As surgical intervention for renal cell carcinoma with tumor thrombus extending into the inferior vena cava is invasive procedure, it is important to evaluate surgical strategy and early and late outcome. We retrospectively reviewed 28 patients with renal cell carcinoma with tumor thrombus extending into the inferior vena cava who underwent surgical intervention at our institution between January 2001 and April 2009. Operations were performed by simple clamp of IVC for expansion level I-III, and using cardiopulmonary bypass for level IV. Early complications included one pulmonary embolism, two deep vein thrombosis, one temporal renal failure and one acute myocardial infarction, but no operation related death. Median follow up period was 18.9 months and two years disease related survival ratio was about 61%. The extension level showed no relation to the prognosis. Lymph node metastasis and distant metastasis at presentation was thought to be associated with the prognosis. From our cases, patients with renal cell carcinoma with tumor thrombus into the inferior vena cava are thought to benefit from aggressive surgical resection.

We performed preoperative screening ultrasonography of lower legs for 447 cases from September, 2006 to April, 2009. Fresh soleal vein thrombosis with non-compression image by ultrasonography probe was observed in 24 cases (5.4%). In the 24 cases, 4 cases of proximal extension, above posterior tibial or peroneal vein, were confirmed. Between the 4 cases with the proximal extension and the 20 cases without the extension, statistically significant difference was not seen in age, gender, body mass index, and the ratio of the benign disease and the malignancy respectively. For the prevention of venous thromboembolism during perioperative period, the operation was held over in a benign disease, intermittent pneumatic compression was not used and anti-coagrant therapy was performed in 3 malignancy cases. Inferior vena cava (IVC) filter was inserted in two cases. In an advanced gastric cancer case that was treated with gastrojejunostomy and IVC filter insertion, IVC occlusion was confirmed by a captured thrombus. Fatal complication due to the venous thromboembolism did not occur in any of the 4 cases.

We investigated the prevention and treatment of pulmonary thromboembolism (PE) and deep vein thrombosis (DVT). During the past 15 years, we experienced 978 cases of DVT and 36 cases of PE. These cases were divided into two groups: cases that presented during the first period (before 2002), when no preventative measures were in use; and cases that presented during the second period (2002 and after), once preventative guidelines had been established and venous ultrasonography was being routinely performed. During the first period, 204 cases of DVT and 24 cases of PE occurred, while 774 cases of DVT and 12 cases of PE occurred during the second period. Preventative guidelines were established for PE and DVT. Venous ultrasonography was performed by each department. Nine cases of PE died during the first period, while no deaths occurred during the second period. During the first period, surgery for PE was performed in 5 cases, and 4 cases died. Medical treatments for PE were performed in 31 cases, and 5 cases died. During the second period, the number of PE cases decreased and the prognosis improved. Thus, these preventative measures are effective for preventing PE and DVT. Therefore, we expect that the incidence of PE and DVT should decrease as a result of this management strategy.

The stab avulsion technique is one of the most common maneuvers for the surgical removal of varicose veins. A 2–3 mm stab wound is made with a number 11 scalpel blade. The varicosities are picked up subdermally with various hooks, such as Varady or Mueller types, and pulled through the stab wound. This operation can be performed under general anesthesia with Propofol and local infiltration anesthesia with 0.5 1% Lidocaine. Tumescent local anesthesia with 0.1% Lidocaine is effective for decrease in vein diameter, dissection of varicosities, low post-operative pain, and minimal hematoma.

Stab avulsion is a highly useful technique combined with conventional selective stripping, laser, radiofrequency, or sclerotherapy.

We present a case of a 76-year-old woman who had a varicose vein with thrombophlebitis of the right leg. The thrombus filled the great saphenous vein and progressed into the deep vein. She also had an asymptomatic pulmonary embolism. A retrievable inferior vena cava filter was placed and anticoagulant therapy was started immediately. Because the thrombus was not reduced it was necessary to perform surgery. The thrombus was removed and stripping of the great saphenous vein was performed. Because the thrombus was proved in the deep inguinal venous region and the vena cava filter after the operation, the filter was not removed and anticoagulant therapy was continued. Finally the thrombus disappeared after 2 months.

Superficial thrombophlebitis in the saphenous vein that progresses to the deep vein is referred to as ascending thrombophlebitis. Because it has the risk of deep vein thrombosis and pulmonary embolism, it may be necessary to administer anticoagulation medication or undergo surgical operation immediately.

47 years old woman case was presented. She has a tumor with pain in her right thigh for 19 years and it became bigger by degrees. By diagnosis of venous thrombophlebitis, she was introduced to our hospital for treatment. The tumor was seen in her right thigh with tenderness. Pulse sound was detected by Doppler auscultation. A glomus tumor was suspected in CT examination. We performed tumor extraction under the local anesthesia. The resection was easily done. The pathological examination indicated it was angioleiomyoma. Tumor lesion is very rare, except an angioma, as differential diagnosis of varicose veins of lower extremities. We report rare case of angioleiomyoma as differential diagnosis of varicose veins of lower extremities.

Venous aneurysms are solitary areas of venous dilation and are relatively rare lesions. Deep venous aneurysms necessitate surgical treatment because of the risk of pulmonary embolism. Tangential aneurysmectomy with lateral venorrhaphy or total excision with venous reconstruction is commonly chosen. Serious complications do not commonly occur with superficial venous aneurysms. Surgical therapy is required only in cases involving pain, or edema, or for cosmetic reasons. Two patients with superficial venous aneurysms located in upper extremities were treated. Simple ligation and excision were performed in both cases without complications.