Atlas de Indicaciones

Investigational adjunctive use; mechanism includes mild diuresis from blood-volume removal and hirudin-mediated vascular endothelial effects. Not a substitute for pharmacotherapy.

Highly investigational adjunct for paroxysmal atrial fibrillation; no controlled trials; conventional anticoagulation and rate/rhythm control remain primary.

Investigational adjunct in compensated NYHA II heart failure; no RCT support; guideline-directed medical therapy remains primary.

Highly investigational adjunct for intermittent claudication; ABI must be assessed first; critical limb ischemia is an absolute contraindication.

Investigational use for primary livedo reticularis; very limited evidence. Secondary causes (lupus, APLAS) require rheumatology referral.

Investigational use for chronic lipodermatosclerosis; small case series suggest softening of fibrotic gaiter-area skin changes.

Investigational use to soften and remodel insulin injection-related lipohypertrophy nodules; very limited evidence.

Investigational use for androgenic alopecia; mechanism via local scalp perfusion improvement. Single-arm series only.

Investigational use for erythematotelangiectatic rosacea; case-series evidence for reduction in facial erythema.

Investigational use for localized stable plaque psoriasis; small case series suggest plaque thinning. Not a primary treatment.

Investigational use for localized refractory atopic dermatitis; very limited case-series evidence.

Investigational use for stable keloid and hypertrophic scars; case-series evidence for softening and flattening.

Investigational use for chronic recurrent (non-acute) cellulitis with underlying lymphedema or venous insufficiency.

Investigational adjunctive use for Hurley stage I-II hidradenitis suppurativa in quiescent phase between flares.

Investigational adjunct for adult recalcitrant atopic dermatitis (EASI >21) refractory to dupilumab or JAK inhibitor; very preliminary data.

Investigational adjunct for chronic plaque psoriasis recalcitrant to biologic therapy; very preliminary case-series evidence.

Highly investigational use for severe nodulocystic acne refractory to isotretinoin; very limited anecdotal evidence and significant scarring risk concerns.

Investigational adjunct for papulopustular rosacea subtype with persistent inflammatory lesions; small case series.

Investigational adjunct for Hurley stage I localized hidradenitis suppurativa; distinct from Hurley II-III with extensive disease.

Investigational adjunct for keloid scars refractory to intralesional corticosteroid; case series suggest volume reduction as adjunctive therapy.

Investigational adjunct for hypertrophic scars (within original wound boundary) distinct from keloid; case-series evidence for volume reduction.

Investigational use for localized cutaneous lichen planus refractory to topical corticosteroid; very limited case-report evidence.

Highly investigational use for small subcutaneous lipoma (<3 cm) with cosmetic concern; surgical excision remains standard; very limited data.

Highly investigational use for refractory plantar warts (HPV-mediated) after cryotherapy and salicylic acid failure; very limited anecdotal evidence.

Investigational adjunct after surgical drainage of small localized skin abscess; not for primary undrained abscesses; small case series.

Highly investigational adjunct for limited stable vitiligo; case reports only; topical calcineurin inhibitors, narrow-band UVB, and ruxolitinib cream remain primary.

Investigational adjunct for stable patchy alopecia areata; case reports only; intralesional corticosteroids and JAK inhibitors (baricitinib, ritlecitinib) remain primary.

Investigational adjunct in Hurley Stage II HS refractory to conventional therapy; case reports only; biologics (adalimumab, secukinumab) and surgical management remain primary.

Highly investigational adjunct for refractory melasma; case reports only; sun protection, hydroquinone, tretinoin, tranexamic acid, and chemical peels remain primary.

Highly investigational adjunct for refractory PIH; case reports only; sun protection, topical hypopigmenting agents, and chemical peels remain primary.

Highly investigational adjunct for refractory anogenital lichen sclerosus; no RCT evidence; potent topical corticosteroid (clobetasol) remains standard of care.

