In clinical application of elastic stockings, the compression pressure is very important. However, interface pressure under elastic stockings varies depending on the posture changes and exercise. Short-stretch stockings produce a higher peak working pressure and a larger pressure amplitude during exercise, indicating these stockings are preferable for use on patients with severe venous insufficiency and lymphedema. Short stretch stockings include thick round-knitted stockings, firm round-knitted stockings and flat-knitted stockings, and characterized by low extensibility and high stiffness. In reducing complications caused by elastic stockings, Laplace’s law should be always taken into consideration.

During the past 6 years, we experienced 15 limbs of 15 cases (mean, 63.5 years) undergoing surgical treatment for venous stasis ulcer (C5: 7, C6: 8 in CEAP classification). Eight limbs had undergone the previous surgery for varicose veins. In diagnosis, saphenous veins, perforators and deep venous valves are firstly inspected using duplex scanning. And then, in limbs with significant deep venous insufficiency, its severity is evaluated with descending phlebography. In this study, insufficiency of perforators and deep venous valves were recognized in each 7 limbs. In operation, stripping and varicectomy were performed in 2 cases, stripping and Linton operation in 5, stripping and deep venous valvuloplasty in one, stripping, Linton and deep venous valvuloplasty in 2, deep venous valvuloplasty and varicectomy in 2 and deep venous valvuloplasty, varicectomy and Linton in 2. In another curious case, tricuspid valve replacement was performed concomitantly with high ligation of great saphenous vein for severe tricuspid regurgitation causing hemorrhagic stasis ulcer. In deep venous valvuloplasty, internal and external techniques were perfonned in 3 and 4 limbs, respectively. In operative results (mean follow-up period of 27 months), early cure of stasis ulcer was observed in all limbs and deep venous valve was competent in all valvuloplasty limbs.

From 1979 to 2005 we treated 46 cosecutive patients with Budd-Chiari syndrome (BCS). Twenty nine were men and seventeen were women and ages ranged from 24 to 76 (mean 48). All presented with ascites and 83% with esophegeal varices. Through right posterolateral thoracoabdominal incision, the diaphragm was divided and occluded inferior vena cava (IVC) and hepatic veins were corrected. A partial cardiopulmonary bypass was used as a measure of NC clamp. Auto pericardium was used as patch graft. In three patients with hepatocellular carcinoma (HCC), partial resection of the liver and correction for BCS was performed simultaneously. There was one hospital death, with early mortality of 2.1 %. In eight patients HCC developed postoperatively 3 to 6 years after the surgery and partial resection was done in seven patients.

All survivors have remained well and had a good quality of life. The cumulative 5-, 10-, 20-years survivals were 96%, 84%, 70.3% respectively. The procedure deviced by authors is beneficial in the treament of patients with BCS.

From 1998 to 2006, we performed two-port system subfascial endoscopic perforator vein surgery (TPS-SEPS) with or without superficial venous ablation (SVA) on 72 limbs of 67 patients. They were classified as C6, according to the CEAP classification. Of the 67 patients, five were thirty years old or less at the onset of stasis ulcers.

Two of the five patients had a history of deep vein thrombosis (DVT). The other three had no episode of DVT. However, two of these three had the same history undergoing radical operation for congenital heart disease. Ultrasonic cardiography before operation showed normal heart function in both cases, and there were no signs of right cardiac failure.

Two patients underwent radical operations, one patient for pulmonary artery arctation, at the age of two and eleven, and the other for tetralogy of Fallot. Duplex scanning showed varicose veins of greater saphenous veins and insufficient perforating veins at stasis dermatitis in both cases. The stasis ulcers of both cases healed after SEPS with SVA therapy and had no recurrence of ulceration after carriage return.

There have been few reports about stasis ulcers in cases having had radical operation for congenital heart diseases, accompanied by right heart failure. According to these cases of young onset stasis ulcers, in patients with a history of congenital heart disease, medical examination of the venous system of the lower limbs is necessary after reaching maturity. This is still the case even if cardiac function has been nonnalized by radical operation in infancy. If possible, APG test and duplex scanning are recommended to examine whether or not there are valve failure and obstruction in the deep venous system.

From 1994 to 2007, eight patients with Klippel-Trenaunay syndrome consulted our hospital. They consisted of 5 males and 3 females at the age of 17 to 52 years old. Among them three patients were associated with abnormalities of other organs.

Case 1: 24-year-old female .Extensive hypertrophy oft he left lower extremity has been present since birth. She has been done orthopedic surgery several times in her teens.S he consulted our hospital because of pyelonephritis.

Computed tomography demonstrated hypodensity round mass near the left kidney 12 cm in maximum diameter and mild splenomegaly with cystic lesions. Cavernous lymphangioma was strongly suspected.

Case 2: 52-year-old male. Extensive varicose veins and hypertrophy of the left lower extremity have been present since birth. He consulted our hospital because of a worsening motor disturbance. Choreoathetoic movements of the fingers and toes were noticeable. A (CAG)_n repeat longer than the normal range was observed on chromosome 4p. He was diagnosed with Huntington’s disease.

Case 3: 40-year-old male. All of the extremities of this patient showed cutaneous port wine hemangiomas, superficial venous varicosities and hypertrophy. He had an intermittent anal bleeding since his adolescence. He was performed endoscopy and varices involving the rectum and sigmoid colon were detected.

Three patients (37.5%) out of eight patients with KTS in our series were associated with abnormalities of other organs. It is important to look for other possible congenital lesions in the diagnosis of KTS. No patient in our series except for two patients who were treated in other hospital needed operation. The patient must be urged to follow a protective policy usually by elastic support and high elevation whenever possible.

A 17-year-old boy who had played baseball as a pitcher from his elementary school days suffered from his right upper extremity swelling, cyanosis and pain in June, 2001. We recognized the same findings as his complaints on his right arm and superficial venous dilatation around his shoulder girdle at our out patient clinic. Echography revealed thrombosis in his right subclavian and axillary vein and it made him admission. Angioplasty was performed for the residual axillary venous stenosis following the systemic thrombolytic therapy for two weeks. He discharged after angioplasty because his symptoms had diminished. But, two weeks later, he needed re-admission for sudden onset chest pain due to pulmonary embolism and the 1st rib resection was performed. He has been well during the whole postoperative course for 6 years.