Smart Library

FDA-cleared application: medicinal leech therapy to relieve venous congestion in compromised tissue flaps awaiting vascular ingrowth.

FDA-cleared application: post-replantation venous decompression in digits, ears, scalp, and partial avulsion injuries.

FDA-cleared application: venous decompression of compromised DIEP, TRAM, and latissimus dorsi flaps in post-mastectomy reconstruction.

Off-label adjunct to compression; the evidence is one small open-label randomized trial in varicose veins (n=50) and a 20-patient uncontrolled series.

Off-label adjunct to compression therapy; the evidence is one 20-patient uncontrolled series in complicated varicose veins plus case reports.

Investigational use; no controlled trial was identified, and the only clinical report is a 1998 conference series of 87 patients without a comparison group.

Investigational use for lumbar radiculopathy; the closest randomized evidence is in chronic low back pain (Hohmann 2018, n=44), not radicular pain.

Investigational adjunct in compensated NYHA II heart failure; only small open-label or uncontrolled studies were identified, mostly in Russian-language sources; guideline-directed medical therapy remains primary.

Investigational palliative adjunct for adenomyosis-related dysmenorrhea and pelvic pain; hormonal therapy (LNG-IUD, dienogest, GnRH antagonists) and (definitively) hysterectomy remain evidence-based.

Investigational adjunct for ME/CFS symptom management; pacing strategies, post-exertional malaise avoidance, and individualized supportive care remain primary; graded exercise therapy is no longer recommended per updated NICE guidance.