Venous diseases, especially deep vein thrombosis(DVT) resulting in pulmonary thromboembolism(PTE), are reviewed here. First of all, the incidence of the venous thrombi at autopsy in Department of Pathology, National Cardiovascular Center is described, and the incidence of acute PTE and chronic PTE leading to pulmonary infarction are followed. Also, pulmonary arterial endoarterectomy done on chronic PTE patients with pulmonary hypertension is examined from the stand-point of histo-pathologic aspects. It is of great importance that clinical physicians should pay much attention of the possibility of DVT/PTE on patients presenting chest pain, sudden syncope and death, and such as symptoms of all of cardiovascular events.

We treated 58 patients with Budd-Chiari syndrome (BCS) by our devised operative procedure, by which theoccluded IVC and hepatic veins were reopened under a partial cardiopulmonary bypass. There were two operative deaths, and the operative mortality rate was 3.4%. Postoperatively, inferior vena caval pressure was decreased, the impaired hepatic function was improved, and esophageal varicx (EV) was disappeared in 12 patients as a result of decreasing of portal pressure. In late postoperative period, EV was disappeared in 5 patients. There were 14 BCS patients with associated with hepato-cellular carcinoma (HCC), which was treated by partial hepatectomy and/or TAE. The cumulative survival rates in postoperative 5, 10, 15 years were 87.2% (n=37), 74.9% (n=22), 64.3% (n=17), and there was no difference between the patients group with and that without HCC, which shows HCC associated with BCS is not always a risk factor of postoperative survival rate after BCS surgery.

Prior to surgery or endovascular therapy for the lower extremity varicose veins or deep vein thrombosis (DVT), conventional dynamic ascending phlebography provides useful information. Under tourniquet contrast media injected from dorsal pedis vein reveals DVT, incompetent perforators (IP) and refluxed superficial varicose veins after stepping. But overlapping superficial veins are very complex and confusing with IP, and it is invasive because of radiation exposure and the use of nephrotoxic and allergic iodinated contrast media. Although computed tomography (CT) with volume rendering (VR) demonstrates superficial varicose veins without contrast media, IP or deep venous system cannot be depicted. On the other hand, magnetic resonance (MR) imaging using steady state free precession (SSFP) in the semispine position can reveal the varicose veins on the muscle fascia on VR and the perforating and deep veins can be identified on maximum intensity projection (MIP) and multiplanar reconstructions (MPR). For DVT, direct thrombus imaging (DTI) using fat suppressed 3D coronal inversion recovery- prepared blood suppressed gradient echo sequence demonstrates fresh clots as high signal intensity, and gadolinium administration depicts clots as filling defects on MPR or the soap bubble (SB)-MIP. MIP with SB also enables the diagnosis of postthrombotic syndrome with mural thrombosis, stenotic/occluded vessels and secondary varicose veins. Similarly, acute pulmonary thromboembolism (APTE) can be diagnosed by MR. However, CT pulmonary arteriography and venography (CT-PAV) can provide faster and more differential diagnoses. Pulmonary arteriography using balloon or pigtail- based catheters is now limited for endovascular therapies including thromboaspiration, fragmentaion, thrombolysis etc.

Pulmonary thromboembolism (PTE) and deep venous thrombosis (DVT) are two manifestation of one pathologic process. Nowadays venous-phase CT venography in combination with pulmonary CTA has been widely used in order to diagnose DVT and PTE. Appropriate protocols of CT are needed for accurate diagnosis. In this article, we review the diagnostic accuracy of multidetector CT and discuss the tip of accurate evaluation of PTE patients. Interpretive pitfalls also are illustrated.

In the present study, clinical application of elastic sleeves and stockings was discussed based on the difference in pathogenesis between arm and leg lymphedema and the analysis of questionnaires to patients with lymphedema concerning with the complains for elastic garments. As compliance of patients for both elastic sleeves and stockings is low, improvement and devise of products as well as education and advices for patients are important to continuation use of them.

Compression therapy remains the mainstay for the treatment of lymphedema including of elastic stockings, elastic sleeves and elastic bandages. Of these compression devices, elastic bandages are the most powerful components, and recently a multilayer bandage system has been widely applied in clinical practice. This system is recommended for two reasons: even distribution of pressure applied around the limb and maintenance of compression pressure for longer period of time. However, a multilayer bandage system has several shortcomings, such as the great difficulty in achieving a constant and precise compression pressure and poor fashionability. Therefore, in clinical application, compression devices should be selected by considering both the advantages and disadvantages.

Although foam sclerotherapy was reported in 1939 by McAusland, the most popular technique of foam production was described by Tessari in 2001. It is a simple and convenience method in the treatment of varicose veins. We are performing foam sclerotherapy in a standardized way and named it the “simple” foam sclerotherapy.

Patients: Five hundreds and seventy patients with primary varicose veins were underwent foam sclerotherapy at our clinic from January to December 2008.

Methods: Foam sclerotherapy is performed in a standardized manner as following. Puncture of the veins is performed with the patient standing and number of injection sites are three. Concentration of polidocanol is 0.5%. The Tessari method is employed for the generation of foam sclerosant with the mixing ratio of 1+5 for sclerosant plus air.

Results: Simple foam sclerotherapy were performed sixty hundreds and forty three sessions. Average foam volumes injected per treatment session was 8.7 ml (2.5–10 ml). No serious complications were shown.

Conclusion: Simple foam sclerotherapy is a safe and effective treatment method for varicose veins with a low incidence of complications.

Klippel Trenaunay syndrome (KTS) is characterized by varicose veins, hemangiomas, and bone and/or soft tissue hypertrophy. 6 male and 5 female patients with KTS, aged 2 to 69, were treated in the 2007 academic year. All of the patients had varicose veins, while hemangiomas and skeletal hypertrophy were observed in 10 and 5 patients, respectively. Through surgery of varicose veins in 7 patients and compression therapy in 4 patients, cosmetic and functional improvements were made.

Case 1: 83-year-old male noticed a soft mass on his right forearm a few years ago and it grew larger and attended our hospital. Physical examination revealed a palpable fusiform mass with a diameter of 2×1.5 cm on the right forearm without pain on pressure and no sign of ischemia in the right fingers. Bruit was heard on auscultaion and thrill was palpated over the tumor. Angiography delineated arteriovenous fistula between a branch of the right radial artery and the dilated cephalic vein. Total resection of the mass was done under local anesthesia. Only small arteriovenous fistula was found and there was no need to cramp the radial artery during the surgery. Histopathological examination diagnosed the mass as the arteriovenous malformation. The post operative course was uneventful and there is no recurrence 6 years after the surgery.

Case 2: 59-year-old female attended our hospital for examination and treatment of the tumor at the left elbow. A small and soft tumor had been recognized about a few months previously. It had recently increased in size gradually and caused dull pain. On physical examination, a nonpulsatile, soft and smooth-surfaced tumor 2×2 cm in size was noticed at the left cubital fossa. The skin over the tumor was colored dark-bluish. Duplex scan echogram showed that the tumor originated from the superficial cubital vein had septa in it and was shaped like multiple locations. Total resection of the mass was done under local anesthesia. Microscopic findings revealed the tumor composed of variety sized veins which had well-developed muscular walls. These findings were compatible with venous malformation. The post operative course was uneventful and there is no recurrence one year after the surgery.

According to the patients’ declaration, the tumors had increased in size due to repeated needle puncture at the same site for blood test. Not only some congenital factors, but also some traumatic factors are strongly suspected for the cause of the tumor in both cases.