Compression therapy was not well understood and performed in Japan until adapation of compression stocking to the national insurance system for prevention of venous thromboembolism and secondary lymphedema therapy due to malignancy. Japanese Society of Phlebology established qualification system of “Compression Stocking Conductor” in 2002 for medical professionals, focusing on education on basic knowledge of veno- lymphatic disease and compression therapy mainly by compression stocking. Medical professionals, such as nurses, medical doctors, medical technologists and physical therapists can be qualified as “Compression Stocking Conductor” after the seminar attendance organized by Japanese Society of Phlebology and clinical experiences. Number of “Compression Stocking Conductor” reached over one thousand in 2011.

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The aim of this report was to review the usefulness of the elastic compression stocking for the therapy of varicose veins. In our clinical study of the venous function with air-plethysmography, venous filling index were significantly decreased using elastic compression stockings. The elastic compression stocking is useful tool for therapy of varicose veins. But it is difficult to put on and put off, and it has a lot of trouble for maintenance. The stocking conductors are working for guidance of elastic stocking not only to adjust the venous hypertension of the legs with varicose veins, but also to conduct to a safety surgery.

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Elastic compression stocking (ES) is essential tool for treatment of deep vein thrombosis, post-thrombotic syndrome and venous stasis ulcer. However, ES had been prescribed for only seventy percent of patient with these diseases according to the survey of Japanese Society of Phlebology. One of important reason of poor recognition of ES is attributing to no reimbursement by the government insurance system. ES is effective for prevention of post-thrombotic syndrome when ES is used it is used after onset of acute deep vein thrombosis. Compression therapy including ES is effective for treatment of venous leg ulcer and prevention of recurrence, although precise of methods of compression is still under discussion. Effectiveness of ES is enhanced by increase of patient compliance for wearing ES which is difficult to wear and uncomfortable. Elastic stocking conductors play important role in enhancement of adherence to ES with close patient consultation and guidance.

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Graduated compression stockings are the most widely used mechanical prophylactic method for venous thromboembolism. They reduce the overall cross-sectional area of the limb, increase the venous flow velocity, reduce venous wall distension and improve venous valvular function. The prophylactic efficacy is proven in general surgical patients. However, graduated compression stockings are not recommended as sole prophylactic methods for high risk patients of venous thromboembolism. The length of stockings is a controversial issue and there is no definite evidence.
In this article, current evidences of graduated compression stockings for the prevention of venous thromboembolism were reviewed.

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In the present paper, the difference in clinical features between arm and leg lympedema and between primary and secondary lymphedema, and the pathogenesis of vulva lymphedema were described, and it was stressed that the treatments for lymphedema should be selected in considerations of pathogenesis and severity of the disease. Furthermore, the clinical significance of exercise under compression was discussed based on the relationship of compression pressure and stiffness.

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The elastic stocking conductor is established as the qualification system by the Japanese Society of Phlebology since 2002. The aim of this qualification is to train medical personnels how to use elastic stockings and sleeves properly and to cope with complications. The total number of doctors, nurses, clinical technologists, occupational therapists, radiological technologists and physical therapists who had obtained the qualification had reached to 706 by June 2009. We investigated effectiveness of this qualification over clinical care and improvement of individual ability by using the questionnaire. The results demonstrate qualification is useful for the improvement of clinical care and individual skill. However, the qualification dose seldom influence over job position in the hospital. We will take these results into consideration for future modification of this qualification.

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On March 11, 2011 at 2:46 PM a massive 9.0 magnitude earthquake occurred near the northeastern coast of Japan. This earthquake created extremely destructive tsunami waves that hit Japan just minutes after the earthquake. The earthquake and tsunami have caused extensive damage in East Japan. The explosion accident occurred at the Fukushima First Nuclear Power Plant the following day. A large number of evacuees from Fukushima have taken refuge in the Yamagata prefecture. The evacuees were screened for deep vein thrombosis (DVT) at the Ochiai Sports Center in Yamagata City. DVT was detected in 14 out of 123 people (11.4%). Logistic regression analysis was performed for the factors of female subjects over 40 years old. Through the screening, we discovered that the risk factors for DVT include gait disturbances and sleeping in the car overnight.

