Day surgery is gaining popularity for varicose vein surgery. There have been many surgical options for the treatment of varicose veins, including stripping, high ligation, endovascular laser treatment and so on. Endovascular laser treatment (EVLT) is a minimally invasive vein surgery and has the possibility to be done as an office procedure.

Patient and Method: Between March 2002 and December 2003, one hundred and sixty-seven patients, 225 legs had EVLT in our hospital. EVLT was done under tumescent local anesthesia. A 810nm diode laser was used with a 600μm laser fiber introduced into the saphenous vein. For venous function study, APG was performed before and after EVLT. Ultrasonographic examinations were performed to follow-up the saphenous vein diameter.

Results: There have been no major complications including skin burns, paresthesias, nor deep vein thrombosis after EVLT. Initial obliteration was obtained in 98.2%. During follow-up, venous obliteration was maintained in 98%. Most of the patients were discharged from the hospital within 24 hours. The values of VFI (Venous Filling Index) were 6.61±2.99 ml/s vs. 6.30±3.88 ml/s (stripping vs. EVLT) preoperatively and 1.84±1.05 ml/s vs. 2.27±1.59 ml/s (stripping vs. EVLT) postoperatively. EVLT had the almost same effect in eliminating venous reflux compared to stripping surgery. Ultrasonography demonstrated that the saphenous vein diameter was significantly reduced after EVLT.

Conclusion: EVLT is a simple and effective method for treatment of varicose veins as a day surgery procedure.

We assessed the potential benefit of catheter-based therapy (CBT) for acute massive and submassive pulmonary thromboembolism (AMPTE). In-hospital clinical outcomes were estimated in 67 consecutive patients with AMPTE. CBT is combination with thrombolysis, fragmentation, thrombectomy, and temporary caval filter placement. The mean pulmonary artery pressure decreased significantly from 32 mmHg to 23 mmHg by CBT (p<0.0001). Inhospital death and recurrence were 7% and 1%, respectively. These findings suggest that CBT provides good clinical outcomes in patients with AMPTE.

Ischemic preconditioning in brain is well documented and several reports have shown that this phenomenon is mediated by activation of mitochondrial ATP-dependent potassium (mitoK_ATP) channels. However, the role of mitoK_ATP channels in the penumbra area has not been studied thoroughly. In a model of venous ischemia, large penumbra-like low flow areas and few no flow areas are created which are susceptible to spreading depression (CSD). Thus, we studied effects of mitoK_ATP channels on infarct development in this model. Male Wistar rats were subjected to 2-vein occlusion (2VO) by photochemical thrombosis of two adjacent cortical veins, combined with 10 KCl-induced CSD and assigned to three experimental groups pretreated intraventricularly before 2VO with vehicle, diazoxide; a mitoK_ATP channel opener, and diazoxide + 5-hydroxydecanoate (5-HD); a selective mitoK_ATP channel blocker. Regional cerebral blood flow (rCBF) and impedance were monitored, and infarct volume was assessed 7 days after ischemia. Pretreatment with diazoxide significantly reduced the infarct volume, while rCBF in the vicinity of the two veins at 70 min after 2VO was comparable in both groups. On the other hand, the mean amplitude of impedance changes evoked by CSD was decreased by pretreatment with diazoxide. These effects of diazoxide were abolished by 5-HD. These results suggest that activation of mitoK_ATP channels plays a major role in neuronal death under penumbra-like conditions as shown in venous ischemia.

Congenital venous abnormalities in the limbs are rare. Klippel-Trenaunay syndrome (KTS) is characterized as cutaneous naevus, varicose veins, and bone and soft tissue hypertrophy. Here we showed our experience to treat the patients for KTS with superficial vein surgery. From April 2001, 6 patients underwent operation for KTS. They were 4 male and 2 female at the age of 20 to 56. All patients had KTS abnormalities in one leg, right leg in 2 patients and left leg in 4 patients. All patients showed the varicose veins, and the naevus was observed in 5 patients, and tissue hypertrophy in 3 patients. The CEAP clinical classification was C2 for 5 patients, and C3 for one patients. Preoperatively, all patients were evaluated by both ultrasonography and phlebography to determine, 1) patency of the deep veins, and 2) extent and reflux of the varicose veins. Surgery for the varicose veins was performed in all 6 patient, including removal of lateral marginal veins in 4 patients. Two patients required surgery repeatedly due to recurrence of the varicose veins. There were not any complications at all postoperatively, and the mean duration of hospital stay was 4.5 days (1 to 8 days). All patients were significantly relieved from the symptoms related to KTS and very satisfied with the outcome. Our experience suggest that, similarly as previous reports by others, surgical removal of the varicose veins could be safe and satisfactory to treat KTS patients, although many patients with KTS can be managed non-operatively. When ultrasonography and venography showed the normal deep veins and the responsible varicose veins with reflux, surgical management should be considered as one of the strategies to treat the patients with KTS.

Edema is frequently associated with venous and lymphatic insufficiency of the leg, but edema of the leg is also a common phenomenon in the general population. Elastic compression stockings are often used to prevent edema in patients with venous or lymphatic diseases, as well as in healthy persons. The beneficial effects of elastic compression stockings on edema prevention have been demonstrated by measurements of circumference and volume of the leg using various kinds of plethysmography such as air plethysmography, strain gauge plethysmography and water plethysmography, optical leg volume meter, three-dimensional measurement system and MRI. However, the degree of edema might depend on the pathogenesis and degree of the diseases, age, sex, BMI and occupation, and differ at the calf, ankle and foot. The techniques for evaluating the effects of elastic compression stockings on edema prevention, therefore, should be selected in consideration of their advantages and disadvantages in accordance with the purposes.

A 75-year-old female was admitted to our hospital with a pain and swelling in the right lower extremity. CT scan showed a hematoma under the crus and an arterio-venous fistula was considered. She had no history of trauma there. Angiography was performed directly, and revealed an arterio-venous shunting from the peroneal artery. Successful embolization was performed and her symptom disappeared. After 20 days the local skin became necrotic therefore debridement and skin transplantation were required.

We present a successful surgical case of abdominal aortic aneurysm with left-sided inferior vena cava (IVC). A 79-year-old man was admitted to our hospital because of pulsatile abdominal mass. Computed tomography revealed abdominal aortic anerysm with bilateral iliac aneurysms and isolated left-sided IVC. There was no thrombus in IVC. We performed aneurysmectomy and bifurcated graft replacement by the left retroperitoneal approach without manipulating left-sided IVC. The postoperative course was uneventful and there was not found thrombus in IVC up to the present.

Two cases of ascending thrombophlebitis in the long saphenous vein were treated with high saphenous ligation and long saphenous vein stripping. They were two women, 71 and 53 years old. They also had varicose vein. Superficial venous thrombophlebitis with varicose vein is relatively common disorder, and it is generally viewed as a benign and self-limiting disorder. But ascending thrombophlebitis will often develop to deep venous thrombosis and pulmonary embolism. If once pulmonary embolism occurs its mortality is high. Therefore ascending thrombophlebitis in the long saphenous vein should be treated carefully with urgent operation or anticoagulation.