Conclusion Flebogrif^® shows promise as an effective and safe treatment for CVD, achieving comparable results to other methods with potential cost benefits. Further studies are recommended for validation.

The clinical importance and optimal management of chronic Gastrocnemius vein (GCV) incompetence have rarely been discussed. In case of an incompetent GCV with varicose degeneration, surgical management of intramuscular varicose vein may be challenging. Combined treatment using endovenous laser ablation and ultrasound-guided foam sclerotherapy for tortuous and dilated left lateral gastrocnemius vein incorporating distal muscular trunk as well as proximal main trunk, showed acceptable early outcome. Longer-term follow-up is warranted to verify the benefits from this novel non-surgical approach for deep-seated vein abnormalities.

Pulmonary embolism (PE) that occurs in patients with severe chronic obstructive pulmonary disease (COPD) can often result in acute exacerbation. Immediate intervention for them is required to prevent acute exacerbations and reduce mortality. A 72-year-old man with severe COPD developed deep vein thrombosis with PE and worsened despite anticoagulant therapy and mechanical ventilation. Thrombolysis was contraindicated due to a history of gastric bleeding 3 weeks ago. He had a pulmonary embolism severity index (PESI) score of 272, placing him in the very high-risk group, with a 30-day mortality rate of 10.0%–24.5%. Mechanical thrombectomy was performed using AngioJet^® Solent catheter to remove the thrombus obstructing the right middle and lower lobe pulmonary arteries. The patient improved without complications and was discharged. PE in severe COPD requires immediate intervention due to the higher severity of symptoms compared to the general population, and the use of AngioJet^® Solent catheter may be an effectively alternative modality of treatment.

The VenaSeal (Medtronic) cyanoacrylate closure system is a non-thermal non-tumescent technique for ablating saphenous veins using a proprietary n-butyl cyanoacrylate. A potential side effect is an allergic reaction to the cyanoacrylate. It is widely known that most reactions occur locally around the saphenous vein at the site of the procedure, while systemic allergic reactions are exceedingly rare. We present the case of a 31-year-old woman who was treated with cyanoacrylate closure and subsequently developed recurrent systemic urticaria. There were no notable issues until one week after the procedure, but on postoperative day (POD) 8, itching and swelling accompanied by a rash appeared at the site of the procedure, with the rash spreading to the abdomen. Following this, a whole body rash and wheezing occurred. While symptoms improved with the use of steroids and antihistamines, the systemic rash intermittently reappeared after discontinuation of the medication.