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Below-the-knee (BTK) peripheral arterial disease (PAD), particularly in patients with critical limb ischemia (CLI), is associated with high rates of limb loss and morbidity. Although endovascular interventions are increasingly used, their long-term benefit remains controversial.
To compare three-year outcomes of medical therapy alone versus endovascular treatment combined with medical therapy in patients with BTK PAD.

This prospective cohort study included 80 patients treated between January 2019 and December 2020. Patients were allocated to medical therapy alone (MT, n=40) or endovascular treatment plus medical therapy (ET+MT, n=40). The primary endpoint was limb salvage. Secondary endpoints included amputation-free survival, wound healing, quality of life (VascuQol), and all-cause mortality. Kaplan–Meier analysis and Cox regression were applied.

At three years, limb salvage was significantly higher in the ET+MT group (88.3% vs. 72.5%, p < 0.001). Amputation-free survival was also improved (84.2% vs. 65.8%, p < 0.001). Wound healing rates were higher in the ET+MT group (68.3% vs. 50.8%, p = 0.002). Quality of life improvement was greater in ET+MT (p < 0.001). Mortality did not differ significantly (12.5% vs. 15.8%, p = 0.42).

Endovascular treatment combined with medical therapy significantly improves limb-related outcomes but does not reduce mortality. These findings support a combined treatment strategy in BTK PAD.

Acute limb ischaemia (ALI) remains associated with substantial morbidity, mortality, and risk of limb loss
despite advances in endovascular and surgical treatment. While clinical outcomes such as amputation,
mortality, and reintervention are commonly reported, no standardised angiographic endpoint exists to assess
the technical success of thrombectomy procedures. The Thrombectomy in Limb Ischaemia (TILI) Score was
developed as a simple angiographic grading system for ALI in non-atherosclerotic vessels. To address
acute-on-chronic limb ischaemia, the Thrombectomy in Acute-on-Chronic Limb Ischaemia (cTILI) Score was
subsequently developed

The TILI Score evaluates procedural success using two components: lesion recanalisation (grades 0–3) and
crural runoff (grades a–c). The cTILI Score expands this concept by incorporating pre-existing peripheral
arterial disease and quantifying changes in crural vessel patency relative to the pre-interventional angiogram.
Interreader reproducibility of the TILI Score was evaluated using 10 angiographic cases assessed
independently by nine vascular specialists with experience in endovascular interventions. Agreement was
analysed using percentage agreement, Gwet’s AC2 coefficient and intraclass correlation coefficients.

The TILI Score demonstrated high reproducibility across readers. Overall agreement reached 93.6% (95% CI: 91.2–96.1).
Interreader reliability was substantial, with a Gwet’s AC2 coefficient of 0.742 and an intraclass correlation
coefficient of 0.756 (95% CI: 0.449–0.886). The score was applicable across different thrombectomy techniques and provided a
concise description of angiographic outcomes following revascularisation.
Building on this framework, the cTILI Score allows assessment of patients with acute-on-chronic limb
ischaemia by integrating both final vessel status and procedural changes in distal runoff.

The TILI and cTILI Scores provide a simple, procedure-independent framework for standardised
angiographic assessment of thrombectomy outcomes in acute and acute-on-chronic limb ischaemia. The
TILI Score demonstrated substantial interreader reproducibility and may facilitate harmonised reporting of
technical outcomes in future clinical studies and registries.

Current guidelines recommend post-procedural antithrombotic therapy according to the revascularisation
strategy used. However, these recommendations are largely extrapolated from stable peripheral artery
disease and do not specifically address acute-on-chronic limb ischaemia.
The angiographic result of revascularisation may range from complete thrombus removal to residual
thrombus burden and distal embolisation, potentially requiring different antithrombotic strategies. However,
current guidelines do not consider the technical success of revascularisation. The recently developed
Thrombectomy in Acute-on-Chronic Limb Ischaemia (cTILI) Score provides a standardised angiographic
assessment of procedural outcomes and enables investigation of antithrombotic treatment patterns
according to the degree of revascularisation achieved.

An international web-based survey was developed alongside the introduction of the cTILI Score. Participants
first reviewed a standardised educational video and subsequently assessed angiographic ALI cases.For
each case, respondents assigned a cTILI Score and selected their preferred antithrombotic regimen. The
survey was distributed through international vascular and endovascular networks.

Preliminary analyses demonstrate substantial variation in antithrombotic treatment strategies after ALI.
Therapeutic anticoagulation is used considerably more frequently than currently supported by available
evidence, particularly in cases with residual thrombus burden, distal embolisation, or incomplete
revascularisation. In contrast, patients with complete technical success are more frequently treated with
antiplatelet-based regimens.
Marked heterogeneity was observed across respondents and specialties, highlighting the absence of a
widely accepted treatment standard.