Highly investigational adjunct for localized granuloma annulare; no RCT evidence; many lesions resolve spontaneously within 1-2 years.

Highly investigational adjunct for stable plaque morphea; no RCT evidence; UVA1 phototherapy and methotrexate remain primary for active disease.

Highly investigational; supportive care and monitoring of associated anomalies remain primary; case reports only for adjunctive use.

Highly investigational adjunct for chronic radiation dermatitis after oncology completion; case reports only; standard skin care and dermatology referral remain primary.

Investigational adjunct for nail psoriasis; topical corticosteroids, intralesional steroid, and (for severe disease) systemic biologics remain evidence-based.

Investigational adjunct for refractory prurigo nodularis; potent topical/intralesional steroids, gabapentinoids, and dupilumab (FDA-approved 2022) remain evidence-based.

Investigational adjunct for chronic pruritus of unknown origin after systemic workup; antihistamines, gabapentinoids, and (for select cases) systemic immunomodulators remain evidence-based.

Investigational adjunct for cutaneous manifestations of Behcet disease; colchicine, apremilast, azathioprine, TNF inhibitors, and rheumatology supervision remain evidence-based.

Investigational adjunct for chronic recurrent chilblains; cold avoidance, smoking cessation, calcium channel blockers (nifedipine), and topical corticosteroids remain evidence-based.

Investigational adjunct for chronic spontaneous urticaria refractory to high-dose H1 antihistamines; omalizumab, cyclosporine, and step-up guideline-directed therapy remain evidence-based.

Investigational adjunct for recurrent idiopathic erythema nodosum; identification and treatment of underlying cause, NSAIDs, potassium iodide, and (refractory) colchicine remain evidence-based.

Investigational adjunct for refractory Hailey-Hailey disease; topical corticosteroids, topical antibiotics, topical calcineurin inhibitors, oral antibiotics, and (refractory) botulinum toxin or surgical interventions remain evidence-based.

Investigational adjunct for lichen simplex chronicus; breaking the itch-scratch cycle with potent topical corticosteroids, occlusion, topical calcineurin inhibitors, and treatment of underlying pruritus etiology remain evidence-based.

Investigational adjunct for stable non-ulcerated necrobiosis lipoidica; topical and intralesional corticosteroids, topical calcineurin inhibitors, glycemic optimization in diabetes, and (refractory) TNF inhibitors or fumaric acid esters remain evidence-based.

Off-label use with one RCT showing symptom and SNOT-22 score improvement at 4 weeks in non-polypoid chronic sinusitis.

Investigational use for chronic subjective tinnitus; case-series evidence for THI score improvement. Mechanism speculative.

Investigational adjunctive use for Ménière's disease; very limited evidence. Standard management (diet, betahistine, intratympanic therapy) remains primary.

Investigational use for pulsatile vascular-origin tinnitus distinct from subjective tinnitus; case-report evidence only.

Investigational adjunct for vestibular attack frequency reduction in definite Meniere's disease per AAO-HNS 2015 criteria; case-series evidence.

Investigational adjunct for peripheral vertigo persisting after Epley maneuvers or during prolonged vestibular neuritis recovery; anecdotal.

Highly investigational cervical adjunct for chronic tonsillitis; case reports only; tonsillectomy and antibiotics remain primary; cervical leech placement carries carotid-proximity risk.

Highly investigational adjunct for adult recurrent otitis media; case reports only; antibiotics and ENT evaluation for underlying eustachian tube dysfunction remain primary.

Investigational adjunct for nonallergic vasomotor rhinitis; case reports only; intranasal ipratropium and antihistamine remain primary.

Highly investigational cervical adjunct for chronic laryngitis; case reports only; ENT evaluation for underlying causes (LPR, smoking, vocal abuse) remains primary.

Highly investigational adjunct for chronic glossitis; case reports only; addressing underlying nutritional, infectious, or allergic causes remains primary.

Investigational adjunct for chronic refractory subjective tinnitus; cognitive behavioral therapy, sound therapy, and hearing aids for concurrent hearing loss remain evidence-based.

