A total of 27 patients with upper arm lymphedema was treated. Among them, 12 patients were treated with compression therapy. The average period for compression therapy was 10.6 months and the average decreased circumference of the forearm was 0.8cm. 18 patients were treated with lymphaticovenous anastomosis under general anesthesia as well as pre and postoperative compression therapy. The average period of follow up was 2.6 years and the average decreased circumference of the forearm was 4.5cm.

A total of 35 patients with lower leg edema were treated. 12 patients were treated with compression therapy and the average period for treatment was 1.5 months. The average decreased circumference of the lower leg was 0.6cm. 16 patients were treated with lymphaticovenous anastomosis under general anesthesia as well as pre and postoperative compression therapy. The averagefoloow up period after surgery was 3.3 years and the average of decreased circumference was 2.7cm. The patients decresed over 4cm were 50% of all patients. Meanwhile, 33 patients were recently operated under local anesthesia. As the results, 82% showed improvement. There was no correlations between the etiology, the severity, and the duration of edema, and the number of anastomosis in each patient.

Compression therapy is one of the most powerful instruments of the phlebologist, and it remains the primary treatment for venous insufficiency, either as the sole type of treatment or in conjunction with other forms of therapy. The effect depends on several factors, including the underlying disease, the exerted pressure, the sites of the limb where the compression therapy is applied, the compression materials such as short-stretch or elastic bandages, and the application technique. After sclerotherapy for the treatment of leg varicose veins, the compression therapy is also used, because the success of sclerotherapy is believed to depend on uninterrupted compression of the veins at the sites of injection. Interface pressure under elastic materials during posture changes and exercise is similar to that under short-stretch bandages when compression pads are used. Therefore, we recommend elastic materials immediately after sclerotherapy. Because low compliance for compression therapy is mostly owing to incorrect application, we should train to be able to use the proper compression therapy.

We reviewed 25 patients with intracranial bleeding from a total of 172 dural arteriovenous fistulas (dural AVFs) patients to investigate bleeding rate, bleeding pattern, clinical result etc. The patients (incidence of bleeding) were 15(20.5%) in transverse sigmoid sinus, 2(2.8%) in cavernous sinus, 6(50%) in anterior cranial fossa, 1(25%) in superior petrosal sinus, and 1(25%) in superior sagittal sinus, respectively. All but one patient had leptomeningeal venous drainage on the angiogram. The craniotomy was performed for anterior cranial fossa, superior petrosal sinus, and superior sagittal sinus, whereas endovascular therapy was achieved for transverse sigmoid sinus and cavernous sinus. The lesion disappeared in 14 patients after the treatment; no clinical deterioration or rebleeding occurred. Five patients, however, had either severe neurological deficit or died due to initial hemorrhage. Leptomeningeal venous drainage plays an important role for intracranial bleeding. Endovascular treatment, particularly transvenous embolization is effective and useful for dural AVFs involving transverse sigmoid sinus and cavernous sinus, while surgical therapy is required for other lesions.

MR venography (MRV) is useful for the diagnosis of deep venous thrombosis (DVT). We evaluated the lower extremity vein as the embolic source of pulmonary thromboembolism (PTE) using MRV. We also investigated the location of pulmonary emboli. Twenty-eight patients with PTE confirmed by enhanced chest CT underwent MRV of the lower extremity. 2D-TOF was used in the pelvis and thigh, and Gd-enhanced MRV with 3-phase dynamic study was used in the calf. The most proximal localization of DVT was evaluated, and the relationship between the proximal site of DVT and the severity of PTE was investigated. Thrombi in the lower extremity vein were found in 26 patients (93%). Thrombi were localized only in the calf in 13 patients (46%). Five patients (18%) had only intramuscular thrombi. In clinical cases, the source of pulmonary thromboembolism had been detected in only 50-70% of cases, because thrombi within the calf were not easily diagnosed. MRV was a very useful method to evaluate DVT. We could detect lower extremity thrombi in 93% patients with PTE by MRV. Especially, Gd-enhanced MRV was effective for the examination of the calf vein. Almost half of the patients had thrombi only in the calf. Severe PTE might occur in patients with only intramuscular vein thrombi. We emphasize the importance of the calf vein thrombi, especially the intramuscular vein. MRV is very useful to diagnose the source of PTE.

Between November 1979 and August 2001, we performed 44 radical operations which consisted of reconstruction of the occluded inferior vena cava and reopening of the hepatic veins under femoro-femoral partial cardiopulmonary bypass for Budd-Chiari syndrome. The cumulative survival rate of these 44 patients was 80% at 10 year and 70% at 20 year respectively. Nine of the patients had combined hepatocellular carcinoma. Six of the hepatocellular carcinomas occured 3 to 9 year after the radical operation and transcatheter arterial chemoembolization or liver resection was carried out. The remaining 3 hepatocellular carcinoma cases were simultaneously diagnosed with the Budd-Chiari syndrome. The 3 patients were 38, 73 and 76 years old, one female and two male. Transcatheter arterial chemoembolization was done 1 month to 2 months preoperatively after which the one stage operation which consisted of radical operation and liver resection was carried out. The postoperative course of these three patients was good despite liver cirrhosis in all with a 32.8% of ICG15 min value in one and high age in one of 76 years old. Three patients was doing well without any recurrence from 1 year to 13 year 1 month after operation. We think that this one stage operation is safe and useful for prolonging survival and the indication can be extended to the more high risk patient.

The patient, a 71-year-old female, consulted a local physician, and a tumor was detected in the right kidney by ultrasonography. The patient was diagnosed as having renal cancer with a tumor thrombus in the inferior vena cava (IVC), and referred to our department. Preoperative examination suspected that the tip of the tumor thrombus reached the region proximal from the hepatic vein. After abdominal median incision and thoracotomy at the ninth costal space, the right hepatic lobe was displaced, and the lesion was found in the IVC. The lesion was confirmed to be a floating tumor thrombus by ultrasonography performed during surgery. Since it was indicated by the blocking tests that blood flow could not be maintained under blocking of the region proximal from the hepatic vein, blocking of the IVC on the distal side from the hepatic vein and right renal vein was performed after the tumor thrombus was manually moved toward the distal side. The tumor thrombus in the cava was removed en bloc together with the renal tumor. The postoperative course was good. The patient was discharged, and no evidence of further disease has been seen in the 47 months since the operation.

In some patients with a tumor thrombus in the IVC caused by renal cancer, removal of the tumor thrombus under simple blocking is possible by detailed preoperative evaluation and ultrasonography and blocking tests during surgery, if it reachs the region proximal from the hepatic vein.

Duplex scan shows the many venous reflux sources in the superficial and deep venous systems, and enables us to assess the hemodynamics of varicose veins. It is thought that the reflux of the saphenous veins and incompetent perforating veins can be stopped with venous ligations and that varicose veins are can be treated with multiple venous ligations. Conseqently duplex scan oriented venous ligations have been performed at our out-patient clinic since 1995 consiting of small incisions under local anesthesia.

The total number of incompetent perforators were 1.2±1.1 per the lower limb. The number of the venous ligations were 5.7±1.8 per the lower limb for the 1108 large saphenous type varicose veins treated with in the last 3 years. The main saphenous vein and direct perforating veins were mainly ligated in about 1cm skin incisions.

Precise preoperative duplex scan assessment and duplex scan oriented venous ligations are effective and less invasive therapy for the varicose veins. It is important that the varicose veins should to be controlled because any operation for varicose veins is palliative rather than radical.