In Japan, living donor liver transplantation (LDLT) has been performed more than 3000 cases and LDLT was established as a treatment for the end stage liver disease. Hepatic venous reconstruction is critical in LDLT because outflow obstruction in small for size graft may lead to graft dysfunction or loss. We describe the usefulness of venoplasties of the graft hepatic vein (HV) and graft HY-recipient inferior vena cava reconstruction in LDLT. We also examined the usefulness of vascular closure staples (VCS) for portal vein reconstruction. We performed portal vein reconstruction using vascular clip for 5 recipients (VCS group) and compared the background and results with 5 hand sutured reconstruction cases (control group). The diameter of the portal vein diameter in the control and the VCS group was 8.0±1.2mm and 7.8±1.3mm, respectively. No difference was seen between control and VCS. The reconstruction time of portal vein in the control and the VCS group was 9.8±0.8 minutes and 5.5±1.1 minutes, respectively. The reconstruction time of VCS group was faster than that of control group (p囗0.01). We concluded that vascular clip was safety and useful method for portal vein reconstruction in LDLT.

To evaluate the safety and limits of ambulatory surgery in an office setting, four hundred and forty eight patients with 526 involved limbs (10 limbs with active ulcer included) treated during a five–year period were investigated. The technique of perforate invaginate (PIN) stripping was used to remove long saphenous vein under femoral nerve block anesthesia supplemented where necessary with tumescent local anesthesia (TLA). Thirty–four patients had both long and short saphenous vein insufficiency. Full–length stripping of long saphenous vein was performed in 35 limbs. All preoperative ulcers were completely cured between 0.9 and 4.5 months after surgery. Subcutaneous bleeding at the groin occurred in one case just after operation and emergency transportation to another hospital was needed. Except for this case, no consultations took place after the patients returned home. Complete day surgery was possible in 98.9% of operated patients. Only six patients actually required admission because: 1) they live far from our clinic (4 patients), 2) postoperative lymphangitis (1 patient) and 3) inguinal subcutaneous bleeding (1 patient—described above). These results suggest that this technique can be safely used in an office setting regardless of the severity of varicose veins and is preferred by patients. Nevertheless, it is important to have a cooperative relationship with other hospitals in order to respond to postoperative complications.

Purpose of this study was to investigate the possible advantages and disadvantages of stripping the greater saphenous veins in primary varicose vein surgery. A retrospective study was conducted in a varicose vein center of a general hospital. Two hundred and seventy patients, 336 limbs, that underwent primary varicose vein surgery due to greater saphenous vein incompetence from January to December 2004, consisted of 17 cases of high ligation alone (2-point ligation in the groin and knee portion), 219 cases of partial stripping, and 34 cases of total stripping. Cases with high ligation had a shorter hospital stay than those with partial stripping or total stripping. However, when total amount of days, which required for the treatment during not only hospital stay but also outpatient clinic, were examined, there is no significant difference among those with high ligation, partial stripping, and total stripping. There was no significant difference either in operation time required among these 3 groups . Saphenous neuralgia was observed in 1.2% of cases with partial stripping, and 23.4% of those with total stripping. Interestingly, when prevalence of saphenous neuralgia was determined in the cases of total stripping according to CEAP classification, symptoms or signs of the neuralgia was not evident in the cases with more than C4. These data suggest that high ligation did not have any advantages in terms of total duration required for the treatment, although its hospital stay was shorter and had advantage for returning to the job. The data also suggest that the risk of saphenous neuralgia should not be considered a reason to avoid total stripping in the cases with venous stasis syndrome (C4–C6).

In spite of major improvements in the management of leg ulcers and wound healing, the best method to manage, cure, and prevent these ulcers are yet to be clarified. One of the problems on bandage of leg with ulcers is how to cover these ulcers without adhesion. In this study, we evaluated the effect of hydrogel wound dressing (Viewgel^®) in 8 patients venous stasis ulcer. The clinical effectiveness and safety of hydrogel wound dressing for the treatment of venous stasis ulcer were assessed. This study showed that these procedures are effective for rapid healing of the ulcer and seemed to be more comfortable for the patients as compared to conventional regular gause dressing. We conclude that the treatment with hydrogel wound dressing was safe and effective for venous stasis ulcers of the lower limbs.