Investigational adjunct for refractory chronic otitis externa; topical antimicrobials, aural toilet, and predisposing-factor management remain evidence-based.

Investigational adjunct for chronic non-allergic rhinitis; intranasal corticosteroids, intranasal antihistamines, and trigger avoidance remain evidence-based.

Investigational adjunct for sicca (dry eye and dry mouth) symptoms; ophthalmologic lubricants, salivary stimulants (pilocarpine, cevimeline), and rheumatology workup remain evidence-based.

Investigational adjunct for primary burning mouth syndrome; clonazepam (topical or systemic), alpha-lipoic acid, low-dose tricyclics, and cognitive behavioral therapy remain evidence-based.

Investigational adjunct for chronic Eustachian tube dysfunction; nasal corticosteroids, antihistamines for allergic etiology, Valsalva maneuvers, and (refractory) balloon Eustachian tuboplasty remain evidence-based.

Investigational use for symptomatic relief of grade II-III internal/external hemorrhoidal disease; does not address anatomic prolapse.

Investigational adjunct for acute external thrombosed hemorrhoids presenting within 72 hours; distinct from internal hemorrhoidal disease.

Investigational adjunct for chronic anal fissure refractory to medical therapy; very limited case-report evidence; surgical sphincterotomy remains gold standard.

Investigational adjunct in NAFLD/MASLD; small case series only; weight loss, dietary modification, and resmetirom remain primary.

Highly investigational adjunct for non-cirrhotic hepatic congestion; case reports only; cirrhosis and portal hypertension are absolute exclusions.

Highly investigational adjunct for chronic pancreatitis pain refractory to conventional therapy; case reports only; pancreatic enzyme replacement and pain medicine remain primary.

Highly investigational adjunct for distal ulcerative proctitis; case reports only; topical 5-ASA and corticosteroids remain primary.

Investigational adjunct for symptomatic Gilbert syndrome; reassurance, trigger avoidance (fasting, dehydration), and acknowledgment of benign genetic etiology remain primary; no FDA-approved therapy.

Investigational adjunct for functional dyspepsia (Rome IV criteria); H. pylori eradication when positive, proton pump inhibitors, prokinetics, and tricyclic antidepressants remain evidence-based.

Investigational adjunct for pain-predominant IBS refractory to dietary and pharmacologic therapy; low-FODMAP diet, antispasmodics, low-dose tricyclic antidepressants, and cognitive behavioral therapy or gut-directed hypnotherapy remain evidence-based.

Investigational adjunctive use for non-suppurative lactational mastitis; case-series evidence for resolution of induration and reduced antibiotic days.

Investigational adjunctive use for chronic endometriosis-related pelvic pain; very limited evidence. Not a substitute for hormonal or surgical management.

Investigational use for primary dysmenorrhea refractory to NSAIDs and hormonal contraception; small case series.

Investigational use for non-specific chronic pelvic pain syndrome; case-series evidence for symptom reduction within multimodal management.

Investigational adjunct for moderate PMS refractory to conventional therapy; small case series only; SSRI and combined hormonal contraception remain primary.

Investigational adjunct in PCOS; case reports only; lifestyle modification, combined hormonal contraception, metformin, and ovulation induction remain primary.

Highly investigational adjunct for chronic vulvodynia refractory to conventional therapy; case reports only; pelvic floor PT, topical therapy, and TCAs remain primary.

Investigational adjunct for severe cyclical mastalgia refractory to conventional therapy; case reports only; reassurance, lifestyle modification, and selective danazol/tamoxifen remain primary.

Investigational adjunct for pelvic congestion syndrome; medical therapy (progestins, GnRH analogs) and ovarian vein embolization remain evidence-based.

Investigational adjunct for severe cyclic mastalgia; first-line care includes proper-fit support, evening primrose oil (debated), and (for severe disease) tamoxifen or danazol short-course.

