Objective: To compare the efficacy of Ulrtasound-Guided Foam Sclerotherapy (UGFS) for great saphenous vein (GSV) with sapheno-femoral ligation and without sapheno-femoral ligation, after 1 year follow-up. Materials and methods: HL+ group were treated by sapheno-femoral ligation and UGFS. HL– group were punctured into GSV branch and treated by UGFS. Foam sclerosant was made by Tessari method, consist of 3%Polidocanol and CO2 in the proportion of 1 : 3. Forty-eight patients enrolled in HL+ group and 43 patients enrolled in HL– group. Duplex ultrasonography was performed 1, 3, 6 and 12 months after treatment to assess the occlusion length and reflux of patent area. Results: The occlusion rate of HL+ group was 80.4% after 6 months and 75.5% after 12 months. HL– group was 63.4% and 52.8%, respectively. There were no adverse events such as deep vein thrombosis and visual disturbances in either group. Conclusions: UGFS for GSV were performed safely in each methods. HL– method was significantly lower occlusion rate compared to HL+ methods, but less invasive and effective for short term.

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On March 11 at 2:46 pm a massive 9.0 magnitude earthquake occurred near the northeastern coast of Japan, creating extremely destructive tsunami waves with hit Japan just minutes after the earthquake. The earthquake and tsunami have caused extensive and severe damage in East Japan. The explosion accident occurred at the Fukushima first nuclear power plant in the next day, a large number of evacuees have taken refuge in Yamagata prefecture. We carried out deep vein thrombosis screening of evacuees at the Ochiai sports center in Yamagata City on 9 and 10 days after the earthquake. Deep vein thrombosis was detected by 14 of 123 (male 24, female 99) people (11.4%). Mean age of thrombus positive people are 75.4±12.8 and thrombus negative people are 59.0±13.6. Five people have gait disturbance and 27 people experienced overnight sleeping in the car. We conducted life style guidance for the prevention of deep vein thrombosis for the evacuees and distributed elastic stockings to the some of the evacuees.

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At 14:46 on 11 March, a magnitude 9 earthquake struck off Japan’s north-east coast, creating extremely destructive tsunami waves with hit Japan just minutes after the earthquake. The earthquake and tsunami have caused extensive and severe damage in East Japan. The explosion in the outer buildings of Fukushima Reactor 1 occurred on the 12 March followed by a similar explosion in Reactor 3 on 14 March. Consequently a large number of evacuees have taken refuge in Yamagata prefecture. We carried out deep vein thrombosis screening of 25 hospitalized evacuees. Deep vein thrombosis was detected in 6 cases out of them (24.0%). Univariete analysis was performed to detect the risk factors for deep vein thrombosis in hospitalized evacuees. We found that gait disturbance and new trauma are risk factors for deep vein thrombosis.

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Most patients with severe motor and intellectual disabilities (SMID) have had restricted mobility capability and have been bedridden for long periods because of paralysis of the extremities caused by abnormal muscular tonicity due to cerebral palsy and developmental disabilities, and such patients are associated with a high risk for the complications of deep vein thrombosis (DVT). Here we have reported eight patients (34.8%) with DVT among 23 patients with SMID during prolonged bed rest. However, we did not detect thrombosis in the soleus muscle veins, finding it mostly in the superficial femoral and common femoral veins. Regarding laboratory data for the coagulation system, there were no cases with above 5 µg/ml of the D-dimer. Concerning sudden death in patients with SMID, we have to be very careful of the possibility of pulmonary thromboembolism due to DVT. Therefore, we should consider the particularity of underdeveloped vascular system from underlying diseases for the evaluation of DVT in patients with SMID. A detailed study of DVT as a vascular complication is very important for smoothly medical care of SMID and compression Doppler ultrasonography of the lower extremity, as noninvasive examination, is very helpful.

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Objective: The aim of this study was to assess the anatomic variations of the sapheno-femoral junction (SFJ) and its incidence. Patients and Methods: Between April 2005 and March 2010, 2,552 limbs of 1,563 patients with complaints of varicose veins underwent ultrasonography. Ultrasonography was used to identify the anatomical variation of the SFJ, especially the relationship to the femoral artery. Results: Variations were seen in 6 limbs (0.24%) at the SFJ. The most common anatomical variation was the great saphenous vein crossing posterior to the common femoral artery, which was present in 3 limbs. Conclusions: It is important to investigate the anomaly of the SFJ using preoperative duplex ultrasound, although its incidence is lower than that of the sapheno-popliteal junction. The anomaly of the SFJ always should be taken into consideration in order to minimize surgical complications of varicose veins.

