Angiogenesis is an essential process in not only the development of tissue/organ but also the tissue remodeling following tissue injuries-inflammation. On the other hand, angiogenesis can participate in the acceleration of basic diseases in angiogenic diseases. In fact, angiogenesis participates in the progression of atherosclerosis, which is the major cause of ischemic diseases in human organs, especially in heart, brain and lower extremities. Therefore, therapeutic angiogenesis can act the bi-directional functions in the promotion of atherogenesis itself besides the rescue of ischemic organs, as a two-edged sword in patients with atheroslcerotic diseases. In this paper, the mechanism of FGF-2-induced angiogenesis in ischemic limb animal models is reviewed, and FGF-2 gene transfer using SeV has been shown to be an effective therapeutic tool for ischemic tissue/organ, on the basis of FGF-2-induced hierarchical and harmonized angiogenesis with other endogeneous angiogenic factors such as VEGF-A, -C, HGF and PDGF, which would be expressed by endothelial cells, smooth muscle cells/pericytes and fibroblastsHowever, the FGF-2- induced effects on exogeneous and endogeneous expression of angiogenic factors are limited to be local but not systemic. From these findings, the FGF-2 gene transfer using SeV can be a novel and effective therapeutic tool for ischemic atherosclerotic diseases to develop functional collateral vessels.

HIT is known as an important adverse reaction in heparin treatment, and heparin treatment should be started with keeping in mind the onset of HIT during 5-10 days after the heparin. HIT had not fully recognized in clinical practice in Japan despite management of HIT well confirmed in Western countries. Also, recognition of HIT has been evoked since argatroban had gotten the approval of FDA for prevention and treatment of HIT. Although the incidence of HIT in Japan has not yet been studied, there is a strong probability that HIT would be encountered in critical patients undergoing heparin treatment. However, there are a few case reports in annual year in Japan. Now, studies of HIT have been initiated in uremic patients requiring hemodialysis. HIT is easily recognized with clotting of extracorporeal circulation under adequate heparin anticoagulation. Hemodialysis session is often discontinued with heparin, and the re-session could be done to switch to alternative anticoagulants from heparin. In these days, argatroban is the first-choice alternative to heparin because of some experience of obtaining clinical improvements in HIT patients. Also, widespread use of laboratory tests for HIT are boosting the recognition of HIT. In Japan, management of HIT will be achieving to the goal of good practice by mean of both development of laboratory tests and application of argatroban.

The review of Japanese reports last ten years (1993-2002) showed that the incidence of proximal deep venous thrombosis after total hip replacement (THR), total knee replacement (TKR), and the surgery of hip fracture was more than 10% and the incidence of clinical pulmonary thromboembolism after the surgery of spine and lower extremity including THR, TKR, and the surgery of hip fracture was about 1%.

The risk level for thromboembolism after THR, TKR, and the surgery of hip fracture was thought to be high risk and that after the surgery of spine and lower extremity excluding THR, TKR, and the surgery of hip fracture was thought to be moderate risk.

Intermittent pneumatic compression or anticoagulation therapy was recommended after the surgeries of high risk group, and elastic stockings or intermittent pneumatic compression was recommended after the surgeries of moderate risk group. If the patients who were performed the surgeries of high risk group had thrombophilia or the history of thromboembolism, anticoagulation therapy should be recommended.

Purpose: We evaluated retrospectively the usefulness of inferior vena caval filters placed via a jugular approach to prevent pulmonary embolism in patients with acute deep vein thrombosis (DVT).