Palliative investigational adjunct for endometrioma-related chronic pelvic pain in patients declining or unable to undergo surgical/hormonal management.

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

Off-label use with three RCTs showing pain and function improvement comparable to NSAID gel at 3 months in mild-to-moderate symptomatic knee OA.

Off-label use with RCT evidence: single-session leech therapy reduces pain and improves function in CMC-1 (basal thumb) OA at 8 weeks.

Off-label use with two RCTs showing significant pain reduction at 7-12 weeks compared to topical NSAID and conventional physiotherapy.

Off-label use with one RCT showing significant heel pain reduction at 6 weeks compared to conservative care.

Investigational adjunctive use; one small pilot suggests transient improvement in tender-point and quality-of-life scores. Not a primary treatment.

Investigational use for acute monoarticular gout when NSAIDs and colchicine are contraindicated; small case series.

Investigational use for chronic mid-substance Achilles tendinopathy; case-series evidence for pain and VISA-A score improvement.

Investigational use for non-surgical rotator cuff tendinopathy and chronic shoulder impingement; case-series evidence for pain reduction.

Investigational use for stenosing tenosynovitis of the digital flexor pulleys; small case series.

Investigational use for early-stage Dupuytren's nodules; case-series evidence for nodule softening, not for established contracture.

Investigational use for plantar fascia nodules in early Ledderhose disease; case-series evidence for symptomatic improvement.

Investigational adjunct in stage II frozen shoulder; small case series suggest accelerated range-of-motion recovery as add-on to physiotherapy.

Investigational use for insertional Achilles tendinopathy distinct from mid-substance disease; weaker case-series response.

Investigational use for stenosing tenosynovitis of the first dorsal extensor compartment; small case series.

Investigational use for trigger finger recurrent after corticosteroid injection failure; pre-surgical alternative explored in case series.

Investigational use for symptomatic plantar calcaneal spur; distinguished from plantar fasciitis by radiographic spur with localized pain.

Investigational use for chronic subacromial bursitis distinct from acute infectious bursitis; case-series evidence for pain reduction.

Investigational use for chronic greater trochanteric pain syndrome including bursitis and gluteal tendinopathy; case-series evidence.

Investigational use for chronic costochondritis with persistent chest wall pain after cardiac causes excluded; small case series.

Investigational use for SI joint mechanical pain with positive provocation tests; case-series evidence for pain reduction.

Investigational use for non-pregnancy-related pubic symphysis dysfunction including athletic osteitis pubis; anecdotal evidence.

Investigational use for chronic coccyx pain after fall, childbirth, or idiopathic onset; small case series for refractory cases.

Investigational use for isolated piriformis syndrome with positive FAIR test and excluded lumbar pathology; case-series evidence.

Investigational adjunct for chronic myofascial trigger-point pain; small case series only; dry needling, manual therapy, and exercise remain primary.

Investigational adjunct for refractory costochondritis or Tietze syndrome; NSAIDs, reassurance, and physical therapy remain primary; cardiac and pulmonary causes must be excluded first.

Investigational adjunct for chronic mid-portion (non-insertional) Achilles tendinopathy; eccentric loading remains evidence-based first-line.

Investigational adjunct for chronic patellar tendinopathy (Blazina stage II-III); eccentric loading and heavy slow resistance training remain primary.

Investigational adjunct for chronic proximal hamstring tendinopathy at ischial origin; eccentric loading and load management remain primary.

Investigational adjunct for chronic greater trochanteric pain syndrome (gluteal tendinopathy); load management and hip-abductor strengthening remain primary.

Investigational adjunct for refractory ischial (ischiogluteal) bursitis; activity modification, hamstring loading, and selective injection remain primary.

Investigational adjunct for symptomatic hip osteoarthritis; weight management, exercise, NSAIDs, and arthroplasty for end-stage disease remain evidence-based.

