Purpose: This reviews 11 consecutive patients with great saphenous vein thrombophlebitis among 529 patients treated for varicose veins in our department.Methods: An assessment was performed by the following factors; proximal end of thrombus, distal extension of thrombus, timing of surgery, surgical procedure and post-operative pulmonary embolism.Result: Of the 11 patients, proximal ends of thrombus are common femoral vein in 3 patients, just below saphenous-femoral junction in 4 patients and middle of thigh in 3 patients. Thrombus distally extended to ankle in 8 patient, below knee in 2 patients and above knee in 1 patient. Interval between the outpatient visits and operation is 11.6 ± 10.0 days. Thrombectomy and stripping procedure was performed in 9 patients and segmental resection of great saphenous vein was performed in 2 patients. Post-operative pulmonary embolism occurred in 2 patients.Conclusion: Acceptable results were obtained in patients with saphenous vein thrombophlebitis by our treatment strategy but we have to overcome a problem of post-operative pulmonary embolism.

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There are a number of elastic stockings (ESs) available in the Japanese market. We aimed to investigate the respective features of different ES brands. We retrospectively studied 91 patients who underwent ES treatment from 2010 to 2011. We typically prescribe the ANSILK^®, JOBST^®, and RxFit^® brands. Of all the patients who use ESs, 41.4% patients complained about its use. Subsequently, ES treatment was discontinued in 31.9% patients. Furthermore, different patients had different complaints regarding the 3 ES brands. Some patients complained that ANSILK^® kept slipping off; the elderly patients found it difficult to wear JOBST^®; and for some others, RxFit^® caused pain under the toe. With the findings of this study, we expect to accomplish effective and timely intervention by caregivers on the basis of important information regarding the features of each ES brand.

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Prevalence of asymptomatic deep vein thrombosis (DVT) in patients with primary varicose veins remains unclear. Here, we conducted a retrospective study to clarify incidence of asymptomatic DVT in patients with varicose veins, especially focusing on those with superficial thrombophlebitis (STP). Among 431 patients with primary varicose veins with saphenous vein incompetence, 20 (4.64%) had asymptomatic DVT. Presence of STP was a significant risk factor for asymptomatic DVT, since 10 out of 24 (41.7%) patients with STP had asymptomatic DVT, the all cases having calf muscle vein thrombosis. In contrast, the patients with primary varicose veins without STP had only 2.46% of asymptomatic DVT. In the patients with primary varicose veins with STP, significant risk factors for DVT were over C3 on CEAP classification.

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Objectives: The statistical results about efficacy of femoral nerve block in one-day surgery for primary varicose veins are reported.Materials and Methods: One thousand and fifty-six consecutive patients (1,297 legs) with great saphenous vein (GSV) reflux were treated under femoral nerve block and tumescent local anesthesia (TLA) between January 2012 to December 2012. The femoral nerve block was performed under ultrasonographic guidance, with 5 to 8 ml of lidocaine 1% injected around the nerve. The TLA was carried out under ultrasonographic guidance with 50 to 80 ml of tumescent fluid injected around GSVs. The subjects were questioned using verbal rating scale about the pain during the procedure and about the wishes to be sedated.Results: In regard with the pain during the procedure, 90.9% of the subjects answered that they did not feel any pain or they felt slight pain. About the wishes to be sedated, 83.9% of the subjects answered that it was better for them to be awake having a conversation than to be sedated. No complication due to the femoral nerve block arose.Conclusion: The one-day surgery for primary varicose veins can be performed under femoral nerve block with TLA, using less than 20 ml of lidocaine 1% alone.

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Venous stasis in the lower limbs is a pathogenesis of primary varicose vein (VV). We attempted to find an index of venous stasis that can be indicated by a duplex scan, considering lower limb hemodynamics. In this study, we examined cross-sectional areas of deep veins in patients with VV one year after striping surgery, and noted the change in deep vein morphology before and after surgery. Ninety limbs and 134 deep veins were studied in patients with VV. Four cross-sectional areas of deep veins were measured with a duplex scanner. Each region was measured before and two months and one year after stripping surgery. We compared the cross sectional areas obtained at the three time points. In the standing position, the popliteal vein was significantly smaller two months after surgery than before surgery in the C2, 3 group (P<0.01), but no difference was noted two months and one year after surgery. No significant difference was seen in the other cross-sectional areas in this position among the three time points. In the lying position, the distal common femoral vein was significantly smaller after surgery than before surgery (P = 0.04), but no difference was noted at two months and one year after surgery. No significant difference in the other cross-sectional areas was seen in this position among the three time points. On the other hand, no significant difference was noted in the cross-sectional areas in either position in the C4, 5 group.

