Air plethysmography (APG) is a noninvasive method for evaluating venous hemodynamics; APG allows the precise quantitative evaluation of volume changes of the entire lower legs from knee to ankle. APG can distinguish the presence or absence of chronic venous insufficiency, but it cannot discriminate the clinical severity. Among APG parameters such as venous filling index (VFI), ejection fraction (EF), and residual volume fraction (RVF), VFI is the most useful diagnostic parameter in the evaluation of chronic venous insufficiency. APG can evaluate changes in overall venous functions associated with nonsurgical and surgical interventions.

There is a potential risk of sacrificing the cortical vein during neurosurgical operations, and the impaired cortical vein might cause cerebral venous circulatory disturbances resulting in venous infarction. However, there are still many problems awaiting solution in effective prevention, diagnosis, and therapy for patients with postoperative venous infarct. We review the management and results of 8 cases with symptomatic postoperative venous infarction in our institute, and describe the prevention of venous problems associated with the surgery. We have encountered 8 cases (0.3%) with symptomatic postoperative venous infarction during the past 5 years. The series is composed of 3 males and 5 females, with ages that ranged from 43 to 76 years (mean age of 58.1 years), and consisted of 5 brain tumors, one cavernoma, dural AVF (arteriovenous fistula), and trigeminal neuralgia. Initial symptoms occurred intraoperatively in 2 cases, on the day of the operation in 1 case, 1 day after the operation in 3 cases, 3 days in 1 case, and 4 days in 1 case. The symptoms were intraoperative brain edema in 2 cases, disorientation in 1, cerebellar sign in 1, hemiparesis in 1, aphasia in 2, and headache in 1 case. Two cases required surgical intervention. The results were a good outcome in 6 and a fair outcome in 2 cases. There are 2 types of postoperative venous infarction; severe onset (severe type) and gradually onset (mild type). The former needs immediate treatment from the intraoperative period onward, and the prevention of the ongoing venous thrombosis is essential in the latter. In conclusion, in order to prevent postoperative venous complications, we should take into account (1) the selection of surgical approach considering the cerebral venous system (especially dangerous venous structures), (2) the technique to preserve veins during the operation, and (3) the treatment of postoperative venous infarction, inoperative strategies.

Deep venous valvuloplasty has been developed to treat severe venous ulcers caused by deep venous insufficiency. In this country, however, this technique is limited to use, mainly because of the lack of the methodology and results. As a whole, deep venous valvuloplasty has two deferent methods, the internal and external methods. We here shows the histological review of these techniques, together with our original modification. Surgeons must be aware of the detail of many modifications and decide which is best suitable to their patients.

The short-term results of endovenous radiofrequency obliteration (RF; 18 legs; 13 patients) and surgical stripping (SP; 36 legs; 27 patients) to treat varicosities of the great saphenous veins were compared 1 month later using air plethysmography and ultrasound echography. The average postoperative venous filling index determined using air plethysmography was significantly improved in both groups (SP, 5.7±2.6 to 1.9±1.1; RF, 5.3±3.4 to 2.2±1.3). Ultrasonography showed complete occlusion of the saphenous vein in all 18 legs immediately after RF, and in 17 of the 18 (94.4%) legs at 1 month thereafter. Only 1 obliterated saphenous vein was partially recanalized at 1 month after surgery. No critical complications such as thrombosis developed. At 1 day after treatment, 2 legs were painful and abnormal sensations in 5 legs were noted. However, all complications were mitigated at 1 month after treatment. The most frequent postsurgical complication in the SP group was pain and/or paresthesia at the internal malleolar region and foot. In conclusion, RF is less invasive and equally effective as stripping. Further study is warranted.

Aim: To elucidate the present situation of diagnosis of deep vein thrombosis (DVT) in patients with acute pulmonary embolism (APE) and to clarify the problem of diagnosis of DVT. Methods and Results: We analyzed cases in three registries of the Japanese Society of Pulmonary Embolism Research (JaSPER) and cases registered by the mailed questionnaires in 2004. JaSPER studies revealed that, in recent years, rate of DVT assessment (60.8% in the first registry, 65.4% in the second and 84.3% in the third) and incidence of DVT increased. But DVT was found in only 29.8% of all cases with APE in nation-wide research in 2004. Contrast venography and radio-isotope venography were used less frequently for diagnosis of DVT, and lower limb venous compression ultrasonography more. Computed tomography has been used in 30.2% in the third registry of JaSPER. Conclusion: Limiting to cases in JaSPER, rate of DVT assessment was improved. But in the nation-wide research, the rate was still low. Diagnostic imaging techniques for DVT changed in recent years.

A pregnant woman aged 30 years with normal pregnant course was spontaneously delivered of the second child on day 5 of gestational week 39. The patient developed pain in the right lower abdomen and fever up on postpartum day 3 and underwent abdominal computed tomography (CT) because appendicitis was suspected. The patient was diagnosed with puerperal ovarian vein thrombophlebitis and referred our department on the day. CT image indicated the possibility that a top of thrombus protruded into the inferior vena cava (IVC) and the right ovarian vein directly entered the IVC at an acute angle, therefore, the patient was considered to have a high risk of pulmonary embolism. On the same day, the patient underwent anticoagulation therapy with temporary IVC filter in the upper renal vein. Following the confirmation of no thrombus entrapped with the filter basket 7 days after filter placement, afilter was removed. At present, the patient is treated by oral administration of warfarin.

A case with cystic adventitial degeneration of the femoral vein was reported. A 48-year-old female visited our outpatient clinic complaining of swelling of her left lower extremity. Ultrasonography and computed tomography revealed a cystic mass of the left groin which compressed the femoral vein. Superficial femoral artery is also compressed by the cyst lateral to the femoral vein. Phlebogram showed that venous flow in the femoral vein was interrupted by the cyst, with development of collateral vessels. We diagnosed that the femoral vein was thrombosed by its cystic adventitial degeneration. Elective operation was performed. We found that the cyst was on the anterior wall of the femoral vein. Fenestration of the cyst was first performed. Its content was yellow, mucinous substance. Exploration with venotomy and balloon catheter revealed that the femoral vein was not occluded with the thrombus, but was competently obstructed by the cyst. Her postoperative course was uneventful.

The treatment for varicose veins is still not standardized. In small veins without saphenous vein reflux, sclerotherapy is usually used. In limbs with saphenous vein incompetence, two procedures, interruption of saphenous vein reflux and elimination of varicose veins should be carried out. Sclerotherapy or varicectomy might be applied for the latter, while the treatment is not standardized for the former. The stripping operation has been the most commonly performed operation for varicose veins associated with saphenous vein reflux. However, the current trend is towards minimally invasive procedures, such as foam sclerotherapy, ligations followed by sclerotherapy, and the endovenous laser or radiofrequency ablation technique. The selection criteria for treatment are base on the wishes of the patients as well as the pathophysiology of the disease, after detailed informed consent.