Investigational adjunct for chronic temporomandibular joint disorder; conservative care (education, jaw exercises, occlusal splint, NSAIDs) remains first-line; specialty referral for refractory cases.

Investigational adjunct for chronic cervical myofascial pain; education, exercise therapy, ergonomic correction, and trigger-point therapy remain primary.

Investigational adjunct for axial pain in ankylosing spondylitis; NSAIDs, biologic DMARDs (TNF and IL-17 inhibitors), and structured exercise remain evidence-based first-line therapy.

Investigational adjunct for chronic iliotibial band syndrome refractory to standard physical therapy and load-management; activity modification, eccentric hip strengthening, and corticosteroid injection remain evidence-based.

Off-label use with one RCT (Michalsen 2018) showing significant pain reduction at 7 days in cervical radiculopathy without surgical indication.

Off-label use with controlled trial evidence (n=80) showing leg pain and Oswestry score improvement at 4-12 weeks in non-surgical lumbar disc disease.

Investigational use with case-series evidence for reduction of migraine frequency and intensity; mechanism plausible via reduction of cervico-cranial venous congestion.

Investigational use with small case series suggesting frequency reduction in chronic tension headache via reduction of pericranial muscle tension and venous congestion.

Investigational use for non-discogenic sciatica including piriformis syndrome; case-series evidence for pain reduction.

Investigational adjunct in acute idiopathic facial nerve palsy; case-series suggest faster House-Brackmann recovery as add-on to corticosteroids.

Investigational use for classical trigeminal neuralgia refractory to first-line carbamazepine; anecdotal pain-frequency reduction.

Investigational use for lumbosacral radicular pain without disc herniation (foraminal stenosis, facet hypertrophy, lateral recess); case-series evidence.

Investigational use for mild-to-moderate carpal tunnel syndrome; small RCT evidence suggests short-term symptom relief comparable to wrist splinting.

Investigational use for posterior tibial nerve entrapment at the medial ankle; very limited case-report evidence.

Investigational adjunct for chronic migraine (≥15 days/month, ≥8 migrainous) refractory to two preventive classes; distinct from episodic migraine.

Highly investigational use for episodic cluster headache between attack cycles; very limited anecdotal data, not for active attacks.

Investigational adjunct for chronic tension-type headache (≥15 days/month) with persistent pericranial muscle tenderness; small case series.

Investigational adjunct for cervicogenic headache referred from upper cervical (C1-C3) joints; case-series evidence for pain reduction.

Investigational adjunct for primary RLS refractory to dopamine agonists; very limited anecdotal evidence; iron status and conventional therapy should be optimized first.

Investigational adjunct to physical/occupational therapy in chronic post-stroke hemiplegia; no RCT support; not for acute stroke care.

Investigational adjunct for MS-related fatigue; no controlled trials; disease-modifying therapy and modafinil/amantadine remain primary.

Investigational adjunct for muscular rigidity in idiopathic Parkinson's disease; no RCT support; levodopa and physiotherapy remain primary.

Investigational adjunct for myalgic encephalomyelitis/chronic fatigue syndrome; no RCT support; conventional pacing and symptom management remain primary.

Investigational adjunct targeting ACR tender points in fibromyalgia; limited case series; FDA-approved pharmacotherapy (pregabalin, duloxetine, milnacipran) and graded exercise remain primary.

Highly investigational adjunct for CRPS Type I; no RCT support; multidisciplinary pain management and physiotherapy remain primary.

Highly investigational adjunct for chronic phantom limb pain; case reports only; mirror therapy and gabapentinoids remain primary.

Investigational adjunct for muscular spasticity after SCI; no RCT support; baclofen (oral or intrathecal) and physiotherapy remain primary.

Highly investigational adjunct for CRPS-I in patients with stable nutritional vascular status; case reports only; multidisciplinary pain management remains primary.

Highly investigational; no clinical evidence supports use for cognitive outcomes; vascular risk-factor management (BP, lipids, antiplatelet, lifestyle) remains primary.