Patients and method: Between October 1997 and August 2003 we treated 26 patients with acute lower-limb DVT by placement of inferior vena caval filters in our hospital. The caval filters included 14 permanent filters consisting of 11 Greenfield and 3 LGM filters, and 13 Antheor temporary filters. The number of patients that received the filters was equivalent to 34% of all patients with lower-limb DVT during the same period. The patients included 11 men and 15 women, aged from 33 to 83, with an average age of 60. Sixteen patients (62%) were complicated with acute pulmonary embolism, and included 7 patients with hypoxia and 4 patients with hypotension. Indications for filter placement were prevention of recurrent pulmonary embolism in 16 patients, prevention of fatal pulmonary embolism for iliocaval thrombosis in 8 patients, and perioperative prophylaxis in cases with deep vein thrombosis in 2 patients. All filters were inserted percutaneously through the right internal jugular vein under local anesthesia and placed in the infrarenal inferior vena cava in 25 patients and in the suprarenal in 2 patients.

Result: All filter placements were safely and successfully performed. Complications such as bleeding, insertionsite thrombus, infection, filter malposition or pneumothorax were not experienced. In 2 of the 13 patients treated with temporary filters, given that a large thrombus was entrapped within the filter basket, thrombolysis therapy was continued for several more days. We experienced two early complications consisting of a fracture of one of the six limbs of the temporary filter in one patient, which retrieved immediately following successful transcutaneous catheter manipulation, and congestive heart failure in one patient with valvular heart disease, who recovered in a week. During the follow up period of 1-72 months, 20 months on average, no cases of recurrent pulmonary embolism, new DVT or occlusion of the inferior vena cava were encountered.

Conclusion: Placement of a vena caval filter is considered to be a useful and reliable procedure to prevent fatal pulmonary embolism in patients with iliocaval thrombosis. Use of the jugular approach in the placement of inferior vena caval filters could be the best alternative to conventional insertion through the femoral vein.

The endovenous obliteration of varicose veins is performed with expectation of less invasive and good results. Venous stripping is performed as day surgery because of better operative and anesthegic methods. The purpose of day surgery is not only to shorten hospital stay, but also to improve QOL after surgery. The aim of this study is to examine the early results and postoperative QOL of Radiofrequency (RF) endovenous obliteration for comparison with venous stripping.

Materials and Methods: The 52 consecutive patients with RF endovenous obliteration(21 cases, 26 legs) and venous stripping (31 cases, 45 legs) for saphenous varicose vein were evaluated as follows, preoperative conditions: C class of CEAP classification, maximum saphenous vein diameter, 1-3 months postoperative results: the anatomical evaluation of venous closure or stripping and complications, and QOL: postoperative pain, duration of pain, duration of returning to daily life or job and satisfaction with the procedure.

Results: There was no significant preoperative C class and maximum venous diameter difference between endovenous obliteration and stripping. All stripping cases were performed completely, all endovenous obliteration cases except one case were closed completely. One case underwent stripping. There were several complications: superficial thromboplebitis 12%, saphenous nerve injury 4% in endovenous obliteration cases, hematoma 35.6%, saphenous nerve injury 4.4% in stripping cases. According to postoperative QOL, pain grades and duration of returning to daily life or job in EO cases were significantly better than that in stripping cases. The duration of temporary pain in EO cases tend to be shorter than that in stripping cases. There is no difference between EO and stripping cases in regard with the satisfaction of operation.

Conclusion: RF endovenous obliteration for saphenous varicose veins was better than stripping in regard with QOL. Based on these results, RF endovenous obliteration appears to be excellent treatment of saphenous varicose veins, although the long-term results should be required.

The aim of this study is to evaluate the impact of the site of venous ligation on post operative sclerotherapy in varicose vein patients. One hundred eleven limbs with greater saphenous varicose veins, whose reflux remains just above or below knee joint, were retrospectively observed. We divided these limbs into two groups; group A, saphenous vein was ligated to the point where saphenous vein reflux disappeared, and group B, saphenous vein was not ligated at the point where saphenous vein reflux disappeared. Number of ligation was 3.2±1.2 in group A, and 2.3±1.0 in group B (p<0.001). Post-operative sclerotherapy per limb was 0.34±0.45 in group A, and 0.7±0.88 in group B (p<0.05). Used sclerosing agent per limb was 0.36±0.55 ml in group A, and 0.74±0.91 ml in group B (p<0.05). Post-operative outpatient office visit was 3.2±0.9 days in group A, and 4.6±1.7 days in group B (p<0.001). Venous ligation at the point where saphenous vein reflux disappeared, decreased post-operative procedures of sclerotherapy, which result in decrease of load of the patients in the therapy of combined high ligation and sclerotherapy for varicose veins.

