Therapeutic role of venous leg compression in worsening heart failure with predominant extravascular congestion: a case report.

Background: Worsening heart failure (WHF) may occasionally present with predominant extravascular fluid overload without clear intravascular congestion. This scenario can challenge traditional diuretic-based strategies, particularly in patients with infiltrative cardiomyopathies such as amyloid light-chain (AL) amyloidosis, where congestion often manifests as volume overload without substantial intravascular volume expansion. Case summary: This case report highlights the potential efficacy of venous leg compression (VLC)-a therapeutic approach traditionally employed in chronic venous diseases to improve venous return-combined with parenteral diuretic therapy in alleviating signs and symptoms in a 50-year-old woman with AL amyloidosis and WHF. In this patient, VLC was associated with tissue decongestion, enhanced vascular refill, and clinical improvement, suggesting its role in optimizing the diuretic response despite the absence of intravascular congestion. Discussion: Venous leg compression emerges as a promising adjunctive therapy for managing WHF with predominant extravascular fluid overload, especially when conventional diuretics may be limited by the lack of intravascular congestion. These findings support the potential utility of VLC as a complementary strategy in this subset of patients. Further studies are warranted to establish its safety and efficacy.