For early detection of venous thromboembolism (VTE), early diagnosis of the deep vein thrombosis (DVT) is required. In diagnostic method of the DVT, it is first choice at the point that the venous ultrasonography is noninvasive and can be examined in real time. However, there are some tasks for the practice, and we do not yet lead to become wide-spread enough. Because this report introduced a conduct of the venous ultrasonography, I want actually to utilize venous ultrasonography in a clinic or a hospital by all means.

The aim of this study is to evaluate our therapeutic strategy for primary varicose vein patients. We retrospectively studied 184 limbs in 119 patients who received varicose vein surgery from 2002 to 2009. The subjects were classified into two periods, 2002–2005 and 2006–2009, and the groups were compared in the view points of the transition of operative procedure and venous filling index (VFI). In comparison with former period, frequency of stripping surgery with varicectomy was decreased, while that of stripping surgery with sclerotherapy was increased during latter period. VFI among each operative procedure was significantly decreased to same level after surgery. In present, our selective criteria for varicose vein treatment are thought to be adequate from our experience.

Objective: We established a new department of vascular surgery and have actively used the day surgery center while considering ways for maintenance and improvement of our medical quality and for provision of patient satisfaction. In this study, we confirmed the treatment situations of varicose veins by surgery to examine the effectiveness of the day surgery center. Methods and Subjects: The subjects were 72 patients (91 limbs) who underwent varicose vein surgery during the 19-month period between October 2008 and April 2010. There were 38 men and 34 women, with an average age of 61.9 ± 11.3 years. Stripping surgery was performed in 74 limbs (56 patients), and high ligation in 16 limbs (15 patients). Ulcers were found in 7 of the 74 limbs for which stripping surgery had been performed. Among all the cases, 49 limbs (53.8%) had C3 or more severe disease according to the clinical, etiological, anatomic and pathophysiologic classification. Results: As for complications, one case required venous thrombus removal. The treatment objectives were achieved in all (100%) of the cases. There was only one complaint of leg edema, in the patient who needed venous thrombus removal. Conclusion: With appropriate treatment planning, we were able to perform safe and satisfactory varicose vein surgery in the existing day surgery center.

It is essential to diagnose deep vein thrombosis during perioperative period especially when we introduce the prophylaxis for DVT. Serum D-dimer level has a high sensitivity to diagnose DVT, however, the specificity is low. We tried to search more efficient method to diagnose DVT just before and after operation founded on our six months research about operations underwent at four departments in our hospital; general surgery, cardiovascular surgery, orthopedic surgery and obstetrics/gynecology. We found that the D-dimer level at 2.0 μg/ml was the best value to diagnose DVT before operation with a sensitivity of 90.9%, a specificity of 50.4% and a positive likelihood ratio of 1.8. Furthermore, we found that D-dimer level at seventh post–operative day over 10.0 μg/ml combined with 3-day bed rest after operation was the best parameter to predict DVT at seventh post-operative day. It has a sensitivity of 100.0%, a specificity of 35.9% and a positive likelihood ratio of 1.6.

Persisting incompetent great saphenous vein (GSV) below the knee and residual incompetent perforating veins (IPV) were often found after selective stripping of GSV from the groin to upper calf. The aim of this study was to evaluate the venous function when the calf GSVs or calf perforating veins are incompetent after stripping surgery. One-hundred thirty one limbs were treated by stripping from the groin to upper calf with stab avulsion or sclerotherapy of varices; Twelve months after surgery, the patients were examined clinically to establish the extent of persisting varices by duplex ultrasonography and air-plethysmography. Venous filling index (VFI) was a little higher in those who had residual calf GSV reflux 12 month later, but was improved to a similar extent in both groups after surgery. It was higher in the group with incompetent perforating veins than the group without it. The chief complaints were improved in all groups. It is considered that removal of the saphenous vein below the knee is not necessary, but it is important to take care of the incompetent perforating veins.