Six cases of superior vena cava (SVC) syndrome secondary to malignant neoplasms were surgically treated during the past 19 years. Complete tumor resection that included vascular reconstruction was performed in 2 of the 3 cases of invasive thymoma, and incomplete resection plus a bypass operation was performed in the other case. A bypass operation alone was performed in the 1 case each of lung cancer and esophageal cancer because the lesions were unresectable, and stenting was performed in the 1 case of uterine cancer. The SVC syndrome improved postoperatively in 5 of the patients, but failed to improve in the other case because of early postoperative graft obstruction. The outcome of complete tumor resection plus vascular reconstruction and of the stent operation was favorable. Although the bypass operation improved the SVC syndrome, the outcome was unfavorable, and the patient died in the early postoperative period.

SVC syndrome caused by invasive thymoma is a good indication for surgery, whereas stenting, which is minimally invasive, appears to be the treatment of first choice when SVC syndrome is caused by other malignancies.

The aim of this investigation was to assess the anxiety level in patients with varicose veins. Under local anesthesia eighty seven patients received multiple ligations of greater saphenous vein followed by sclerotherapy. Before and after operation they underwent state test anxiety inventory (STAI). State anxiety score increased on the operation determination day and operative day. After operation, state anxiety score decreased. The operation under local anesthesia is connected with high fear as well as the operation under general anesthesia.

It is possible to select the patients who are like to be unstable psychological state during an operation using STAI. These patients need the hospitalized care during the operation.

This study was made to clarify the changes of treatments for primary varicose veins in the last 6 years, by comparing with the previous results which was carried out in 1997. Eighty-two institutions belonging to the Japanese College of Phlebology answered questions using a questionnaire, and 6,784 new patients with primary varicose veins of the leg were analyzed.

The following results were obtained.

1. Male patients increased when compared with the previous study.

2. Patients older than 70 years increased.

3. Male patients visited the hospital for severer signs (CEAP 4-6) when compared with female patients. The incidence of pulmonary embolism in patients with varicose veins was unchanged in comparison with the previous study.

4. In treatments of varicose veins with saphenous vein incompetence, stripping operation was the most often selected (37.0%), and subsequently ligation of the saphenous vein and/or sclerotherapy was performed (30.0%). When compared with the previous study, the incidence of stripping operation increased, while that of ligation and/or sclerotherapy decreased.

In treatments of non-saphenous varicose veins, sclerotherapy was the most often carried out.

5. In the first choice of treatment for saphenous varicose veins , stripping operation and decision depending on the pathophysiology were the same percentage.

6. In ligation technique, multiple ligations at 3 or more sites were the most often selected. As the site of ligation, the sapheno-femoral junction was primarily selected, followed by the thigh and the calf.

7. A tendency of increase of stripping operation under local anesthesia or local anesthesia with intravenous anesthesia was observed.

The hospitalization in stripping operation largely shortened.

Striping operation was performed as a day surgery in 21% of institutions

8. The incidence of valvuloplasty in varicose veins was unchanged in comparison with the previous study.

MR venography is useful method for diagnosis of deep venous thrombosis. The purpose of this paper is to show practical method of MR venography and pit fall of diagnosis.

2D-TOF technique is suitable for evaluation of iliac and femoral veins. Gd-enhanced MR venography is useful for diagnosis of calf veins. Especially this method is able to evaluate muscular vein thrombosis.