Central venous stenosis has emerged as a significant clinical problem in hemodialysis patients. Endovascular interventions, including percutaneous transluminal angioplasty (PTA), have gained popularity for the initial treatment of venous hypertension due to central venous lesions. The purpose of our study was to evaluate the efficacy of PTA for the treatment of central venous stenosis or occlusion in patients undergoing hemodialysis. We retrospectively identified 17 hemodialysis patients (9 men and 8 women with a mean age of 64 years) who had central venous lesions treated by PTA. The lesions involved the axillary, subclavian, and innominate veins with complete occlusion in 3 cases. The procedure of PTA was a technical success without complications in all cases. The mean follow-up was 23 months (range, 1–67 months). The cumulative primary patency rates were 85.7%, 78.6%, 44.2%, and 33.1% at 6, 12, 24, and 36 months, respectively. The cumulative secondary patency rates were 100% at 6 and 12 months, and 90.9%, 77.9% at 24 and 36 months.In conclusion, percutaneous central venous angioplasty can provide symptomatic relief and restore the functionality of the vascular access in hemodialysis patients. Although multiple procedures are often required, PTA would be a first-line approach in this condition, in terms of its safety and minimal invasiveness.

We reviewed six venous thromboembolism cases (VTE) diagnosed with enhanced computed tomography incidentally in our hospital from December 2006 to May 2008, and evaluated the clinical features. Age of the patients were 16–79 years (median: 73.5 yrs.) and three patients had malignancy. The scanning phase of four cases were the equilibrium phase, one case was the arterial phase and remaining one was coronary artery phase. Pulmonary embolism was confirmed in 3 cases, deep vein thrombosis (DVT) was suspected in 3 cases. Definite diagnosis of DVT was venous phase computed tomography or echo venography. The patients had been admitted with different clinical specialties such as internal medicine, surgery, respiratory division and neurosurgery. The symptoms of VTE varied ranging from no symptom to fatal disease. Because it is not unusual for VTE to be diagnosed with enhanced computed tomography incidentally, we believe that a very careful interpretation of radiogram is mandatory keeping in mind, VTE as a differential diagnosis.

In the lower limbs swelling, certain differential diagnosis is needed for deep vein thrombosis (DVT), because it causes pulmonary thromboembolism (PTE), which is a lethal complication at high rates. We report the cases ultrasonographic examination of venous system for the patients who complained of lower limb swelling. We examined 114 patiants of lower limb swelling from January to December, 2007. Among the 114 cases, DVT were detected in 18 cases. As concerns about thrombosis area, 13 were proximal type, 5 were distal type. By the examination, we found 21 cases such as superficial thrombophelebitis, Baker’s syst, abscess and so on. Ultrasonographic examination is very useful not only for the ditection of DVT but also for differential diagnosis of lower limb swelling.

Background: Arteriolization of varicose veins is well known as its histopathological change. However, histopathological analysis of venous valves less discusses regarding valvular dysfunction.

Materials and Methods: We analyzed histopathological change of venous valves in 22 patients (8 men, 14 women; mean age 54 ± 15 years), using surgical specimens obtained by stripping of varicose veins of lower legs. Fifty venous valves from 22 patients with varicose veins of lower legs were subjected. Thickening, thinning, thrombus formation, and inflammation of valves were evaluated.

Results: All patients had fibrous thickening of the venous valves in the order of the basal (90%), middle (64%), and free edge (60%). Thickened venous valves with dram-stick shape were composed of increment of elastic fiber, collagen fiber and myofibril. Thrombus of venous valve was in a small number (6%). No inflammatory changes were seen in valves.

Conclusion: Histopathological changes of varicose vein and venous valve were irregular thickening and thinning. We suggest to pay attention to venous valve, as a marker of regurgitation and venous pressure elevation.

Varicose vein surgery is consisted of high ligation of sapheno-femoral junction (SFJ), treatment of saphenous trunk, treatment of varicosity, and disconnection of incompetent perforating vein. Today, many therapeutic strategies including endovenous surgery are available. Insufficient treatment leads to recurrence of varicose vein, which may result in distrust of varicose vein treatment. We herein describe our conventional surgery including high ligation of SFJ, stripping of great saphenous vein, and treatment of varicosity with literature review.

Inferior vena cava filter (IVCF) is a recent treatment of choice for prophylaxis against pulmonary embolism (PE). Although a temporary and a permanent type of IVCF are available, it remains lack of evidence for prophylactic effect on PE for perioperative patients with venous thromboembolism (VTE). This study reviewed 51 patients with active VTE at perioperative period, who underwent placement of an IVCF in our department from January in 1999 to March in 2008. There were 14 men and 37 women with an average age of 56.2 years old. Underlying diseases for surgery included gynecologic (n = 18) and orthopedics (n = 13), diseases treated by general surgery (n = 12), neurosurgery (n = 6), urologic diseases (n = 1) and plastic surgery (n = 1). Thirty five patients underwent a temporary IVCF insertion (Group T, Antheor™ n = 28, Neuhaus Protect™ n = 7) and 16 patients underwent permanent filtration of IVC (Group P). Both groups had neither fatal nor anticoagulant-related complications. However, PE occurred in one patient of the each group at a perioperative period. The patient in Group T developed PE after withdrawal of a temporary IVCF, whereas placement of a permanent IVCF caused symptomatic PE in the other patient in Group P. On the other hand, filter-related complications occurred in Group T included filter migration (more than 3 cm, n = 11), filter connection trouble (n = 1) and infection of catheter (n = 1) during the hospitalized period. Two patients out of 11 had a migrated temporary filter in the atrium. Moreover, nine patients in Group T had attached thrombi at a filter and needed additional thrombolytic therapy to remove a filter. Unfortunately, one patient underwent venotomy and ligation of the IVC to withdraw a filter attached with thrombi. Long-term follow-up showed that Group P experienced one IVC occlusion. The present study indicated that a temporary IVC filter, for prophylactic use against PE for the patients with VTE at a perioperative period, supports the needs for innovative design.