Highly investigational adjunct for secondary trigeminal neuralgia after MRI evaluation; carbamazepine and oxcarbazepine remain first-line; microvascular decompression for refractory cases.

Investigational adjunct for refractory restless leg syndrome after iron and pharmacologic optimization; case reports only.

Investigational adjunct for refractory vestibular migraine; migraine prophylaxis (propranolol, topiramate, amitriptyline) and vestibular rehabilitation remain primary.

Highly investigational. Acetazolamide, weight loss, and (for vision-threatening cases) CSF shunting or optic nerve sheath fenestration remain primary; no evidence supports leech therapy for ICP.

Investigational adjunct for convalescent-phase Ramsay Hunt syndrome residual facial weakness; antiviral plus corticosteroid started within 72 hours of onset remains evidence-based.

Investigational adjunct for chronic post-herpetic neuralgia; gabapentinoids, tricyclics, and topical lidocaine/capsaicin remain evidence-based; herpes zoster vaccine prevents new cases.

Investigational adjunct for symptomatic diabetic peripheral neuropathy; glycemic control, foot care, and pharmacotherapy (duloxetine, pregabalin, gabapentin) remain evidence-based.

Investigational adjunct for mild cubital tunnel syndrome; elbow extension splinting and ergonomic modification remain first-line; surgical decompression for moderate-severe cases.

Investigational adjunct for neurogenic thoracic outlet syndrome; postural correction and scalene rehabilitation remain first-line; surgical decompression for refractory or vascular subtypes.

Investigational adjunct for meralgia paresthetica; weight loss, loosening of constrictive clothing, and selective nerve block remain first-line.

Investigational adjunct during withdrawal phase of medication-overuse headache; supervised medication discontinuation and preventive therapy initiation remain the foundation.

Investigational adjunct for paraspinal pain in mild cervical spondylotic myelopathy; surgical decompression remains evidence-based when myelopathic signs progress; conservative management for mild non-progressive disease.

Investigational adjunctive use in primary open-angle glaucoma; weak case-series evidence. Not a substitute for IOP-lowering eye drops or surgery.

Investigational use for dry eye disease; mechanism via reduction of meibomian gland inflammation. Weak case-series evidence.

Highly investigational periocular adjunct for stable thyroid eye disease; ocular risk is critical; teprotumumab and orbital decompression remain primary.

Investigational adjunct to lifestyle modification in metabolic syndrome; small case series only; weight loss, dietary modification, and pharmacotherapy remain primary.

Highly investigational adjunct in stable Hashimoto's thyroiditis; case reports only; levothyroxine replacement remains primary.

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.

Highly investigational adjunct for advanced postsurgical lymphedema; complete decongestive therapy and (selectively) surgical options (LVA, VLNT) remain evidence-based.

Investigational adjunct for severe recurrent aphthous stomatitis; topical corticosteroids, chlorhexidine, and (for severe disease) colchicine or systemic immunomodulators remain evidence-based.

Investigational adjunct for chronic postsurgical pain after surgical site healed; multimodal pain management including pharmacotherapy, physical therapy, and (for neuropathic features) interventional pain procedures remain evidence-based.

Investigational adjunct for painful lipomatous nodules in Dercum disease; analgesics, weight management, surgical excision of selected painful nodules, and lidocaine infusion remain investigational themselves; no FDA-approved disease-modifying therapy.

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.

Investigational use for stable-phase Peyronie's disease; case-report-level evidence only. Standard treatments (verapamil, collagenase, surgery) remain first-line.

Investigational use for category III CP/CPPS; small case series suggest symptom reduction. Multimodal therapy remains standard.

Investigational extended-protocol adjunct for NIH Category III chronic prostatitis/CPPS; small case series only; UPOINT-directed therapy remains primary.

Highly investigational adjunct for IC/BPS refractory to conventional therapy; case reports only; AUA-guideline stepwise therapy remains primary.

