The advent of ultrasound-guided foam sclerotherapy(UGS) has introduced a new era in sclerotherapy. UGS has become accepted as a technique in the treatment of saphenous trunks. Foam sclerosants have the advantage of creating a homogenous distribution with greater sclerosing ability than corresponding liquid sclerosants, increasing the safety and echogenicity with which the distribution of foam is controlled under ultrasound guidance.

Thirteen patients with short saphenous varicose veins with a diameter less than 10 mm were treated by UGS. The foamed sclerosant was produced with polidocanol (1%) and carbon dioxide, in a ratio of 1:3, using the Tessari method. An 18G venipuncture catheter was inserted into the short saphenous vein (SSV) at 10 cm below the saphenopopliteal junction under ultrasound guidance. Two injections in one session (total of 8 ml foam sclerosant) were administered slowly while the patient lay in the prone position with the affected leg elevated. Massage with a duplex probe was carried out to work the foam sclerosant to the required section of the trunk of SSV. We were able to observe venous spasm within minutes of injection, although the venous spasm was not of uniform extent. No concomitant treatment was carried out on other varices during the same session. After injection, compression pads and elastic bandages were immediately applied and maintained in place continuously fort he first 3 days, and then only during the day for the next 3 weeks. There was no follow-up treatment.

Patients were reviewed after 3-4 weeks by color duplex ultrasound examination. Five patients showed complete occlusion of the total length of refux area in SSV, but the other eight patients showed partial occlusion with only segmental total occlusion. Three patients developed asymptomatic mural thrombus in the popliteal vein. One of these three has received warfarin and compression therapy for 3 months.

The results reported here are very early post-treatment, and it remains uncertain whether these results will translate into satisfactory longer-term outcomes. Further objective assessment of the efficacy and appropriate use of the numerous foam sclerotherapy techniques is essential.

Aims: To evaluate the results of foam sclerotherapy for primary varicose veins under the consideration of foam sclerosant with optimalra tio of solution to air. Methods: 1. Foam stability and viscosity of foam sclerosants with different ratio of 1% Polidocanol (POL) to air were evaluated. 2. The adverse effects and recurrent rate of varicose vein after foam or liquid sclerotherapy in 110 legs (Foam sclerotherpy: 58 legs, Liquid sclerotherapy: 52 legs) after surgical intervention of saphenous reflux were evaluated. Results: The ratio of POL to air had the best stability and viscosity of foam sclerosant was 3-4 to 1. The major adverse events of foam sclerotherapy were superficial thrombophlebitis, pigmentation, urticaria and blister, there is no significant difference between cases with form and liquid sclerotherapy. The recurrence rate of varicose vein at post 2 years was 4% in cases with foam sclerotherapy, 7% in cases with liquid sclerotherapy. Conclusion: The best ratio of POL to air for foam sclerosant was 1 to 3-4.The clinical results of foam sclerotherapy with the smaller dose of POL were as same as liquid sclerotherapy.

We report trends of sclerothrapy for primary varicose vein in general comm unity hospital where sclerotherapy has begun in early 1990’s. High ligation of sapbenous trunk and sclerotherapy for varicosity were performed at first for less illed saphenous type varicose. Postoperative clinical and duplex analysis demonstrated relatively high mid-term recurrence, leading to difficulty for selection of good candidate for high ligation and sclerotberapy. Therefore due to difficulty of selection of patients, sclerotherapy has been mainly performed for non-saphenous type varicose veins.

Sclerotherapy regimen has been changed liquid self made polidocanol to foam, self made polidocanol in 2004 and then changed to ready made Polidocasclerol^™ in 2007. There is tendency lo decline number of sessions of sclerotherapy. We anticipate new advance in sclerotherapy.

In clinical application of compression therapy for venous diseases and lymphedema, the appreciate compression method should be selected on the basis of each characteristic of compression methods and pathogenesis of the diseases. In comparison of interface pressure between elastic stockings and bandages, the latter showed the higher elevation in interface pressure with posture changes and greater amplitude between muscle contractions and relaxations, indicating that the elastic bandages caused the greater augmentation of muscle pump than elastic bandages. This finding indicates that in clinical application of elastic stockings and bandages, the interface pressure during posture changes and exercise should be always considered in addition with interface pressure in the supine position.

We report a case of high output heart failure due to an iatrogenic iliac arteriovenous fistula which becomes evident 23-years after lumbar laminectomy. A 47-year-old man consulted a general physician complaining of palpitation and dyspnea on effort. Chest X-ray and ECG demonstrated cardiac enlargement, pleural effusion, and atrial fibrillation.

Hew as referred to a department of cardiology in our hospital. The previous clinical history was completely unremarkable except for a lumbar discectomy at L4-L5 performed 23 years previously. Operative record show that abnormal bleeding through the intervertebral space and severe hypotension was observed during the operation. Examination revealed continuous bruit throughout the right lower abdomen. Angiography demonstrated an enlarged right cavity and inferior vena cava, and an AV fistula arising at the bifurcation of the right common iliac artery, communicating with the right common iliac vein. Contrast enhanced CT confirmed these findings and demonstrated pseudoaneurysmal formation of right common iliac artery. We elected to manage this fistula with an open surgical procedure. At surgery,th e right iliac AVF was ligated and excluded, and straight 8 mm Dacron graft was inserted to substitute for the distal abdominal aorta and the proximal external iliac arteries. Operative findings revealed severe adhesion around the aortic bifurcation. The patient was completely asymptomatic postoperatively, although postoperateive CT scan revealed the remnant AVF. Hew as discharged in good clinical condition 10 days after surgery.

A 35-year-old man visited our hospital with redness, swelling, and pain in the bilateral lower extremities. As deep venous thrombosis (DVT) on the bilateral lower extremities was suspected, ultrasound examination was performed; the results indicated intravenous thrombosis in the femoral vein to the iliac vein bilaterally. Computed tomography (CT) scan demonstrated intravenous thromboses in the femoral and iliac veins. However, the inferior vena cava was not detected from the junction with the iliac vein to the junction with the renal vein. Venous anomaly was detected, consisting of iliac vein inflow to the ascending lumbar vein at the level of the sacral spine, joining the azygos and hemiazygos veins, and merging to the superior vena cava. Although the inferior vena cava peripheral to the renal hilus was not found, right and left renal veins combined to form the inferior vena cava. The hepatic vein connected to the inferior vena cava and flowed into the right atrium. Generally, absence of the inferior vena cava is caused by hypoplasia of the inferior vena cava at the part of the hepatic vein and binding to the azygos vein. Our case was suggested to have absence of the inferior vena cava peripherl to the renal hilus caused by bilateral venous congestion of the lower extremities leading to DVT.