Since over one million residents in Mid Niigata Prefecture Earthquake stranded into small compact car, prevalence of deep vein thrombosis (DVT) in residents in the area of the quake has been still high. We investigated prevalence of DVT in the residents every year. Subjected were 867 residents in Ojiya and Tohkamachi City in 2010. 262 of them were first comer. DVT in lower limb was detected in 85 residents by ultrasound examination. Since 17 of 85 residents were first comer since the quake, prevalence of DVT in the area in 2010 was estimated 5.8%. Hypertension was significant correlated with DVT (p<0.01). Cerebral infarction or transient ischemic attack (TIA) in the residents with DVT was significantly higher than those without DVT (odds ratio; 2.73, 95% CI; 1.11–6.68).

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Background: A magnitude 9.0 earthquake followed by a tsunami hit the eastern part of Japan on March 11, 2011. High rate incidence of deep vein thrombosis (DVT) among evacuees after giant earthquake has been reported. We took a mobile ultrasound screening as part of disaster response as well as the Iwate-Miyagi Nairiku Earthquake in 2008. Methods: In the collaboration of local headquarters for emergency disaster control, Calf sonography by portable ultrasound machines was performed to 330 subjects in 27 shelters of Miyagi prefecture during five weeks after the earthquake of 2011 and 127 subjects during three years after the earthquake of 2008. Direct ultrasound signs, thrombotic echoes or lack of venous compressibility allows a definite diagnosis of deep vein thrombosis. Multivariate analysis was performed using logistic regression analysis with the presence of DVT as independent variables. Time course of residual DVT probability was estimated by the Kaplan-Meier procedure from the data of 20 evacuees with DVT. Results: In the earth quake of 2011, 74 of 330 evacuees (22%) developed DVT in the calf. 41 of 65 (54%) were symptomless. Trauma in lower extremities [odds ratio (OR): 6.133, 95% confidence interval (CI): 2.326–16.170, P= <0.001], refrain from urination [OR: 3.565, 95% CI: 1.978–6.426, P= <0.001] were independent positive predictors of DVT in this disaster. From the three-year follow-up data of the earthquake of 2008, the ratio of evacuees with residual DVT decreased gradually to a plateau of 55% at one and a half years, then dropped to 16% at three years. Discussion: A DVT incidence of 22% is much higher than annual incidence. Tsunami increased risks of DVT in stricken area, through venous injury associated with leg injury, immobility and hypercoagulable state secondary to suboptimal living space. Prolonged DVT presence indicates that early intervention and continuous follow-up are important as a disaster response to prevent venous thromboembolism.

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After the Great East-Japan Earthquake on March 11, 2011 there were more than 70,000 people who were suffered from earthquake in the area of Ishinomaki. The high incidence of deep vein thrombosis (DVT) in the evacuees has been recognized since Niigata-Cyuetsu Earthquake in 2004, therefore, we examined candidates for calf DVT using portable sonography. Surprisingly, we found high incidence of DVT as 45.6% in March, which was higher than previously reported. Also we found 6.8% of elders in the shelters were reduced the degree of independent living to need nursing care and the incidence of DVT was obviously higher in the tsunami-flooded shelters than non-flooded (36.4% and 20.7%, expectively). According to our observasion, we suposed the reasons of high incidence of DVT in Ishinomaki area as; the crowded shelter might reduce the activity of senior evacuees, and the worsening of sanitary conditions in the tsunami-flooded shelters might induce dehydration secondary to diarrhea and vomiting and restriction of water intake for avoiding unsanitary toilet. Our survey revealed that evacuees in unsanitary and crowded shelters have multiple, serious risks for DVT. Therefore, we recommend not setting up the shelters in flooded areas after disasters.