Considerable variation exists in contemporary antithrombotic management after ALI. The recently developed
Thrombectomy in Acute-on-Chronic Limb Ischaemia (cTILI) Score provides a standardised angiographic
assessment of procedural outcomes and enables the investigation of contemporary antithrombotic treatment
patterns according to the degree of revascularisation achieved.

Data on volume changes after complex decongestive therapy (CDT) for leg lymphedema are sparse.
This naturalistic prospective cohort study aimed to quantify the intraindividual changes of leg volume after comprehensive
inpatient rehabilitation, focusing on intensive CDT, and to relate these changes to health-related quality of life (HRQOL).

Limb volume of patients with leg lymphedema (n = 101; 75 women) were measured between entry
and discharge (3 weeks later) by the 4 cm measurement method according to Kuhnke and the Perometer® method.
Changes were also expressed as standardised response means (SRM). The change on the Freiburg Quality of Life As-
sessment for lymphatic disorders, short version (FLQA-lk) total score was predicted using multivariate linear regression
analysis with volume data adjusted for various confounders. Results: The overall mean volume decrease on the 4 cm/
Perometer® method for both legs combined was 1.94/1.31 l for all patients, corresponding to SRMs of 1.04/0.86. In the
lymphedema-affected limbs, the decreases ranged between 1.03 and 1.40 l/0.77 and 0.99 l (SRMs 0.70–1.72/0.67–1.28).
The total volume loss (4 cm) of both legs of all n = 101 patients correlated by 0.240 (bivariate, p = .010) and by 0.216
(multivariate, adjusted, p = .045).

The overall mean volume decrease on the 4 cm/ Perometer® method for both legs combined was 1.94/1.31 l for all patients, corresponding to SRMs of 1.04/0.86. In the
lymphedema-affected limbs, the decreases ranged between 1.03 and 1.40 l/0.77 and 0.99 l (SRMs 0.70–1.72/0.67–1.28).
The total volume loss (4 cm) of both legs of all n = 101 patients correlated by 0.240 (bivariate, p = .010) and by 0.216
(multivariate, adjusted, p = .045).

After multidisciplinary rehabilitation focusing on intensive CDT, moderate to large effects on reducing limb volume were observed. Volume reduction was positively associated with improvement in HRQOL. The most important strength of this study is that it presents the largest worldwide sample of absolute leg volume data.

Experience with perivenous hyaluronic acid injections for local compression has been gained in phlebology since 2013. In specialized centers, this procedure has now become part of daily routine, primarily when venous compression cannot be achieved properly by other means.

To demonstrate the technical aspects of current applications of perivenous hyaluronic acid gel injection, seven typical cases are presented: 1) Gel-mediated valvuloplasty of a large aneurysmal VSM lesion (female, 32 y/o); 2) Compression of a proximal VSM segment, d = 22 mm, to prepare it for endovenous thermal ablation (male, 58 y/o; 3) Prevention of thromboembolism in a floating saphenous vein thrombus (male, 54 y/o) ; 4) Focal hyaluronic acid block of a 9-mm-wide perforator vein in the lower leg to ensure safe and effective foam sclerotherapy (female, 52 y/o); 5) Lumen reduction of a valveless, insufficient SSV in a patient with cancer (male, 69 y/o, 5 years follow-up); 6) perivenous hyaluronic acid compression following ablation of a varix-like, protruding GSV, 8–16 mm wide (CEAP C4, physician, male, 58 y/o); 7) modification of an abdominal ectatic collateral following unilateral iliac vein occlusion to eliminate phlebitic symptoms (female, 64 y/o). Commercially available biphasic volume gels with concentrations of 18–24 mg/ml and particle sizes between 1.0 and 2.0 mm were used and injected under ultrasound guidance.

All aims of compression and therapy were achieved without complications. 1) Reflux elimination over four years of follow-up, with one maintenance injection. 2) Primary occlusion established, stable over four years. 3) Thrombus migration prevented; ablation successful. 4) Occlusion of perforator vein achieved, no DVT. 5) Symptom-free over 5 years; 6) Fast regression of that large following laser and foam therapy, without induration, discoloration, or symptoms. 7) Significant improvement in venous flow, reduction in phlebitic symptoms, and improvement in cosmetic appearance.

Injectable medical substrates such as hyaluronic acid gel can support a wide range of treatment goals in phlebology. They provide a continuous, long-term, and localized compression effect that cannot be achieved with textile materials or tumescent fluids. Injection techniques are safe and simple; they can be easily adopted by physicians trained in ultrasound-guided punctures.

Endovascular therapy (ET) has become the preferred revascularization strategy for peripheral arterial disease in many vascular territories. The common femoral artery (CFA), however, remains an exception, where surgical thromboendarterectomy (TEA) continues to be the preferred treatment approach. Whether TEA is superior to contemporary endovascular treatment strategies has not been evaluated in a randomized clinical trial.

