Endovenous surgery in the treatment of varicose veins generally consists of laser or radiofrequency ablation (RFA) as endovenous thermal ablation (ETA) with a phlebectomy or foam sclerotherapy of tributary varicose veins to improve symptomatic or cosmetic problems. Nevertheless, the efficacy of their concomitant treatments is still controversial for a decade. In the guideline of Japanese Society of Phlebology, concomitant phlebectomy of tributary varicose veins with ETA is described that it is not recommended officially. In our hospital, RFA without concomitant phlebectomy of tributary varicose veins accounts for seventy four percent of the RFA cases and it shows relatively higher percentage than other institutions in Japan. The data of RFA without concomitant phlebectomy of tributary varicose veins is evenly matched in RFA with concomitant treatments in our data concerning recurrence, remnants, endovenous heat-induced thrombosis (EHIT) and complications. This article provides the conclusion that it would be acceptable to perform isolated RFA compared to RFA with concomitant phlebectomy or foam sclerotherapy of tributary varicose veins in short and midterm period. In addition, concomitant treatments might contribute to rapid improvement of the short term and better long-term outcome, not to mention cosmetic problems those are not identified demonstrably.

An 89-year-old woman developed aortic dissection (type B) with unruptured abdominal aortic aneurysm measuring 40 mm. She has treated atrial fibrillation with direct oral anticoagulants (DOAC); then, we switched to antihypertensive therapy and discontinued DOAC. Eight days post-admission contrast-enhanced computed tomography showed a new floating mural thrombus (37×27 mm) in the abdominal aortic aneurysm. DOAC was resumed without surgery owing to advanced age and frailty. The new floating thrombus disappeared 3 months later. Drug therapy should be considered for new floating thrombi in aneurysms if they show both low with no echoic areas (AC sign) on echography.

We herein report a case of finger necrosis caused by primary macroglobulinemia with cold agglutinin disease. A 65-year-old man was admitted to our hospital because of right index finger cyanosis and middle finger necrosis. The ischemic change extended from both fingertips to the distal interphalangeal joints. A cold agglutinin’s blood test was positive. A subsequent thorough examination revealed IgM kappa type M protein. Consequently, we diagnosed the patient with primary macroglobulinemia. Our case suggests that primary macroglobulinemia should be considered as a differential diagnosis for finger necrosis, although it may be of low priority.