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The Great East Japan Earthquake gave the serious damage to the northeastern 3 prefectures and to the neighborhood. After earthquake disaster outbreak, we made prototype of a corrugated box portable bed (CBPB) to prevent hypothermia and to help refugees on March 20th, 2011. It was recognized that CBPB was effective in prevention of economy-class syndrome, respiratory tract disease and disuse syndrome. Then we offered about 3,000 CBPB to northeastern 3 prefectures, Nara and Wakayama prefecture. CBPB was made with the height that legs sticks to the ground well, is not necessary of special tool for making and is able to use for about 6 months. CBPB has many advantages such as prevention of daily life activity decrease, relief of mental stress and reduction of dust aspiration. We inspected the Italian north earthquake 2012, and marquees and pipe beds were arranged promptly at those refuges. For emergent supply of CBPB we have pushed forward the making agreement of disaster prevention with self-governments. Sentences of CBPB were firstly added to the law of disaster prevention master plan. Stop the sleeps in a huddle! We will learn this lesson in future and want to make an effort to improve of refuge quality as the corrugated fiberboard industry practitioner.

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The demand for vascular laboratories that provide vascular surgical services is growing in Japan. Noninvasive examination for venous and lymphatic diseases can be repeated, and data obtained from these examinations can be easily restored like a personal soft bank for both patients and healthcare providers. In June 2009, we established a vascular laboratory with a vascular specialist in a university hospital with a research institution. Approximately two years have passed since this laboratory was established, during which a few hundred patients have used its services, and we have obtained interesting results. Our results suggest that the role played by the vascular laboratory and vascular specialist in the care of venous and lymphatic disease patients is contributing greatly not only to clinical work and education but also to developing techniques and strategies for venous and lymphatic care.

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Our institute has provided effective medical care for vascular diseases with the establishment of a department of vascular surgery in 2004, an outpatient department for lymphedema in 2005, and the introduction of authorized clinical vascular technologists in 2008. Regarding the treatment of venous disease and lymphedema, the findings and problems to be solved that were obtained through collaborative treatment with comedical staff are described. [Physiotherapists] Interface pressure and stiffness were measured by various compression devices and compression therapy is also being performed.
[Clinical laboratory technologist] Vascular ultrasounds examination showed the incidence of a sole reflux of the perforating vein of the thigh in the patients of the varicose vein of the lower limbs. Below-knee tourniquet-photopletysmography showed the usefulness of screening to determine the indications for limb varicose vein surgery, high ligation combined with sclerothrapy of the saphenous vein trunks. As transthoracic echocardiography during foam sclerotherapy showed higher incidence of microbubbles in the right heart, we choose CO2 foam sclerosant instead of air foam sclerosant to reduce the side effect due to microembolism.
[Nurse] Regarding one day varicose vein surgery of the lower limb, an increased understanding/reduced anxiety of the patient by conducting preoperative visual path orientation and improvements in patient QOL were exhibited (reduced body pain, overall healthy feeling, vitality, and mental health) both prior to and following surgery.
In the future, it will be necessary to increase health insurance income for complex decongestive therapy as well as strong support to improve the environmental management of the hospital which is easy to carry out clinical study, thus allowing for comedical staff members to play an increasingly active role.

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We have taken a survey about psychological problems during and after thrombolysis with inferior vena cava filter (IVCF) in patients with deep vein thrombosis (DVT). We also have created a questionnaire to nursing staff in charge, concerning nursing care for DVT patients. According to outcome of inquires, patients fell into panic condition, because of unexpected illness and treatment in initial stage. They have trait and state anxiety for treatment, results and sickness. Furthermore, the anxiety was aggravated by complex problems of occupations, economics and family matters. That is why patients want to be well acquainted with results of thrombolysis of DVT with microcatheter. It will promote the intimate relationships (Rapport formation) and reduce the uncertainty that concrete and detailed explanations for treatment with CVT nurses who have qualifications of cardiovascular technologist and cardiovascular nursing. We hope adequate and professional assistances with CVT nurses, coworkers and doctors will reduce the anxiety of patients and lead to better clinical results.

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Objectives: The purpose of this study was to evaluate venous patency, valvular function, and freedom from re-thrombosis in patients with acute proximal deep vein thrombosis (DVT) who underwent catheter-directed thrombolysis (CDT). Material and methods: Fifty patients with acute proximal DVT between January 2003 and October 2010 underwent CDT. CDT was performed with temporally inferior vena cava filter and the infusion catheter was inserted through a sheath in popliteal vein by percutaneous puncture. A solution of urokinase was infused either continuously and using the pulse spray technique together with heparin and intermittent pneumatic compression. Results: The median CDT duration was 4.3 days, the median total dose of urokinase was 1,050,000 IU, mechanical thrombolysis was performed in 39 patients and a metallic stent was inserted in 5 limbs. At the time of completion venography, the median recanalizaion rate was 91% and there were thirty nine patients in complete recanalization. 51-month primary and secondary patencies, venous reflux free-rate, and freedom from re-thrombosis were 80%, 83%, 88.6%, and 93.9%. Conclusion: Treatment with CDT for acute proximal DVT achieved good patency, prevention of valvular function, and low freedom from re-thrombosis after 51-month of follow up in current study.

