ObjectiveEffective patient communication is critical in acute deep vein thrombosis (DVT) management. This study evaluated and compared the intelligibility and clinical appropriateness of patient-directed explanations for acute DVT generated by vascular surgeons versus a diverse panel of large language models (LLMs), using a balanced, unit-matched design.MethodsIn this observational, cross-sectional study, 11 board-certified vascular surgeons and 11 distinct, independently developed LLMs each produced one response to a standardized acute DVT vignette in Spanish. Responses were blinded and scored using an 8-item clinical appropriateness grid (two independent graders, consensus) and five validated Spanish readability indices. Central tendency was assessed with Mann-Whitney U tests; dispersion was assessed descriptively (coefficient of variation, range) and, exploratorily, with Brown-Forsythe tests.ResultsClinical appropriateness did not differ significantly between groups (median 7/8 in both; p = 0.258), dispersion was descriptively far smaller for LLMs (SD 0.40 vs 1.92; coefficient of variation 5.9% vs 32.5%). LLM responses were more readable on three of four content-complexity indices (Fernández-Huerta, Gutiérrez de Polini, Szigriszt-Pazos; all p < 0.02) and required a numerically lower educational grade level (Crawford 5.4 vs 6.1; p = 0.075). Readability dispersion was descriptively far lower for LLMs (Fernández-Huerta range 31 vs 200 points; coefficient of variation 15% vs 181%), driven in the surgeon cohort by a single response that fell far outside the interpretable range; formal variance tests did not reach significance at this sample size. LLM responses were longer (median 903 vs 354 words; p = 0.003) and took longer to read (4.5 vs 1.8 min; p < 0.001). Neither group addressed screening for silent pulmonary embolism. Free-versus-premium comparisons were model-specific rather than uniform.ConclusionCurrent-generation LLMs matched board-certified surgeons in clinical completeness and produced more readable, descriptively far more consistent patient-facing explanations, without the communication failures observed in a minority of human responses. Both cohorts share an important, guideline-adjacent counseling gap.

ObjectiveEndovenous laser ablation (EVLA) is standard for superficial venous insufficiency. This retrospective study evaluates the safety profile of "flush" EVLA, assessing whether thermal ablation directly at the saphenofemoral junction (SFJ) increases postoperative thromboembolic complications like deep vein thrombosis (DVT) and pulmonary embolism (PE).MethodsWe retrospectively analyzed 501 patients (281 female; mean age 45.8 ± 8.2 years) undergoing "flush" EVLA via a 1470-nm dual-radial laser (ELVeS Radial 2ring™, Biolitec) between February 2023 and June 2025. Unlike traditional sub-junctional positioning, laser delivery was initiated flush with the SFJ origin under tumescent anesthesia. Postoperative chemical anticoagulation was routinely omitted. Patients wore Class 2 compression stockings and were followed for six months. Systemic thromboembolic events were tracked nationwide using the National Electronic Health Record Database (e-Nabız), which mandatorily integrates data across all public, university, and private healthcare facilities in Turkiye to ensure complete cross-institutional complication ascertainment.ResultsNo patient developed DVT or PE during six-month follow-up (0% incidence). One patient (0.2%) experienced localized superficial thrombosis in a calf tributary at day 10, successfully managed via ambulatory phlebectomy without systemic sequelae. Low-grade endovenous heat-induced thrombosis (EHIT Class 1-2) occurred in 12 patients (2.4%) and resolved spontaneously. This absence of major thromboembolic phenomena confirms a favorable safety profile.Conclusion"Flush" EVLA using a 1470-nm dual-radial catheter is safe and carries a negligible risk of major thromboembolic events. Eliminating the proximal saphenous stump at the SFJ line does not increase DVT or PE incidence, even without chemical anticoagulation. The utilization of nationwide integrated digital tracking further validates the longitudinal completeness of outcome ascertainment.

