A retrospective study was performed on 2961 limbs of 2082 patients who had primary varicose veins with saphenous vein insufficiency, to assess the value of different types of treatment. Compression sclerotherapy combined with high ligation (CS+HL) was frequently chosen in surgery from 1994 to 1997; however, selective stripping has become more accepted lately. CS+HL was more frequently associated with cutaneous pigmentation and recurrent varices than stripping procedure. Damage to superficial nerves rarely occurred with selective stripping compared to standard stripping. Patient satisfaction within 3 months after treatment in the CS+HL group was significantly lower than that in the stripping group, because a number of patients claimed cosmetic imperfection and they complained about prolonged wearing of elastic stocking or the long duration of treatment. Patients who underwent stripping listed prominent wound scar or superficial nerve damage as reasons for dissatisfaction in the early postoperative days, while they complained of residual or recurrent varices in the late period. Patient satisfaction after treatment in the stocking group was the lowest of all the groups, because of the troublesome wearing of elastic stocking. In conclusion, it is essential to evaluate the pathologic condition of varicose veins and to select a treatment that meets each patient’s needs and produces the best outcome.

Objective: To determine which method of eliciting venous reflux allows obtaining more repeatable venous reflux parameters measured by duplex ultrasound (DU), and which of these parameters is most repeatable.

Materials and methods: Sixteen limbs with chronic venous insufficiency were measured for venous reflux parameters at superficial femoral vein: SFV and great saphenous vein: GSV, twice under Valsalva maneuver and cuff compression by two different examiners using DU.

The venous reflux parameters were • venous reflux time • peak venous reflux velocity • timed average venous reflux velocity • venous reflux time velocity integral • total reflux volume • timed average reflux volume • venous reflux time index • peak venous reflux velocity index • timed average venous reflux velocity index • venous reflux time velocity integral index (Index-type parameters which are the rate between reflux and outflow).

The intra- and inter- observer repeatability of these venous reflux parameters were judged from the testretest reliability (Correlation Coefficient: CC).

Results: 1) The Valsalva maneuver elicits 13 SFV and 7 GSV refluxes by two examiners, the cuff compression method, 7 SFV and 13 GSV refluxes. 2) The inter-observer CC of all parameters between first and second examination was worse than inter-observer CC. 3) Seven of 10 intra-observer and 8 of 10 inter-observer CC of parameters under cuff compression were higher than that under Valsalva maneuver.

4) The CC of peak venous reflux velocity index and venous reflux time velocity integral index under cuff compression were best of all parameters.

Conclusion: The peak venous reflux velocity index and venous reflux time velocity integral index under cuff compression were most repeatable, and should be good quantitative venous reflux parameters.

Purpose: The correlation between air plethysmography (APG) and CEAP classification in patients with varicose veins is not well defined. The purpose of this study was to evaluate the usefulness and problems of the CEAP classification from the standpoint of venous function determined with APG.

Subjects and Methods: From January 2002 to December at Hiroshima Teishin Hospital, 691 extremities in 470 patients with varicose veins were studied with air plethysmography. They were classified as follows: 36 limbs were in C_0-1 category, 581 limbs in C₂, 12 limbs in C₃, 53 limbs in C₄, 4 limbs in C₅, and 5 limbs in C₆.

Results: The venous filling indices(VFI) were 1.82±0.99ml/sec in C_0-1 group, 4.31±2.84ml/sec in C₂, 3.22±1.96ml/sec in C₃, 6.22±3.27 ml/sec in C₄, 9.43±6.73 ml/sec in C₅, and 9.59±4.2ml/sec in C₆.

Conclusions: The VFI had significant correlations with the severity of the clinical classification, although the VFI of the C₃ cases were not higher than those of the C₂ cases because of the difficulty with the definition of the term “edema”. We noticed that in some cases caused by the reflux of short saphenous veins or incompetent perforating veins below the knee or some cases with severe lipodermatosclerosis, the VFI had little correlation with the clinical classification.

Two hundred and forty-three patients with varicose veins affecting 350 limbs visited Kudanzaka Hospital between 2001 and 2002. Color Duplex Scanning (CD) was performed in 295 limbs (84.3%) as an initial imaging examination, and the origin of the varicose vein and the extent of reflux was investigated. Among them, varicose veins were originated from the great saphenous vein (GSV) in 175 limbs (59.3%), and the short saphenous vein in 46 limbs (15.6%). The reflux ceased at the proximal to the middle shin in 89 of GSV type limbs. In such cases we could preserve the distal portion of the GSV to avoid saphenous nerve injury.

Varicography and/or ascending venography was performed in 45 limbs including 35 limbs where some atypical pathways of reflux were found on CD. These radiological imaging tests were useful to visualize the complicated networks of varicosity. They provided valuable information especially when examined with careful techniques and earnest observation.

Though in only a few cases, there were important anomalies around the saphenofemoral junction and GSV. At least B-mode ultrasound examination should be essential for all patients with varicose vein before surgery.