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It has been reported that an incompetent perforator vein (IPV) causes chronic venous insufficiency, along with stasis ulceration of the lower extremities. The Linton procedure used to be commonly performed, which involved directly removing the IPV from the subfascial space via the overlying skin. Postoperative wound complications often occur when approaching the abnormal skin directly. However, the theory of the Linton procedure and an endoscopic surgical technique have been combined into the subfascial endoscopic perforating vein surgery (SEPS) procedure. We recently employed the SEPS procedure by applying a two-port system using laparoscopic surgical devices and carbon dioxide compression. We can quickly and safely approach the subfascial space and have an improved endoscopic surgical view. This procedure is very useful for patients with stasis ulceration of the lower extremities.

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We routinely perform femoral nerve blocks for greater saphenous vein surgery; however, transient palsy of quadriceps femoris muscle remains one of the major complications (93%). To reduce complication rates, we used a modified femoral nerve block method using 2 ml of 1% lidocaine (instead of 6 to 10 ml) combined with saphenous nerve blocks using 10 ml of 1% lidocaine. To evaluate the efficacy of the modification, we performed nerve blocks on 99 involved legs from 81 patients undergoing greater saphenous vein stripping surgery between Nov. 1st 2010 and June 6th, 2011. The grade of complications was divided into three groups depending on the degree of post-operative paralysis: grade 0 = no complication—patients could walk immediately after the surgery; grade 1 = patients could stand but were unable to walk; grade 3 = patients could not stand. The complication rates were as follows: Grade 0 was 86.9% (86/99); Grade 1 was 9.1% (9/99); and Grade 2 was 4.0% (4/99). No other complications involving infection, bleeding, or saphenous nerve injury were observed. This modified nerve block method dramatically reduced the complication rate of quadriceps muscle palsy, and facilitates treatments involving areas distal to the knee.

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Since May 2010, 825 consecutive cases of varicose veins have been treated in day surgery. Operative procedures consisted of high ligation, stripping of the saphenous vein, and varicotomy in small incisions. A balanced anesthesia, including tumescent local anesthesia, intravenous administration of remifentanil and propofol, and oxygen inhalation was applied. Mean age of the patients was 61.5±11.0 years old. Men/women ratio was 1: 2.73. Operation times averaged 36.5 minutes and on average 4.31 skin incisions were made. Immediately after surgery, all patients were able to walk, drink, and return home. Major complications were not observed. Most patients having incompetent saphenous veins could be treated this way in day surgery.

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Compression therapy such as elastic bandages and elastic stockings is an essential treatment tool for venous diseases and lymphedema of the limbs. However, it has some disadvantages. One of the main disadvantages of elastic bandages is difficulty in achieving a constant and precise compression pressure, while that of elastic stockings is difficulty in putting them on and taking them off, resulting in important limitation of the practical acceptability. In the present study, therefore, some solutions to reduce these difficulties were described; multilayer bandaging, bandages with a mark which indicated a compression pressure and education in techniques to put the elastic stockings on for the disadvantages of elastic bandages, and double stockings, separated stockings which were divided at the ankle region into leg and foot portions and the use of gaiters to augment the calf muscle pump for the disadvantages of elastic stockings.

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Migration of a fractured strut of an inferior vena cava (IVC) filter to the heart and pulmonary artery is a rare case. We report the case of a 72-year-old woman who had this complication four years after infra renal IVC filter placement. Five struts were noted to be completely separated from the filter body and two of them lodged in right pulmonary artery. The other three had migrated to inferior vena cava, right ventricle and left pulmonary artery each. Without symptomatic complications, surgical removal was not performed.

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