The purpose of this study was to report short-term follow-up results of endovenous laser treatment for saphenous varix.

One hundred fifty-four GSVs and thirty-one SSVs in 138 subjects with varicose veins (26 male, 67.3 yrs, 112 female, 56.6 yrs) were treated with 980 nm diode laser energy delivered into the GSV or the SSV via a 600 or a 400 micro meter optical fiber. Tumescent anesthesia was delivered perivenously under ultrasound (US) guidance. Patients were evaluated clinically and with duplex US at 1 week, 1 month, 3 months, 6 months, 1 year and yearly thereafter to assess treatment efficacy and adverse reactions.

A total of one hundred eighty-five procedures were performed with an average follow-up time of 7.6 months (227.1 days). The average delivered energy was 9.8 W, 54.4 J/cm. The mean diameter was GSV 6.3 mm, SSV 6.9 mm. The average VFI was GSV 5.2 ml/sec, SSV 3.5 ml/sec. Successful occlusion of the saphenous vein, defined as absence of flow on color Doppler imaging, was noted in all immediately after treatment. Occlusion rate was 100% at 1 month, 98.4% at 3 months, 97.4% at 1 year and 93.5% at 2 years. There were four cases of recanalization (GSV 1, SSV 3). Main parameter influenced recanalization seemed the low delivered energy and the branching pattern of the junction. The floating thrombus was found at SFJ in 78 years old man 3 days after the ablation. Thrombectomy with high ligation of SFJ was done additionally. No other major adverse reaction was occurred.

Short-term follow-up results available in this study are compatible to those of reported. Endovenous lasers appeared to offer these benefits with no severe complication.

Stasis ulcers of the lower leg are sometimes left untreated or are maltreated for long periods. Although there are some reports showing the effectiveness of conservative treatment, we believe surgical intervention is superior in terms of quickness and radicality of ulcer healing. Our strategy for a stasis leg ulcer is; 1. for a severe deep valve insufficiency we apply deep venous external valvuloplasty using a rigid angioscope. 2. For massive arterio-venous communication, coil embolization to the feeding arteries is performed followed by superficial venous treatment. 3. For other venous diseases we perform high saphenous ligation or stripping. Since 2002, we have treated 29 patients (31 legs) for stasis ulcers. We undertook valvuloplasty in 5 patients (7 legs), coil embolization with stripping in 2, stripping only in 11, and high ligation with perforating vein ligation in 11. There were no operation-related deaths and no major complications. During the mean follow up of 1.5 years, the ulcers healed in 26 patients, improved in one and recurred in two. One recurrence occurred after re-do ligation of the vein, but a duplex scan revealed no venous disorders though the ulcer remained. We concluded that our surgical strategy for stasis leg ulceration was an acceptable treatment method. However, some ulcers remain unhealed, implying the presence of other unknown factors related to the ulcer.

There have been 22 cases (23 limbs) of constructed prosthesis arteriovenous fistulas (PAVF) in our department since January 1996. The average age of the recipients was 67.7 ± 9.50 years old and included 8 male and 14 female patients. The causes of introduction of hemodialysis were diabetic nephropathy in 8 patients, chronic glomerulonephritis in 2, tuberculosis nephrophthisis in 2, nephrectomy in 2, and unknown in 8.6-mm-diameter ePTFE graft was used in all cases. The site of the PAVF was the forearm in 6 patients (all left limb), the upper arm in 16 (right 3, left 13) and the neck in 1. The causes of PAVF failure were stenosis or obstruction at the venous side of arteriovenous fistula (AVF) in 6 cases, stenosis of vein anastomosis in one, and infection of the prosthesis in one. Obstruction of the subclavian or axillary vein occurred in 3 cases (4 sites). In venous stenosis/obstruction cases, two patients underwent a jump bypass of a stenosis segment and two patients underwent thrombectomy and percutaneous transluminal angioplasty (PTA). Stenosis of the vein anastomosis repaired the site. In the case with an infection of the prosthesis, the prosthesis was removed and then a PAVF was constructed on the opposite arm. The subclavian vein or axillary vein was obstructed in 3 cases (4 sites). An axillo-axillary vein bypass was performed in 2 patients, a brachio-carotid vein bypass was performed in one and an axillo-carotid vein bypass was performed in one. Eight-mm ePTFE prosthesis was used in all bypasses. Two died 3 and 16 months after the operation, respectively. Two grafts were obstructed 12 and 24 months after bypass grafting, respectively. The primary patency rate of the PAVF was 68% for one year and 25% for three years. The cumulative survival rate of the cases was 66.6% for one year and 32.9% for three years. Because of the poor prognosis of patients receiving PAVFs, it is important to minimize invasive repairs according to the cause of PAVF failure other than the long-term patency.

Pregnancy and delivery experiences were examined in regards to their impact towards the onset of varicose veins in the lower limbs, as it related to age.

Subjects were patients with varicose veins in their lower limbs who visited a surgical clinic between Sep. 2004 and Mar. 2007. Data was derived through interviews and those three hundred seventy nine female patients who were aware of the onset age of their varicose veins were analyzed.

The number of pregnancies/deliveries had significant influence for the onset age of varicose veins after the controlling effect from family history was considered. Patients who experienced more than two deliveries showed a younger onset age than one or no experience patients. However, minimum interval of deliveries and age at first/last delivery ages showed no significance for the onset age. An appropriate intervention, according to number of pregnancy or postpartum conditions, would decrease the risk of varicose veins and the hefty cost of beauty and health care over younger women.

Venous malformations (VM) are low-flow vascular malformations. Symptomatic venous malformations are much more common than AVMs. The true size of the lesion is best demonstrated by T2-weighted MRI and by direct intralesional contrast injection. There are two major forms or venous malformations: one consisting of clusters of interconnecting venous spaces with minimal or no connections to adjacent normal systemic veins, and another in which the clusters of venous channels communicate freely with dysplastic systemic veins. Surgical treatment may be effective in localized lesions, but often involves excision of surrounding normal tissue, and also has a high rate of recurrence. Venous malformations do not respond to arterial embolization. The most effective interventional management is direct intralesional injection of a scleosant (sclerotherapy). One hundred percent ethanol has been has found to have the lowest recurrence rate of the liquid sclerosants. It produces extreme pain on injection and therefore requires general anesthesia. Because of its neurolytic effect, the injection’s use is generally associated with relatively minor postprocedural pain. Polidocanol and Monoethanolamine oleate (EO) can be diluted with liquid contrast medium. It has the advantage of causing minor discomfort on injection, so that it can be used without a general anesthesia.

Inferior vena cava filters are aggressively used for treatment of acute pulmonary embolism in Japan to capture floating thrombi from deep vein thrombosis. In patients with acute proximal deep vein thrombosis, inferior vena cava filters prevent pulmonary embolism and increase recurrent deep vein thrombosis without changing the mortality rate. Moreover, inferior vena cava filters decrease both mortality and acute deterioration in patients with pulmonary embolism. Endo et al. recommended that non-permanent filters should be used for less than 7 days to prevent, if possible, the increase of filter-related complications. There are no evidences that concurrent anticoagulation reduces thromboembolism in recipients of inferior vena cava filters. Only one report is a randomized clinical study. The benefits and demerits of inferior vena cava filters are not sufficiently clarified. Therefore, further study is desired.