Highly investigational extended-protocol adjunct for stable Peyronie's disease; case reports only; collagenase clostridium histolyticum and surgical correction remain primary.

Highly investigational adjunct in symptomatic varicocele; case reports only; embolization or surgical ligation remain primary for fertility or pain indications.

Investigational adjunct for chronic epididymitis after infection ruled out; NSAIDs, scrotal support, and selective surgery (epididymectomy) for refractory cases.

Investigational adjunct for chronic orchialgia (testicular pain) after workup; pharmacotherapy, pelvic-floor physical therapy, and (selectively) microsurgical denervation of the spermatic cord remain evidence-based.

Investigational adjunct for symptomatic prostatic calculi associated with chronic prostatitis; targeted antibiotics, alpha blockers, and selective transurethral resection remain evidence-based.

Investigational adjunct for symptomatic benign prostatic hyperplasia; alpha-blockers, 5-alpha-reductase inhibitors, and minimally invasive surgical therapy remain evidence-based.

Investigational adjunct for chronic pelvic floor myalgia; pelvic-floor physical therapy is first-line; biofeedback, trigger-point injection, and (for selected refractory cases) onabotulinumtoxinA remain evidence-based.

Off-label use with controlled trial evidence for symptomatic improvement in venous claudication, leg heaviness, and edema in CEAP C3-C5 stages.

Off-label adjunct to compression therapy with case-series evidence for accelerated healing in compression-resistant venous ulcers.

Off-label use with case-series evidence for symptomatic relief of leg pain, heaviness, and ulceration in PTS following deep vein thrombosis.

Investigational use for symptomatic relief of varicose tributary discomfort and inflammation; does not eliminate underlying venous reflux.

Investigational use for primary Raynaud's phenomenon; mechanism via local vasodilation and rheologic improvement. No RCT evidence.

Investigational adjunctive use; case-series evidence for limb-volume reduction when combined with complete decongestive therapy.

Investigational adjunctive use following breast cancer treatment with axillary node dissection; case-series evidence for arm volume reduction.

Investigational use for residual symptoms in the post-acute phase of DVT (>6 weeks); contraindicated in acute DVT.

Investigational adjunct specifically for primary congenital/idiopathic lymphedema in stage I-II; distinct from secondary or advanced disease.

Investigational adjunct for post-mastectomy lymphedema in late survivorship phase (≥2 years post-treatment); distinct from early post-treatment period.

Investigational use for superficial thrombophlebitis of saphenous tributaries distinct from DVT; case-series evidence for pain and inflammation reduction.

Investigational use for primary livedo reticularis; must exclude secondary causes (APS, cholesterol emboli, vasculitis) first.

Highly investigational use for primary or secondary erythromelalgia (red, hot, painful extremities); very limited anecdotal evidence.

Investigational adjunct for early microvascular complications of type 2 diabetes; case series only; glycemic control and standard pharmacotherapy remain primary.

Investigational adjunct for Buerger's disease; absolute tobacco cessation is the only disease-modifying intervention; iloprost and surgical sympathectomy for selected cases.

Investigational adjunct for asymptomatic mild-to-moderate carotid stenosis; risk-factor management (statin, antiplatelet, blood pressure, smoking cessation, glycemic control) remains evidence-based; symptomatic or high-grade disease requires vascular surgery referral.

Investigational adjunct for vascular and neurosensory components of hand-arm vibration syndrome; cessation of vibration exposure, smoking cessation, calcium channel blockers for vascular component, and gabapentinoids for neurosensory pain remain evidence-based.

Investigational adjunct for stage 1 lipedema; conservative complete decongestive therapy, daily compression garments, weight management, and (selected stage 2-3) tumescent liposuction remain primary management.

Investigational adjunct for livedoid vasculopathy; rheumatology referral, antiplatelet therapy, anticoagulation, hyperbaric oxygen, intravenous immunoglobulin, and rivaroxaban (off-label) remain evidence-based; thrombotic disease workup is essential.