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Daily Medical Update
Venous disease of the lower extremities
Monday, September 28, 2026
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🔬 Practice-Changing Findings
Evidence from RCTs and meta-analyses published in the
last 12 months.
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Journal of vascular surgery. Venous and lymphatic disorders (2026) - Network Meta-Analysis
Key Findings
- High ligation and stripping showed improved long-term freedom from failure compared with cyanoacrylate closure, 1470-nm EVLA, and radiofrequency ablation in C2-C5 disease.
- Minimally invasive interventions improved recovery speed, with faster return to normal activities than high ligation and stripping.
- High ligation and stripping increased ecchymosis and infection, while ablation procedures had skin pigmentation rates of 4.34%-11.41%.
📋 Practice Implication: For GSV insufficiency, discuss long-term durability alongside recovery priorities: stripping favored freedom from failure in this analysis, whereas minimally invasive options offered faster functional recovery.
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Journal of vascular surgery. Venous and lymphatic disorders (2026) - Randomized Controlled Trial
Key Findings
- Venous leg ulcer recurrence was 12% with periulcer foam sclerotherapy versus 45% without it over a mean 2.2-year follow-up (P = .006).
- The adjusted hazard of recurrence was 80% lower with periulcer foam sclerotherapy (hazard ratio 0.20, 95% CI 0.06-0.75).
- Ulcer-free time increased and final revised Venous Clinical Severity Score improved with periulcer foam sclerotherapy.
📋 Practice Implication: After venous ulcer healing, treating the incompetent periulcer venous network may be a useful recurrence-prevention strategy, particularly when durable ulcer-free time is a priority.
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Deutsches Arzteblatt international (2025) - Randomized Controlled Trial
Key Findings
- Complete wound healing favored the intervention group (odds ratio 3.60, 95% CI 0.97-13.36; P = .049).
- Guideline-compliant compression was more common with the intervention than usual care (72% versus 33%; P = .010).
- Depression scores and outpatient treatment costs were reduced in the intervention group (P = .019 and P = .016, respectively).
📋 Practice Implication: Primary-care VLU programs can target a modifiable implementation gap—consistent compression—while potentially improving mental health and reducing outpatient costs; larger trials are still needed to establish healing efficacy.
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International angiology : a journal of the International Union of Angiology (2025) - Systematic Review and Meta-Analysis
Key Findings
- Mean ankle and calf circumferences were reduced by 7.6 mm and 8.0 mm, respectively (both P < 0.001).
- Venous ulcer healing improved, with ulcers healed in 48.9% of patients and regressed in 73.4% (P < 0.001).
- Redness and Venous Clinical Severity Score also improved significantly (P < 0.001).
📋 Practice Implication: MPFF is a reasonable adjunct for reducing edema and other clinical signs across chronic venous disease stages, but the frequent heterogeneity and risk of bias warrant calibrated expectations.
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Journal of plastic, reconstructive & aesthetic surgery : JPRAS (2026) - Systematic Review and Meta-Analysis
Key Findings
- PRP increased the odds of complete wound healing 1.5-fold compared with conventional treatment (95% CI 1.09-2.07; I² = 58%).
- Ulcer area reduction favored PRP (odds ratio 16.37, 95% CI 6.45-26.28), although heterogeneity was high (I² = 97%).
- PRP reduced ulcer recurrence (odds ratio 0.25, 95% CI 0.06-0.99).
📋 Practice Implication: PRP may be considered as an adjunct for difficult-to-heal venous ulcers when resources permit, while clinicians should explain the substantial heterogeneity and need for larger confirmatory trials.
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Summary
Recent evidence supports tailoring lower-extremity venous care to the clinical problem: interventional comparisons weigh long-term durability against faster recovery, while adjunctive and pharmacologic therapies may improve ulcer or edema outcomes. Primary-care case management improved compression use and selected patient outcomes, but the small randomized trial did not definitively confirm time-to-healing efficacy, and PRP evidence remains supportive but heterogeneous.
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