Aim: This study is to clarify the optimal concentration of polidocanol (POL) in foamsclerotherapy (FS). Methods and Results: Firstly, 0.5% POL, 0.33% POL and 0.25% POL were injected into the great saphenous vein (GSV) below the knee trunk following thigh stripping. The procedurse’s success (disappearance of varicose veins) rates at 1 month showed no difference in the 3 groups. The incidence of the complications such as intravariceal thrombosis, pigmentation or thrombophlebitis was low in the 3 groups. Secondly, 0.5% POL and 0.33% POL were injected into the segmental varices. The procdruree’s success rates showed no difference between both groups. The complications were rare between the both groups. Thirdly, 3% POL was injected into the trunks following high ligation of the GSV. The occlusion rate was 72% at 1 year. The recanalization with less than 3 mm in diameter was seen in 23% without reflux. There was no reccurence. A high incidence of thrombophlebitis (23%) was seen. Conclusions: This study demonstrated equivalent efficacy for 0.5% P0L, 0.33% POL and 0.25% POL in FS of main tributary varices following a thigh stripping, and also for 0.5% POL and 0.33% POL in FS of the segmental varices, the FS may start using less than a 50% concentration of the liquid POL. However, further investigation is necessary to obtain a reliable concensus concerning the optimal concentration.

Foam sclerotherapy (FS) has gaining popularity in the treatment of saphenous vein reflux. The aim of this study was to assess the early efficacy and complications of FS.

Methods: Between January 2007 and July 2009, forty-seven truncal veins were treated in 38 patients. The diameter of the veins ranged from 3.3 mm to 11.6 mm. Twenty-five veins were treated with high ligation plus reverse foam sclerotherapy (H group), 16 veins with direct cannulation (D group), and 6 veins with branch cannulation (B group). Polidocanol (3%) was foamed 1:4 with air by the Tessari’s method. In group D, the saphenous vein was accessed with the Seldinger method under ultrasound guidance. In group B, foam sclerosant was injected into the superficial branch connected directly to the saphenous vein.

Result: An average total volume of 10.8 ml foam was injected. Occlusion rates were 100% in H group, 81.5% in D group and 66.7% in B group, respectively. The size of the treated vein was significantly reduced. Venous filling index (VFI) was improved significantly. No serious adverse outcomes were observed. Asymptomatic deep vein thrombosis were observed by ultrasound examination in 2 patients, spontaneously disappeared within one month. Other minor complications included superficial thrombophlebitis and skin pigmentation.

Conclusion: FS was considered safe and effective modality in the treatment of saphenous vein reflux. Further studies are needed to validate FS.

Purpose: The endovenous laser treatment (EVLT) of saphenous vein insufficiency has been found out as less-invasive procedure than that of conventional procedure. Postoperative surgical trauma is reduced, since it is possible to treat legs under local anesthesia in the EVLT. Furthermore, early ambulation becomes possible immediately after the treatment because of less postoperative pain. An excellent long-term result has been obtained by applying the EVLT method. In order to improve a technique, this study was performed to evaluate the thermal fluctuation around the EVLT fiber tip.

Methods: The close circulation circuit was made by using 10 mm silicon tube, and milk was circulated as a pseudo-material for blood. The optical fiber was inserted in this pseudo-blood vessel, and the 810 nm laser was generated. As the laser output has been changed with 5 W, 10 W, and 15 W, the temperature changes around the optical fiber were measured.

Result: Thermal changes of pseudo-blood during early laser delivery phase were up to 2˚C. None of thermal changing was observed after 10 seconds of laser energy delivery. After carbonization around laser fiber tip due to thermal degeneration of circulating protein, increased temperature change more than 20˚C, possibly higher at laser tip, was observed.

Conclusion: In EVLT, carbonization around laser tip takes major role in elevation of temperature around laser fiber. Optimal condition for the procedure should be determined with consideration of carbonization and its effect to temperature change.

The aim of this study is to evaluate the effectiveness of inferior vena cava filter (VCF) in the management of venous thromboembolism from our experience. We also discuss the advantage and the disadvantage of temporary/permanent filters. The subjects were followed up 1999–2007. They were 119 patients with deep venous thrombosis (DVT), of which 65 patients were placed VCF. Our criteria for VCF was changed in 2005. The subjects were classified into two periods, 1999–2004 and 2005–2007, and the groups were compared in the view points of the ratio of VCF insertion, effectiveness and others. Follow-up data were obtained by the medical record. In our cases, frequency of VCF insertion of symptomatic pulmonary thromboembolism (PTE) was decreased. Although significance of VCF is to prevent fatal PTE, VCF itself might cause new thrombus. VCF insertion might not be needed under adequate anticoagulation/thrombolytic therapy. In present, our criteria for VCF insertion are thought to be adequate from our experience. To evaluate precise effectiveness of VCF, large studies are needed because of low incidence of PTE recurrence.

To investigate the priority of selection in treatments for leg varicose veins, the questionnaire survey was performed, and 91 institutions returned the answers. As the first choice in treatments for varicosities with saphenous vein insufficiency, 64% of institutions answered the stripping operation, and 27% ligation of the saphnous vein followed by sclerotherapy. In the varicosities without saphenous vein insufficiency, including segmental type, reticular type, and web type of varicosities, the first choice of treatments was sclerotherapy. From this investigation, it is clear that sclerotherapy still plays an important role in treatment of leg varicose veins, although it is necessary to improve the techniques, and to reduce the complications and the recurrence rate.

The flowmetry of the leg veins has not been thoroughly investigated. We researched the flow velocity of the deep (femoral; FV, popliteal; PPV) and superficial veins (great saphenous vein; GSV) of the leg.

Material and Results: In 10 healthy persons, 13 legs were examined using ultrasound Doppler imaging in the standing position. Post-operative cases after varicose vein stripping or laser ablation were also studied in 8 persons (10 legs). FV velocity was 6.6±2.7 cm/s, PPV was 6.3±1.8 cm/s, and GSV was 3.8±1.1 cm/s. In the post-operative cases, deep vein flow showed almost the same velocity as that of the healthy persons.

Conclusion: Statistic studies showed deep vein velocity was significantly faster than that of superficial veins. Deep veins keep the main flow in the legs. The discussion was focused on varicose veins or the phlebitis developmental mechanism.

A 45-year-old man visited complaining of swelling of his left lower extremity. Abdominal computed tomography revealed a left inguinal tumor compressed the external iliac vein. Venography showed a sandglass like stenosis of iliac vein. The tumor was 5 cm in size, and showed high intensity in T1-weighted magnetic resonance imaging. We diagnosed that is retroperitoneal lipoma, and performed a tumor resection. The tumor was yellow and its surface was smooth with a thin capsule. A part of tumor was adhered to external iliac vascular sheath, and we suppose that is the origin of the tumor. Histopathological diagnosis was benign lipoma.