In this prospective, randomized, multicenter trial patients with de novo atherosclerotic lesions involving the CFA were randomized in a 1:1 ratio to TEA or ET using atherectomy followed by drug-coated balloon angioplasty plus bail-out stent placement. The primary efficacy endpoint was primary patency of the target lesion at 12 months. The primary safety endpoint was a composite of death, myocardial infarction, minor or major amputation, and procedure-related complications occurring within 30 days of the intervention. The study was based on the hypothesis that ET is non-inferior to TEA with respect to the primary endpoints.

A total of 193 patients at 11 clinical sites in Germany and Switzerland underwent randomization. Ninty-eight were assigned to TEA and 95 to ET. Fifty-five (28.5%) female patients, and 86 (44.5%) with diabetes were included. One-year follow-up was completed in February 2026. Analysis for the 1-year primary and secondary outcomes will be completed prior to the presentation.

The PESTO-CFA trial is the first prospective randomized clinical trial comparing TEA with ET for the treatment of de novo atherosclerotic lesions involving the CFA. The complete one-year follow-up results will be presented on the USGG congress 2026.

Establishment of Bleomycin electrosclerotherapy (BEST) in the Treatment of Arteriovenous Malformations.
Congenital vascular malformations (CVMs) are a heterogeneous group of vascular anomalies due to an abnormal development of the vascular system. Sclerotherapy and surgery are currently the first-line treatments. In the past, ethanol was the most widely used sclerosant due to its potent endothelial ablation effect, but it is associated with a high risk of complications like necrosis, infections and nerve injuries. In recent years, bleomycin in combination with the application of electrical pulses to the treatment area arised as a promising treatment alternative (Bleomycin electrosclerotherapy, BEST). We present the cases of two patients with arteriovenous malformations (AVM) of the hand unsuccessfully treated with multiple alcohol embolizations and coiling in the past.

The procedures were conducted under general anesthesia due to the significant pain associated with electroporation. We injected in both cases 5 mg of bleomycin dissolved in 0.9% NaCl intra-arterially via a catheter inserted through a 5 French sheath in the common femoral artery and advanced to the distal radial artery. Following injection of the bleomycin, electroporation was performed using the Cliniporator device (IGEA, Carpi, MO, Italy) with a six-needle finger electrode. Electroporation was applied transcutaneously. The application involved electric pulses of 1000 V/cm, with the number of pulses adjusted based on lesion extent.

Post-intervention, the patients experienced a significant reduction in pain, subsidence of swelling, and no further spontaneous wound formation. Duplex ultrasound revealed a decrease in shunt volume. The MRI of the hands demonstrated regression of the intramuscular AVM.

Currently, there is limited high-quality evidence supporting the use of BEST for AVMs. The available data are primarily based on small case series and case reports. Large, randomized trials that definitively demonstrate long-term success in AVM treatment are still lacking. Nevertheless, BEST is a fascinating development in the treatment of vascular malformations. Further prospective, multicenter studies are needed to define optimal dosing protocols and to determine its precise role compared to established therapies.

Edema can arise from multiple underlying causes, including (among others) venous, cardiovascular, inflammatory/infectious or lymphatic disorders. Lymphedema often presents as unilateral swelling of an extremity and is due to congenital or secondary causes. While lymphedema has distinct clinical features in later stages such as non-pitting edema with fibrosis and skin induration, it's differential diagnosis can be more challenging in earlier stages.

We describe a series of 3 patients presenting with unclear chronic extremity swelling seen at the Angiologic department of Swiss cantonal hospitals with clinical characteristics of lymphedema.

3 patients (52, m; 52, f; 71, f) presented with unilateral swelling and heaviness of the lower extremity for at least 6 months. The edema was characterised by pitting swelling of the calf and forefoot, the Stemmer sign was positive in 3 of 3 patients, 2 patients showed livid discoloration. Further investigations regarding secondary lymphedema revealed positive serology for Borrelia burgdorferi in all 3 patients and histological pattern of skin biopsies was consistent with acrodermatitis chronica atrophicans. In 2 out of 3 skin biopsies PCR was positive for Borrelia burgdorferi (PCR detects multiple clinically relevant species of the Borrelia burgdorferi sensu lato complex, including B. afzelii, B. garinii, B. spielmanii, B. lusitaniae, and B. burgdorferi sensu stricto). No other signs of chronic borreliosis (e.g. erythema migrans, facial-nerve palsy or meningitis-like symptoms) had been present. In all 3 patients, the edema improved after antibiotic treatment (Doxycyclin p.o. for 21-28 days).

Lymphedema is characterised by an accumulation of protein-rich fluid due to congenital or secondary damage or obstruction of the lymphatic system. The borrelia-associated edema is caused by vascular permeability and fluid leakage due to inflammatory processes, while the lymphatic system remains intact. This case series describes 3 cases of acrodermatitis chronica atrophicans (a chronic skin manifestation of Lyme borreliosis) presenting with unilateral swelling that resembled early stages lymphedema, probably caused by inflammation-induced high-volume transient and reversible insufficiency of the lymphatic system.
This highlights the importance of a good clinical assessment of edema, including relevant differential diagnoses.