Background/Objectives: Characterizing factors associated with intensive care unit (ICU) admission among hospitalized patients with pulmonary embolism (PE) is clinically relevant, particularly when established risk-stratification variables are incompletely documented in routine electronic medical records. The D-dimer-to-albumin ratio (DAR) combines a marker of fibrin turnover with serum albumin, a marker of systemic vulnerability; however, whether DAR provides clinically meaningful information beyond D-dimer alone remains uncertain. We evaluated the association between peri-diagnostic DAR and ICU admission and compared DAR with its component biomarkers. Methods: This single-center retrospective cohort study used electronic medical record data from 2009 to 2024. Candidate PE-related hospitalizations were identified from diagnostic records and clinically reviewed to verify a current acute PE event. Patients were eligible when DAR were measured within ±48 h of the PE diagnosis timestamp in the electronic medical record; the first eligible hospitalization per patient was retained. The primary outcome was ICU admission. Logistic regression models were adjusted for age, sex, recorded malignancy, and concomitant deep vein thrombosis (DVT). Results: Among 159 clinically reviewed patients with current acute PE, 143 (89.9%) had documented objective imaging confirmation, and 22 (13.8%) were admitted to the ICU. Each 1-unit increase in log-DAR was associated with greater odds of ICU admission (odds ratio [OR], 2.02; 95% confidence interval [CI], 1.43-2.86; p < 0.001), and the highest DAR quartile (Q4) was associated with greater odds than Q1-Q3 (OR, 6.78; 95% CI, 2.52-18.20; p < 0.001). However, in a temporally restricted analysis including 145 patients and 8 subsequent ICU admissions, the associations were attenuated and no longer statistically significant. Log-DAR was almost perfectly correlated with log-D-dimer (Spearman ρ = 0.995) and did not materially improve discrimination (area under the receiver operating characteristic curve [AUC], 0.788 vs. 0.785; ΔAUC, 0.003; p = 0.471; optimism-corrected AUC, 0.738 vs. 0.737). Conclusions: Peri-diagnostic DAR was associated with ICU admission in the primary analysis, but the temporally restricted analysis did not support prospective prediction of subsequent ICU admission. Its incremental value beyond D-dimer appeared limited, and DAR should be considered an exploratory adjunct rather than a replacement for established PE risk-stratification tools.

Uremia is the most common pathophysiological symptom in chronic kidney disease (CKD) patients, particularly in end-stage kidney disease (ESKD) patients. Uremia can lead to several vein-specific vascular diseases, such as renal vein thrombosis (RVT), deep vein thrombosis (DVT) and dialysis access-induced venous stenosis. One of our previous studies demonstrated that uremic serum exposure induced different cellular responses in pig venous smooth muscle cells (vSMCs) compared with arterial smooth muscle cells (aSMCs). To explore the underlying mechanisms responsible for vein-specific cellular responses, bulk RNA sequencing was utilized to examine differential gene expression in porcine vSMCs after uremic serum exposure. Differentially expressed genes (DEG) analysis revealed that 408 genes were upregulated, and 387 genes were downregulated after uremic serum treatment. Gene Ontology Biological Process analysis demonstrated that uremic serum exposure led to transcriptomic downregulation of cellular energy expenditure activities, such as the Cell Cycle, and positive transcriptomic enrichment of Cellular Response to Endoplasmic Reticulum (ER) stress, unfolded protein response and hypoxia. Both Gene Set Enrichment Analysis (GSEA) and Overrepresentation Analysis (ORA) obtained similar results. ORA revealed additional signaling pathways predicted to be transcriptomically downregulated, such as the Hippo signaling pathway and Focal Adhesion and Cytoskeletal Structure Regulating pathways. ORA also predicted several positively enriched signaling pathways related to cellular stress responses and waste disposal. To precisely identify vSMCs-specific alterations, an interaction-based KEGG GSEA was performed. The analysis revealed several significantly different responses between vSMCs and aSMCs, such as Protein Processing in the Endoplasmic Reticulum, Integrated Stress Response signaling pathway and Mitophagy, which showed more positive responses in vSMCs, while Oxidative Phosphorylation showed a more positive response in aSMCs. These altered signaling pathways may be responsible for vein-specific clinical symptoms, such as venous segment stenosis in arteriovenous fistula, observed in CKD/ESKD patients.