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Most patients with severe motor and intellectual disabilities (SMID) have 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 twelve patients (42.9%) with DVT among 28 patients with SMID during prolonged bed rest. However, we did not detect thrombosis in the soleal veins, finding it mostly in the superficial femoral and common femoral veins. We applied anticoagulant therapy (warfarin), and carefully followed up the cases with DVT, regulating the warfarin dosage at PT-INR values around 2 for prevention of recurrence for chronic thrombosis. Regarding laboratory data for the coagulation system, there were no cases with above 5 μg/ml of the D-dimer. The plasma levels of D-dimer in patients with DVT diminished under 1.0 μg/ml after warfarin treatment. 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 serial assessment of compression Doppler ultrasonography of the lower extremity, as noninvasive examination and measurement of D-dimer, are very helpful.

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A part of lower extremity lymphedema patients secondary to pelvic cancer treatments suffer from lower abdominal lymphedema and/or genital lymphedema, which deteriorates patients’ quality of life with urination troubles and genital lymphorrhea. Genital lymphedema has already progressed and its treatment is challenging, when a patient complains swelling of her genitalia. It is important to diagnose and commence treatments at an early stage of genital lymphedema. Indocyanine green (ICG) lymphography, which clearly visualizes superficial lymph flows, is considered useful for early diagnosis. Genital dermal backflow (GDB) stage, a pathophysiological severity staging system, allows early diagnosis of lower abdominal and genital lymphedema before symptom manifestation. Lower abdominal lymphedema precedes genital lymphedema from a lymphodynamic point of view, and early diagnosis and intervention to lower abdominal lymphedema may prevent genital lymphedema. ICG lymphography would ameliorate management of lymphedema secondary to pelvic cancer treatments.

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The case is an 83-year-old woman who was implanted a permanent-type inferior vena cava (IVC) filter for pulmonary thrombosis and deep vein thrombosis ten years ago. After that, she had been treated with warfarin for anti-coagulation, but stopped taking warfarin on her self-judgement 3 months before admission. A week before admission, she suffered from lumbago, and due to the appearance of disturbed consciousness. She was taken to our hospital by ambulance due to disturbed consciousness. On arrival, she was in pre-shock and laboratory analysis revealed that she had severe anemia. Computed tomography showed that large hematoma existed in a right retroperitoneum, and there was massive thrombus distal part of IVC filter. The intensive therapy with rapid administration of fluid and blood could not save her life. According to the results of autopsy, the IVC filter was full of clots and there was significant hemorrhage in retroperitoneum and abdominal cavity due to the rupture of right iliac vein. The massive thrombus and the vulnerability of right iliac vein could be a cause of the rupture. There are several reports regarding the retroperitoneum hematoma after IVC filter implantation, but previous cases were not severe. To our knowledge, this is the first case of the rupture of right iliac vein after IVC filter implantation leading to death. This case taught us that discontinuation of anti-coagulation therapy after the implantation of permanent IVC filter could induce lethal complications.

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A case of retroperitoneal venous aneurysm is reported. A 79-year-old man was referred to a hospital because of edema of both feet. Computed tomography revealed a retroperitoneal cyst. The cyst compressed inferior vena cava. Therefore, he was admitted to our hospital to undergo surgical treatment. October 2012, transperitoneal extirpation of the cyst was performed. The cyst contained yellowish serous fluid. Microscopically, the wall of cyst Structure of the cyst wall was found to be consistent with the structure of the vein wall by immunostaining. Pathological diagnosis was retroperitoneal cyst of venous origin. Several similar cases have been reported as retroperitoneal venous aneurysm. This is the 11th case of retroperitoneal aneurysm reported in Japan.

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We reported a case of iliac vein compression syndrome (IVCS). A 46-year-old man was admitted complaining of a tumor in the left inguinal area. Ultrasonography revealed a tumor as a various vein. Computed tomography revealed left common iliac vein compressed between right common iliac artery and lumbar spine. Venography of the left leg showed that the contrast medium injected from lower leg did not drained to left iliac vein, but drained to right iliac vein via suprapubic crossover collateral veins.

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