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Ruptured Baker’s cyst is sometimes called “pseudothrombophlebitis” because it is physically indistinguishable from acute deep vein thrombosis. The purpose of this study was to determine the incidence and characteristics of ruptured Baker’s cysts. The hospital records of 424 patients who were referred to our department with swollen legs during last 5 years were reviewed retrospectively. Deep vein thrombosis was found in 163 cases (38.1%), lymphedema in 26 cases (6.1%), and ruptured Baker’s cysts in 5 cases (1.2%: 2 men, 3 women; mean age 66.4 years). In the cases of ruptured Baker’s cysts, there were preceding knee pain in 2 cases, the history of osteoarthritis in 3 cases, leg edema in 2 cases, calf muscle tenderness in 2 cases, and subcutaneous bleeding of the foot in one case. Ultrasonography in all these cases revealed an easily detectable echo-free space behind the calf muscles. All of the cases were treated conservatively by non-steroidal anti-inflammatory drugs without anticoagulation. In conclusion, Ruptured Baker’s cyst may mimic the presentation of acute deep vein thrombosis and is reliably diagnosed by ultrasonography.

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A major cause of lower leg pain after a stripping operation is due to the saphenous nerve injury. We report a case of severe lower leg pain, which was diagnosed as the complex regional pain syndrome (CRPS). A 43-year-old woman who had undergone the selective invagination stripping for the varicose veins of lower extremity presented a severe lower leg pain at 12-day after operation. The initial symptom was a stabbing pain and numbness localized around the ankle joint, with walking difficulty due to the pain. A saphenous nerve injury was suspected, although the severity and area of the pain changed over the period and not limited to the innervations of the saphenous nerve. She was referred to the orthopedist and diagnosed as CRPS type 1. If the patient presented a severe pain disproportional to the operative injury, we should consider the CRPS.

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This study was performed to investigate the risk factors, diagnostic method, distribution, and treatment of deep vein thrombosis (DVT) and to investigate venous thromboembolism (VTE) prevention in Japan. A questionnaire survey was mailed to the members of the Japanese Society of Phlebology. The contents of the survey dealt with the treatment of new DVT cases in the year 2009 and the prevention of VTE. 1162 DVT patients were reported from 72 institutions. Operation was the most important risk factor for DVT (38.2%). For diagnosis, an ultrasound method was mainly used (87.7%), whereas phlebography was used in only 33 patients (2.8%). DVT locations were proximal type (52.2%) and distal type (47.8%), which included 119 patients with bilateral peripheral type. In the distal type, soleal vein thrombosis was most frequent (84.3%) and then peroneal vein thrombosis (19.9%). Patients were mainly treated medicinally (80.8%). Medication included unfractionated heparin (57.0%) and Urokinase (11.1%). Prophylactic methods were used at 60 institutions (85.7%). The precautions were elastic stockings (91.4%), early ambulation (84.3%), pneumatic compression (81.4%) and anticoagulant (52.9%). The number of DVT patients has increased and the frequency of the distal type especially increased. Anticoagulant therapy is most commonly used for treatment. Prophylactic methods for VTE were used in most institutions, however, the rate of anticoagulation administration was not high and is considered to be insufficient in Japan.

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Background: Stent implantation for iliac compression syndrome with deep venous thrombosis (DVT) is effective, however, long-term result is not well known. Purpose: To clarify the long-term result of stenting for iliac compression syndrome (ICS). Method: From December 2000 to February 2011, total of 20 patients who suffered from acute DVT with ICS and had been treated using stent implantation, were included in this study. ICS was diagnosed when there was significant stenosis by angiography and intravascular-ultrasound findings or pressure gradients more than 2 mmHg after sufficient thrombolysis. Their initial success and long-term patency and clinical outcome were analyzed retrospectively. Result: Stent implantation were successfully done in all patients. In-hospital death and procedure related symptomatic pulmonary embolism (PE) was not documented. 2 patients had early stent thrombosis during hospitalization and received thrombectomy subsequently. One patient could not achieved successful recanalization, and therefore 19 patients improved symptoms and had kept patency at discharge from hospital with warfarization. 17 of 19 patients (90%) could be followed after discharge. During 50 months follow up, one patient had sudden death, and other 16 patients (94%) had not documented recurrent DVT and symptomatic PE. Angiographic or ultrasound follow up were performed in 16 patients. There was only one patient had documented restenosis due to stent collapse after 19 months (restenosis rate 6.2%). Conclusion: In this small number cohort study, stent implantation for ICS with acute DVT appeared to be safe and effective, and showed good long-term outcome.

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