External banding valvuloplasty for deep vein with additional procedures (high ligation and stripping of saphenous vein etc.) were performed in 8 limbs of 8 patients with deep venous valve incompetence between June 2004 and November 2007. Air plethysmography was used to evaluate venous function. The mean follow-up period was 29.5 months. All patients showed the improved symptoms as early results. Reflux of the femoral vein by descending venography improved from grade 3.7 to 2.0 after surgery. The venous filling index by air plethysmography was also improved from 11.3 ml/sec to 2.6 ml/sec. It is important to fix the banding materials to the vein and to observe the reflux with intraoperative angioscopy. There were one case of wound lymphorrhoea and one case of delay in wound healing as postoperative complications. We avoided postoperative deep vein thrombosis which may be induced by using angioscopy by antithrombotic therapy such as warfarin for one month after surgery. Conclusions: External banding valvuloplasty for primary deep venous valve incompetence was an effective treatment option, especially in the mild reflux case or as an auxiliary procedure for internal valvuloplasty.

A 33-year-old female had left leg pain and edema. Since enhanced multidetector CT revealed venous thrombosis from inferior vena cava (IVC) to calf and pulmonary thromboembolism, she was transferred to our department. As she was Jehovah’s Witnesses, systemic thrombolytic therapy was withheld for bleeding risk. After the implantation of the Günther Tulip IVC Filter as retrievable filter, anticoagulant therapy was begun. Cavogram on 26 days after filter implantation showed 1 cm × 6 cm sized thrombus below the filter. After the exchange of the filter, anticoagulant therapy was continued. As the repeated cavogram on 28 days after reimplantation of the filter demonstrated that the clot burden was reduced, the retrieval of the filter was attempted. Although the filter was not tilted, the superior grasping hook of the filter was surrounded by the small clot and the hook could not be snared by standard retrieval kit. Subsequently, an alternative method by creating a wire loop between the filter legs led to successful retrieval of the filter. No complications occurred during these procedures.

Two cases of postpartum ovarian vein thrombosis (POVT) are reported.

Case 1: A 27-year-old gravida 1, para 1 woman presented with fever and right lower abdominal pain 2 days after vaginal delivery. The leukocyte count was 11700/μl and CRP was 15.0 mg/dl. A diagnosis of endometritis was made and antibiotic therapy was initiated. Three days after initiation of antibiotic therapy, the patient remained febrile and continued abdominal pain. She underwent a contrast-enhanced computed tomography (CECT), which revealed thrombosis of the right ovarian vein.

Case 2: A 29-year-old gravida 1, para 1 woman presented with fever and right lower abdominal pain 8 days after vacuum assisted delivery. The leukocyte count was 8900/μl and CRP was 12.7 mg/dl. A diagnosis of adnexitis was made and antibiotic therapy was initiated. Her symptoms gradually worsened. She underwent a CECT, which revealed thrombosis of the right ovarian vein.

Both of the patients were treated with intravenous heparin and antibiotics. They were discharged uneventfully on warfarin. A high index of suspicion is crucial to diagnose and treat POVT. The diagnosis of POVT can be made accurately with CE-CT. Anticoagulation with heparin is the main stay of treatment for POVT. Additionally, broad-spectrum antibiotics are used for bacterial infection which provoke thrombosis.

Superior vena cava syndrome (SVCS) caused by thrombotic obstruction of the superior vena cava and the brachiocephalic veins is less common. We experienced with a middle-aged patient suffering from SVCS probably due to hereditary protein S deficiency. In a case of 39-year-old man who had a history of skin transplantation for the ulcer of his right leg and anticoagulation therapy for thrombosis of the right iliofemoral veins 1 year before, cyanotic edema of his face and bilateral arms, and distended subcutaneous venous collaterals at the anterior chest and the abdomen spontaneously developed thereafter. Total protein S antigen was lower than normal limit and D-dimer level slightly increased. However, protein C activity and antithrombin level were normal, and lupus anticoagulant was negative. Three-dimensional CT showed complete obstruction of the superior vena cava and the brachiocephalic veins associated with numerous collateral veins at the anterior thoracoabdominal wall and in the mediastinum. He suffered from hemorrhagic shock caused by ruptured esophageal varicose vein, and endoscopic varicose vein ligation was required 6 months after. However, life-long anticoagulant therapy might be essential to avoid not only pulmonary artery thromboembolism but also circulatory collapse because whole body venous return to the right heart seems to be only through the inferior vena cava.