A 57-year-old woman often experienced toothache and gingivitis because of dental caries. She was admitted to our hospital with a 12-day history of right headache and neck pain. She also had low-grade fever, and the blood count showed leucocytosis on the first day. The patient was treated with intravenous antibiotics for infection. Whole-body contrast CT revealed multiple cerebral nodules, thrombus in the branches of the right internal jugular vein, mild left tonsil swelling, and multiple pulmonary nodules. Additional anticoagulant therapy was started to avoid the intracranial progression. The blood culture was negative and the origin was still unknown, but we suspected Lemierre syndrome from these examination results. The follow-up chest X-ray revealed the disappearance of lung nodules, and she was discharged on the 30th day. Lemierre syndrome is not only rare but is also frequently fatal. We should perform the examination and treatment with careful attention particularly in young cases with oral or oropharyngeal infection causing metastatic disease.

We report five cases of deep vein thrombosis caused by iliac vein compression due to intrapelvic tumor. All of such patients consulted our hospital with a chief complaint of swelling of their lower extremities. Ultrasonography and computed tomography imaging revealed deep vein thrombosis and intrapelvic tumor. These tumors were diagnosed as metastatic cancer, malignant lymphoma, ovarian cancer, and ovarian cyst. We should consider the intrapelvic tumor in the differential diagnosis of the swollen legs.

A duplicated popliteal venous aneurysm is very rare. We experienced this rare entity in a 53-year-old male. He complained swelling of his left popliteal fossa. Contrast enhanced computed tomography revealed both of 30×33 mm and 27×30 mm saccular venous aneurysms without thrombus formation at the left proximal popliteal vein. No pulmonary thromboembolism was detected. He was successfully treated by tangential aneurysmectomy with lateral venorrhaphy. The histopathological examination revealed disappearance of the medial smooth muscle layer and intimal hypertrophy at caudal part of the venous aneurysm. On the other hand, the medial muscle layer was hypertrophic at the cephalad. After aneurysmectomy, the popliteal vein was patent one year later. He also had a 20 mm fusiform venous aneurysm at the opposite side, and a long term follow-up is mandatory.

The purpose of this study was to elucidate frequency and normal size of soleal vein groups.

The subjects were 52 lower limbs of 40 persons who were diagnosed to be competent veins without thrombus and arteries with normal Doppler flow pattern by ultrasonography. The detection rate of the vein size more than 2 mm in diameter was 40% in proximal vein, 100% in central vein, 42% in medical vein, 27% in lateral vein, 27% in distal medial vein, and 10% in distal lateral vein. The detection rate of the vein size in maximum diameter was 0% in proximal vein, 90% in central vein, 6% in medial vein, 2% in lateral vein, 2% in distal medial vein, and 0% in distal lateral vein. The mean diameter of central vein was 6.7±1.8 mm, so that the upper limit became 10.3 mm if the normal range was double of standard deviation.

In conclusion, since the central vein is the most frequent and maximal among the soleal vein groups, it is suitable that the normal size of soleal vein is 10 mm ≥ in diameter.

Although new strategies such as foam sclerotherapy and endovenous laser ablation have been introduced for surgery of the incompetent great saphenous vein, the stripping is still performed as a standard and established treatment. Recently, a new device, named InvisiGrip^TM Vein Stripper, has been developed for the surgery. We have first introduced InvisiGrip^TM Vein Stripper in Japan and have reported our initial experience. In this review, we briefly describe the charecteristics and outcomes of the surgery with InvisiGrip^TM Vein Stripper in our varicose vein center.

Recent reports indicated good outcome of pulmonary embolectomy for acute massive pulmonary embolism owing to early diagnosis by enhanced CT and improvement of a cardiopulmonary support technique. Prompt triage of critically ill patients and early intervention is essential to improve outcome of surgical embolectomy. Twenty-two patients underwent pulmonary embolectomy using the extracorporeal circulation during 22 years. There were 19 patients having acute massive pulmonary thromboembolism and 3 patients having acute on chronic pulmonary thromboembolism. In the former group, 17 patients exhibited preoperative shock and 4 patients experienced cardiopulmonary arrest requiring resuscitation. These patients underwent emergent pulmonary embolectomy and all of them survived the operation. On the other hand, patients who had acute on chronic pulmonary thromboembolism could not wean from extracorporeal circulation due to massive pulmonary hemorrhage in two and over-systemic pulmonary hypertension in one. In conclusion, pulmonary embolectomy for acute massive pulmonary thromboembolism is efficacious treatment for patients having unstable hemodynamics. Care should be taken to indicate pulmonary embolectomy for acute on chronic pulmonary thromboembolism.