limbs, including volume reduction and prevention of cellulitis. Therefore, a combination therapy might be useful for lymphedema cases at advanced stages.Purpose To define the current forms of treatment in a contemporary population of lymphedema (LED) patients for (1) LED related to breast cancer (BCRL), the most prevalently diagnosed LED comorbidity in Western countries, and (2) phlebolymphedema with venous leg ulcers (PLEDU), a sequela of chronic venous disease. Background The goals of LED therapy are to reduce edema, thereby improving function and related symptoms, and improve skin integrity to prevent development of infection. Treatment is generally non-surgical conservative care (CONS), including complex physical therapy, manual lymphatic drainage (MLD), and compression bandaging; or pneumatic compression device therapy (PCD), by a simple non-programmable device (SPCD) or an advanced programmable device (APCD). Methods To determine the frequency of individual types of treatment for LED and their relationship to breast cancer-related lymphedema (BCRL) and PLEDU, we queried claims from a de-identified HIPAA-compliant commercial administrative insurance datare treated. Compared with BCRL patients, PLEDU patients were less likely to receive CONS and more likely to be prescribed SPCDs for pneumatic compression therapy. These differences suggest that lymphatic therapy may be undervalued for treatment of chronic venous swelling and prevention and treatment of PLEDU.Objective Although the development of lymphatic collaterals is expected following lymphedema, little is known regarding the anatomical details of such compensatory pathways or their association with symptoms. Magnetic Resonance lymphangiography (MRL) has shown to be superior to lymphoscintigraphy and indocyanine green lymphography in visualizing lymphatics. This study aimed to analyze MRL images of lower limbs to elucidate the patterns of lymphatic collateral formation and their association with the clinical stages of lymphedema. Z-VAD-FMK Methods We enrolled 56 consecutive patients (112 lower limbs) with lymphedema who underwent MRL. Two radiologists performed a consensus reading of MRL images for the presence or absence of collateral lymphatic pathways, and the results were compared with the clinical stages. Furthermore, the frequency of abnormal MRL findings in 43 asymptomatic lower limbs of patients with unilateral lymphedema was analyzed and compared with that in the 69 symptomatic lower limbs of the patients. The results suggested that the two superficial lymphatic groups and the deep lymphatic system act as major collaterals of the lower limbs in patients with lymphedema. Furthermore, MRL of most patients with unilateral lymphedema demonstrated abnormal findings, including collateral formation, not only in the affected lower limb but also in the asymptomatic lower limb. In primary lymphedema, the collaterals may appear less frequently than in secondary lymphedema. Collaterals should be taken into consideration when planning the site of lymphaticovenous anastomosis and assessing disease progression. MRL can visualize preclinical alterations in lymphatic flow and compensatory pathways; therefore, we expect that it will be useful for the early diagnosis of lymphedema.Objective To describe typical clinical presentation of patients with microfistular, capillary- venule (CV) malformation as a variant form of arterio-venous malformations (AVM). Methods A retrospective clinical analysis of 15 patients with CV-AVM confirmed by a computational flow model enrolled in a prospective database of patients with congenital vascular malformation between January 2008 and May 2018. Results Mean age of patients at first time of presentation was 30 years with balanced gender ratio. Presentation was dominated by soft tissue hypertrophy (n=12, 80.0%) and atypical varicose veins (n=11, 73.3%). Anatomical location of enlarged varicose veins gave no uniform pattern and did not correspond to the typical picture of primary varicose vein disease. Most often symptomatic CV-AVM was found at the lower extremities in this series of unselected patients. The most frequent compartment affected was the subcutis (n=14, 93.3%), involvement of muscle was recorded in a third and cutis in a fourth of patients. Conclusions A high grade of clinical suspicion is needed to recognize CV-AVM and to prevent inadequate therapy due to failed diagnosis.Objective Venous insufficiency is commonly bilateral, and patients often prefer single-episode care compared with staged procedures. Few studies have investigated clinical outcomes after unilateral vs bilateral venous ablation procedures or between staged and concurrent bilateral procedures. Here, we report data from the Vascular Quality Initiative regarding truncal venous ablation for chronic venous insufficiency. Methods Using data from the Vascular Quality Initiative, we investigated immediate postoperative as well as long-term clinical and patient-reported outcomes of patients undergoing unilateral vs bilateral truncal endovenous ablation from 2015 to 2019. We further investigated outcomes between staged bilateral and concurrent bilateral ablations. Preprocedural and postprocedural comparisons were performed using t-test, χ2 test, or their nonparametric counterpart when appropriate. Multivariable ordinal logistic regression was performed on ordinal outcome variables. Results A total of 5029 patients were .2%; P = .144). Staged bilateral patients were older (56.9 ± 13.3 years vs 54.2 ± 12.9 years; P = .002), less likely to have had prior varicose vein treatment (14.3% vs 19.8%; P = .020), and more likely to be therapeutically anticoagulated (10.8% vs 6.5%; P = .028) compared with concurrent bilateral patients. Staged patients also have higher preprocedural VCSS compared with concurrent patients (median, 8 [IQR, 6-10] vs 7 [IQR, 5.5-9]; P less then .001). In multivariable analysis, there was no difference in the likelihood of VCSS improvement for concurrent compared with staged procedures (odds ratio, 0.70; 95% confidence interval, 0.40-1.24; P = .226). Conclusions Concurrent bilateral truncal endovenous ablation can be performed safely without increased morbidity compared with staged bilateral or unilateral ablations.