Lymphedema appears in most cases after surgery for breast cancer, uterine cancer and other cancers, manifesting as swelling of the upper or lower limbs. Conservative therapy of peripheral lymphedema is known as a complex decongestive physiotherapy (CDP), which involves a two-stage treatment program. The first phase consists of manual lymph drainage, range of motion exercise, skin care and compression typically applied with multi-layered bandage-wrapping.

The CDP is performed exclusively on an inpatient basis in specialized hospitals. The second phase aims to conserve and optimize the results obtained in Phase 1. It consists of compression by a low-stretch elastic stocking or sleeve, skin care, exercise and repeated selflymphdrainage as needed.

Important thing, however, is that these medical treatment can produce enough effects even if on an outpatient basis.

Intermittent pneumatic compression and elastic stocking are methods of the prevention of deep vein thrombosis. They vary in form, compression site, pressure, cycle, and holding time. It is important to choose physical method according to operative method and patients status.

One hundred and eighty-one limbs of 129 patients with primary varicose veins were investigated the influence of the extent of reflux in the long saphenous vein (LSV) regarding clinical severity by using a duplex scan and photoplethysmography. In the skin changes group which includes pigmentation, eczema, lipodermatosclerosis and venous ulcers, the number of limbs with reflux extending throughout the length of the LSV were significantly higher than that in the simple varicosis group. In the group with limbs with reflux through the whole length of the LSV’ the half venous refilling time (112 VRT) in photoplethysmography was significantly shorter than that in the group with limbs with reflux in only the thigh segment of the LSV (sapheno-femoral junction to below-knee LSV). Moreover, when a below-knee tourniquet was applied to block the superficial vein reflux, no significant difference was observed in the rate of improvement of 1/2 VRT between the limbs with and the limbs without incompetent Cockett perforators. We concluded that the limbs with reflux extending throughout the length of the LSV develop a high degree of venous dysfunction in lower legs and tend to be followed by skin lesions, and in the progression of skin lesion, the incompetence of the superficial vein plays an more important role than the incompetence of perforating veins.

Purpose: The safety, feasibility, and early efficacy of subfascial endoscopic perforator vein surgery (SEPS) for chronic venous insufficiency have been reported, but the longterm clinical outcome after SEPS is still undetermined. This study was undertaken to investigate the long-term rates of ulcer healing and recurrence.

Materials and Methods: We performed TPS-SEPS (two port system SEPS) on 446 limbs of 360 patients (118 men and 242 women with an average age of 58.9 years). Forty-five limbs were Class 6 according to the CEAP classification. Among these 45 limbs, 3-5 limbs of 33 patients (20 men and 13 women with a mean age of 54.3 years; range: 27 to 74 years) were followed up for longer than 1 year. All of them had active ulcers at the time of operation, and the ulcer healing rate and recurrence rate were documented. Twenty-five limbs (71%) underwent concomitant superficial venous ablation (stripping, high ligation, varicose ablation, and sclerotherapy). Seven out of ten limbs that were treated by SEPS without superficial venous ablation had a past history of saphenous vein stripping. All patients underwent duplex US scanning to document reflux in the deep, superficial, and perforating venous systems. Three patients had a past history of deep venous thrombosis.

Results: The follow-up period for the 33 patients averaged 33 months (range: 12 to 56 months). There were no deaths and no cases of pulmonary embolism. The size and number of ulcers did not influence the healing rate significantly, but single ulcers with a diameter of less than 2 cm were more likely to be healed by SEPS. On the other hand, the duration of ulceration had a significant influence on healing after SEPS. In 91.4% of the limbs (32/35), ulcers healed within 7 to 256 days (average: 50.0 days, median: 27 days). In 8.6% of the limbs (3/35), ulcers failed to heal. Ulceration recurred in 3 limbs (9% (3/33)) of three patients. One of these three patients underwent repeat SEPS, but obtained no additional benefit from the operation. One of the recurrent ulcers was cured by split-thickness skin grafting. Finally, 5 of the 35 limbs (14.3%) had active ulcers, and the healing rate was 85.7% (30/35) at the latest follow-up examination.

Conclusion: The results suggest that including the SEPS procedure in the overall treatment plan for patients with CVI can achieve active healing with a minimum of postoperative complications. However, long-term prospective and randomized studies are still required to provide level I evidence of late efficacy.