Importance of functional assessment for the management of chronic venous disease (CVD) has been gradually recognized, according to recent advanced technology in noninvasive modalities. We, therefore, reviewed our previous findings with reference to venous function using air plethysmography (APG) and near-infrared spectroscopy (NIRS), trying to clarify the clinical significance of noninvasive diagnostic tools in the management of patients with CVD. The first study examining limbs with primary varicose veins revealed that the ambulatory venous retention index (AVRI) obtained from NIRS and the venous filling index (VFI) derived from APG were significantly different between groups of limbs with different clinical severities of disease. Moreover, the sensitivity and specificity of AVRI for detecting severe disease were superior to those of VFI. The second study was conducted to determine the diagnostic acumen of NIRS and APG in detection of deep vein thrombosis (DVT). As a result, NIRS was more sensitive than APG for detecting isolated calf DVT, while both tests identified proximal DVT in all limbs. We believe that an accurate evaluation by use of current noninvasive technique would yield a better understanding of venous hemodynamics in CVD and ultimately lead to better patient care.

A 63-year-old male was referred to a cardiologist of our institute for investigation and treatment of swelling in his right lower leg. Pulmonary thromboembolism (PTE) was suspected. The patient was transferred to our department for treatment of PTE. Systemic thrombolytic therapy was chosen for the treatment because the patient’s general condition was stable. Pulmonary blood flow scintigraphy showed a defect in part of the right lower lobe on December 16, 2002.Systemic thrombolytic and anticoagulant therapy were begun and continued. Pulmonary scintigraphy revealed deterioration of the perfusion to the whole right middle and lower lobe four days after the first scintigraphy. A chest CT showed thromboembolus in the right middle and lower pulmonary arterial trunk. Pulmonary arteriography revealed complete occlusion of the right middle and lower pulmonary arteries. The thromboembolus was too hard to be inserted and fragmented with a guide wire or catheter. Selective thrombolysis by urokinase using a catheter was performed intermittently, thereafter some blood flow was recognized in the circumference of the thromboembolus. A temporary inferior vena caval filter was placed under the orifice of the renal veins via a left femoral vein.

Eleven days after the caval filter placement, pulmonary angiography revealed no thromboembolus and no stenosis of the right middle and lower pulmonary arteries. The temporary inferior vena caval filter in which we did not find out any trapped thromboembolus was removed. Pulmonary blood flow scintigraphy and chest CT revealed disappearance of the theomboembolus and reflow of the pulmonary artery. The patient left our institute 34 days after the thrombolytic treatment (on January 6, 2003), uneventfully. At the present time, the patient is being followed up in the outpatient clinic with anticoagulant therapy.

We report a 88-years-old-man effective with Trafermin, who had chronic and multiple venous leg ulcers with long-standing resistance to therapy. He had three skin ulcers on his bilateral legs, 10.0 ×3.5 cm outside his rt. ankle joint, 4.5 × 2.3 cm ulcer inside his lt. ankle joint, and 14.0×10.0 cm ulcer outside his lt. ankle joint. We treated these ulcers by once-daily spraying of Trafermin. Two ulcers was completely epithelialized at 5～6 months after the beginning of the treatment and do not relapse till now. His biggest ulcer was also reduced the size to 8.5 × 5.0 cm at 10 months after the beginning of the treatment and good granulation with good epithelialization was observed. Trafermin was developed aiming at the basic fibroblast growth factor playing an important role in the wound healing process. The good effects of Trafermin was expected in the patients ineffctive with other drugs. Trafermin may be effective tretment for the shortening of treatment period with other surgical treatment.

Recently, venous aneurysm has attracted a great deal of attention and many articles about it have been reported. But venous hemangioma, which has similar symptoms with venous aneurysm, has little concerned. We herein report a case of venous hemangioma and discuss about differential diagnosis between venous aneurysm and hemangioma. A 56-year-old woman attended our hospital for examination and treatment of the tumor at the left elbow. Although a small and soft tumor had been recognized on the same aspect about 10 years previously, it had been ignored because of asymptomatic. However, the tumor had recently increased in size gradually and caused dull ache and numbness. On physical examination, a nonpulsatile , soft and smooth-surfaced tumor 2×3 cm in size was noticed at the left cubital fossa. The skin over the tumor was colored dark-bluish. The tumor was reduced the size by the elevation of the arm above the head but not completely disappeared. As these findings, we suspected localized dilated venous disease; that is venous aneurysm or venous hemangioma, and planed duplex scan echogram, venogram and MRI. These examinations showed that the tumor originated from the superficial cubital vein had septa in it and was shaped like “multiple loculations”. Accordingly, we diagnosed the tumor as venous hemangioma presumptively, and extracted it under local anesthesia. Macroscopic findings of the resected specimen showed the tumor consisted of thick-wall and multiple lumens containing with red thrombi and “phleboliths”. Microscopic findings revealed the tumor composed of variably sized veins which had well-developed muscular wall. These macroscopic and microscopic findings of the specimen were compatible with venous hemangioma.

A 53-year old female had sudden onset of left lower limb pain and swelling at 16 days after her right sided hip joint replacement surgery. Femoro-femoral crossover bypass using a ringed ePTFE graft was performed for her acute deep vein thrombosis without arterio-venous fistula achieving disappearance of the left thigh edema. The graft was patent by venography even after 13 years.