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In clinical application of elastic garments and bandages for treatments of venous disease and lymphedema of the limbs, the stiffness should be always considered as well as the interface pressure. Using a stiffness-determining device, the stiffness was measured in single use and in several combinations of various kinds of elastic stockings and elastic bandages. The stiffness is changeable according to the combinations of material, such as double stockings, double bandages, and the wearing of bandages over stockings. The use of short-stretch bandages as the outside layer produces the highest stiffness at a high initial pressure. The highest stiffness was observed in double short-stretch bandages, and the lowest stiffness was shown by double short-stretch stockings. For appropriate selection of the combination, therefore, stiffness should be taken into account in addition to the interface pressure in consideration of their advantages and disadvantages.

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A 35-year-old female with swelling of the right lower limb in Week 9 of pregnancy was referred to our hospital. The coagulation marker level was abnormally high, and ultrasonography revealed thrombi in the right femoral and popliteal veins. Furthermore, the antithrombin (AT) activity and antigen level were reduced, suggesting pregnancy with AT deficiency-related thrombosis. As thrombosis exacerbated despite physical therapy, anticoagulant therapy was performed to control thrombosis. The thrombus involved the inferior vena cava, requiring IVC filter insertion. She delivered a baby in Week 38 of pregnancy via transvaginal delivery. There were no maternal or neonatal complications.
It is recommended that prophylactic drug therapy be started in the first trimester in pregnant women with a history of venous thrombosis or thrombophilia. In the present case, it was necessary to perform anticoagulant therapy after admission. On the other hand, admission-related mental stress for pregnant women is marked. Thrombosis control with non-fractional heparin subcutaneously injected at the outpatient clinic was useful. Although pregnant women with thrombosis comprise a high-risk group, it is possible to continue pregnancy through appropriate thrombosis control.

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The incidence of greater saphenous vein duplication has not been clearly established. We herein report three cases of duplicated greater saphenous vein. During a three year period from 2008 to 2010, 200 limbs in 162 varicose vein patients with greater saphenous vein incompetence were evaluated with color flow duplex scanning. They were consisted of 73 men and 89 women and their ages ranged from 34 to 84 years old, with a mean of 62.9 years old. Among them three cases of closed loop double system in the thigh portion of the greater sapheous vein were encountered. The incidence was 1.5%. They were successfully treated with stripping. Perforator vein incompetence was not detected in any of them.
Case 1: A 59 year-old female. The left greater saphenous vein was duplicated 3cm in length in the lower third of the thigh. Stripping was done in both sides. However, there was no duplication in the right side.
Case 2: A 71 year-old male. He had congestive dermatitis in the so-called “gaiter area” bilaterally. The right greater saphenous vein was duplicated 5 cm in length in the middle third of the thigh. The left side was normal.
Case 3: A 41 year-old male. Stripping of the left greater saphenous vein was done for the varicose vein with congestive dermatitis. Closed loop double system in the thigh portion 2 cm in length was detected.
Surgical problems can be minimized if the possibility of these congenital anomalies is always considered. Proper knowledge of saphenous vein anatomy is vital to the surgeon stripping this vein or preparing it for a bypass conduit.

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We report two cases of intractable groin lymphoceles treated by omentopexy with a peritoneal window. Case 1 was an 87-year-man who three years previously underwent a femoro-popliteal bypass surgery using artificial vessels for peripheral arterial disease. He presented with an intractable groin lymphocele. We performed omentopexy with a peritoneal window for the purpose of lymph drainage from the peritoneal space and to prevent graft infection. The postoperative course was uneventful. Case 2 was a 77-year-old man who underwent an open biopsy of a groin lymph node and presented with an intractable groin lymphocele. We performed omentopexy with a peritoneal window and there has been no recurrence for the last four years. Omentopexy with a peritoneal window is an effective, but invasive treatment method for an intractable groin lymphocele.

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