Objective: To investigate the initial result of subfascial endoscopic perforator surgery (SEPS) using endoscopic vein harvesting device. Patients: Four legs of 4 patients with chronic venous disease ranging from C2 to C5 with multiple incompetent perforators (IPFs) were treated with SEPS in our institution in 2004, and included in this study. Operation: IPF was checked and marked with ultrasonography before surgery. Transverse incision was done below knee at the point where posterior arch vein connected to the greater saphenous vein. Fascia was incised and endoscope was inserted into subfascial space bluntly without using carbon dioxide gas. After confirming IPF, double clips were applied. Endoscopic saphenectomy was performed in all cases, and deep vein valvoplasty was done in 2 cases. Result: In all cases, clinical symptom and skin condition improved. Eleven of 13 IPFs checked preoperatively were successfully divided by SEPS. Temporary saphenous nerve palsy was seen in 2. No severe complication occurred. Conclusion: SEPS using vein harvesting device is safe and useful for patients with chronic venous disease with IPFs.

The purpose of this paper is to evaluate feasibility and of catheter-directed thrombolysis for deep venous thrombosis (DVT). We considered the result of treatment for never DVT, and aim of developing its usefulness. Twenty-five patients with DVT whose average is 10.4 day, underwent catheter-directed thrombolysis during 5 years from January 1999 to December 2003. The location of DVT was above popliteal vein in 20 cases and below one m

5 cases. The average volume of urokinase (UK) in usage was 2,540,000 IU. Total or partial recanalization was achieved in 22 cases (effective rate 88%). Four cases were subsequently treated with stent placement using WALL-STENT^TM for iliac compression syndrome. The median 3-year follow up rate showed the reocclusion ofDVT in one cases (recurrence rate 4%). In conclusion, catheter-directed thrombolysis is considered to be an effective therapy for acute or subacute DVT above popliteal vein.

In varicose veins, reflux in the saphenous vein causes overflow in the deep venous system that leads to dilatation and incompetence of the deep vein. Surgical intervention can relieve the volume overload and hence the incompetence of the deep vein. In the present paper, the reflux circuit theory of venous overload was tested using our clinical data. A total of 110 varicose veins of 85 patients were treated surgically (stripping in 41 limbs and high ligation in 69 limbs) between May 2004 and April 2005. Venous function was evaluated by air plethysmography, and the diameter of the femoral vein was measured by ultrasound pre-operatively and at 1 month after the surgery. The venous filling index decreased significantly after high ligation (from 6.6±4.4 ml/sec to 2.0±1.8 ml/sec, mean±SD; p<0.001) and after stripping surgery (from 8.6±4.7 ml/sec to 1.6±0.7 ml/sec, p<0.001). The vertical diameter of the femoral vein decreased significantly after the stripping surgery (from 13.1±2.41mm to 11.2±1.8mm, p<0.05), but, there was no significant change in the transverse diameter (from 12.3±3.1mm to 10.6±1.9mm) or cross-sectional area (from 99±28mm² to 93±22mm²). There was no significant change in the vertical diameter, transvers diameter, or cross-sectional area after the high ligation (from 10.9±2.8mm to 9.9±2.0mm; 10.4±2.6mm to 10.0±1.7mm; 90±35mm² vs. 82±28mm; respectively). The vertical diameter of the femoral vein decreased after the stipping surgery but not after the high ligation.

We present a surgical case of primary venous aneurysm retarded of preoperative diagnosis. A 28-year-old man was admitted to our hospital, because a soft tumor in the left lower extremity had been growing. And he had noticed the tumor since ten years ago, but had no symptom or no history of trauma. An ultrasonic study revealed a cystic tumor without an active blood flow signal. Magnetic resonance imaging revealed a cystic tumor with a smooth outline adjacent to the greater saphenous vein. Arterial and venous angiography revealed no vascular area in the tumor. We had in mind whether dealing with a soft tissue tumor or not. The tumor was excised successfully and the jelly-like coagulation of blood is choked up in the tumor and a blood flow was not seen into it. But, the greater saphenous vein and tumor are continuing, and the outflow and inflow vein could be checked. That was the image which does not have inconsistency as venous anemysm histologically.