The purpose of this study was to evaluate surgical results for primary varicose veins with non invasive examination of venous function. Nine hundred twenty five limbs with primary varicose veins treated by surgical procedure from January 2002 to December 2004 were studied. Six hundred fifty two limbs were treated with stripping (Group L-Str), 175 limbs were treated with high ligation and main stem foam sclerothrapy (Group HL+Scl), 107 were with short saphenous stripping (Group S-Str), and 20 limbs were treated with limited stripping below Dodd perforating vein (Group Dodd). Pre-operative venous dysfunction was evaluated by duplex scan and air-plethysmography, and post-operative improvement of venous function was examined with air-plethysmography. The mean diameter of saphenous vein at the middle thigh was 6.6 mm in Group L-Str, 5.3 mm in Group HL+Scl, and 5.3mm in Group Dodd pre-operatively. The mean diameter of short saphenous vein was 7.4 mm in Group S-Str. The Group L-Str had significantly higher preoperative values of venous filling index (VFI) than in the other groups. A significant decrease and normalization of the VFI was observed in the all Groups, 5.5 ml/sec to 1.6 ml/sec in Group L-Str, 2.9 ml/sec to 1.3 ml/sec in Group HL+Scl, 3.4 ml/sec to 1.7 ml/sec in Group S-Str, 2.8 ml/sec to 1.5 ml/sec in Group Dodd. It is concluded that the venous insufficiency could be controlled by adequate operation in all groups. The adequate operative method for each group could be decided by preoperative non invasive examination, Doppler sonography and air-plethysmography.

Histopathological features of calf–type deep vein thrombosis (DVT) in 60 autopsy cases with pulmonary thromboembolism were investigated. Among them, 43 cases showed fresh thrombi in bilateral, and 17 cases in unilateral leg. Organized thrombi as bilateral DVT were found in 55 cases. These results suggested that the most effectible factor of thrombrosis might be due to blood stagnation that occluded bilateral crural leg veins. Distributions of detection rate of DVT in 1 20 legs were as follows; iliac vein 4%, femoral vein 20%, popliteal vein 55%, posterior tibial vein 62%, peroneal vein 73%, soleal vein 89%, gastroenemius vein 39%, and anterior tibial vein 28%. Soleal vein was the most frequent site of deep vein thrombosis. The detection rate tended to reduce gradually as drainage veins of soleal vein from peroneal vein, through posterior tibial vein, to popliteal vein, femoral vein and finally iliac vein. Further investigation by dividing leg deep veins into three areas; soleal vein and its drainage, non–drainage vein, and proximal veins, showed the assumption of thrombi propagation and detachment. At first, primary thrombi would be formed at soleal veins, and then the thrombi wou l d propagate from soleal drainage veins to proximal veins. Nextly, proximal veins would be occluded by fresh thrombi, thereafter secondary thrombi were made at nondrainage calf veins. Finally, only proximal veins were embolized and the residual s were organized. In conclusion, soleal vein is the most important for primary prophylaxis of DVT, because soleal vein thrombi and its proximal propagation lead to secondary large thromboemboli.

A 69-year-old woman was admitted to the hospital under a diagnosis of ascending thrombophlebitis of left great saphenous vein and underwent an emergency surgery on the same day. In the operation, venous thrombectomy was performed in the vein after a high ligation of the sapheno-femoral junction. An elective stripping of the vein was added thereafter. Although she was discharged from the hospital at the third day after the operation with no symptoms, a postoperative pulmonary perfusion scintigraphy showed an asymptomatic multiple pulmonary embolism in the bilateral lung. Because the ascending thrombophlebitis often causes the pulmonary thromboembolism and the deep vein thrombosis, it is necessary to perform an operation or an anticoagulation as soon as possible.