After the endovenous laser ablation (EVLA) procedure with a 980-nm diode laser was approved by the Japanese National Health Insurance in 2011, our institute has primarily performed EVLA for primary varicose vein treatment. In the present retrospective study, we assess the short-term results of EVLA in our institute. Between April 2004 and May 2013, we have performed EVLA in 71 limbs and great saphenous vein (GSV) stripping in 104 limbs. Overall, we noted that EVLA treatment for patients with primary varicose veins yielded sufficient satisfaction rates as compared to conventional GSV stripping surgery. In particular, EVLA has advantages such as the decreased risk of massive bleeding from the major venous branch at the saphenofemoral junction and lower wound infection rates. However, we believe that the surgical treatment strategy should be carefully chosen while considering the findings and condition of each patient to achieve a favorable result.

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Elastic compression stockings are used in surgical treatment of varicose vein. In a trial of low versus high compression stockings (15–20 mmHg vs. 20–30 mmHg) after varicose vein stripping, both showed no statistical significance in the reduced degrees of the venous volume (VV) and venous filling index (VFI) at 1 month after the operation. In a further study in higher VFI cases (over 6 ml/sec, preoperatively), comparable results were obtained. Our results indicate that, after surgery, low and high compression stockings were equally effective in improving the venous function. Therefore, good results have been produced by recommending the low compression stocking especially to the discomfort patients.

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Objective: This study was designed to assess the necessity of treatment of branch varicose veins after endovenous laser ablation (EVLA) for insufficient saphenous vein. Methods: From January to March 2013, 98 patients (108 limbs) with primary varicose veins for the insufficient saphenous vein (91 great saphenous vein (GSV) and 17 small saphenous vein (SSV), 42 men and 56 women, mean age 68 years old, mean GSV diameter 6.5 ± 1.5 mm, mean SSV diameter 5.9 ± 1.4 mm, mean diameter of maximum branch varicose vein 5.4 ± 2.6 mm) underwent EVLA without concomitant microphlebectomy or sclerotherapy. We evaluated improvement of symptoms and size reduction in visible varicosities 2 months after operation. Results: Mean length of ablated GSV and SSV were 39.2 ± 12.8 cm and 17.0 ± 4.1 cm, respectively. A complete resolution of branch varicose vein was found in 11 limbs (10.2%), reduction in size in 97 limbs (89.8%), and no change in no limb. Additional sclerotherapy for branch varicose veins was needed in 7 limbs (6.5%) for cosmetic reason. Conclusion: EVLA alone for the insufficient shapenous vein result in improvement of symptoms and visible varicosities regression in more than half of the cases at two months after EVLA. However, complete resolution could be seen in only a few cases. Further observation will be needed to evaluate the necessity of treatment of branch varicosities.

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Objective: To evaluate the efficiency and safety of endovenous laser ablation (EVLA) compared with high ligation and stripping (HL/S) for primary varicose vein, and evaluate the role of EVLA in the foundation hospital. Methods: A total of 99 patients (108 limbs) with primary symptomatic great saphenous vein reflux were treated with EVLA (EVLA groups). Thirty-nine patients (41 limbs) who received HL/S (HL/S groups) last one year before starting EVLA were enrolled to compare operative outcome of HL/S with that of EVLA. Results: No statistically significant differences were noted between the two groups with respect to preoperative background (age, sex ratio, preoperatice clinical, etiologilal, anatomical and pathological [CEAP] classification). All EVLA procedures were performed under tumescent local anesthesia, while HL/S was performed under spinal anesthesia. In all treated limbs, occlusion was demonstrated ultrasonographically immediately after the procedure. After three months, all of the treated veins remained occluded. No statistical significance was noted in rated of postoperative complications between EVLA and HLS. The mean operating-room time was 54.1 min in the EVLA group and 102 min in the HL/S group (p<0.0001). EVLA required significantly fewer operating-room staff, including physicians, nurses, and sonographers, than in HL/S (3.8 people vs. 6.2 people; p<0.01). Mean hospital stay was also shorter in EVLA than in HL/S (2.1 days vs. 3.9 days; p<0.01). Given the above, the index of person-minutes was consequently four times higher in HL/S than in EVLA (176.2 vs. 632.4; p<0.0001). Conclusion: EVLA is not only as efficient and safe as HL/S in terms of clinical outcome but can also be performed in less time and with fewer operating staff than HL/S. EVLA is four times more effective than HL/S with respect to personnel expenses.

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The prognosis is poor for patients with chronic thromboembolic pulmonary hypertension (CTEPH) accompanied by progressive right cardiac failure and respiratory failure. We performed a pulmonary thromboendarterectomy (PEA) using deep hypothermia and circulatory arrest on 9 such patients from May 2013 to October 2013 in Daiyukai General Hospital. Mean age was 61.4 years old and male/female was 3/6. Obstructive types of pulmonary artery were proximal type in 6 and distal type in 3 patients. Mean cardiopulmonary bypass time was 253 minutes, mean cardiac arrest time was 128 minutes and mean circulatory arrest time was 43 minutes. The surgical results and the postoperative quality of life in the 9 patients who tolerated the surgery well were examined. PEA using intermittent circulatory arrest under profound hypothermia was very effective in 9 patients. Postoperative respiratory and hemodynamic conditions were remarkably improved. However the management of CTEPH involved difficulties in selecting surgical patients and postoperative managements.

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To investigate adverse events of the elastic stockings, the questionnaire was mailed to the members of the Japanese Society of Phlebology and the elastic stocking conductors of Japanese Society of Phlebology. The answers were obtained from one-hundred ninety two medical institutions. Nerve injuries were reported from 6 institutions, skin ulcers were from 20 institutions, below knee amputation from one institution, and pulmonary embolisms were reported from 2 institutions. We considered that it is important to enlighten proper use of the elastic stocking. The elastic stocking conductors that are qualified by Japanese Society of Phlebology have an important role for proper use of the elastic stocking.

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A stainless steel Nabatoff vein stripper, connected to vinyl chloride extension tube, is applied for stripping surgery of incompetent saphenous veins. This type of stripping has an advantage as inversion technique which may reduce perioperative complications such as bleeding and saphenous nerve damage, with an additional benefit of reuse. The practical method and the recent results in our clinic are reported.

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Sclerotherapy is an effective treatment for reticular and telangiectatic varicose veins. However, it is not easy to perform injection of appropriate dose of sclerosant to the targert leiosn, especially for invisible subcutaneous varices. Therefore visualized sclerotherapy, which can observe those invisible veins to the naked eye, using a novel device, enable sure sclerotherapy. VeinViewer Flex^® (V-V-F) utilizes visible and near-infrared light to illuminate and project subcutaneous venous structure up to 10 mm depth, directly onto a patient’s skin with a real-time digital image. V-V-F enables real-time observation of sclerosant spreading, that allows for appropriate dose injection into the target veins, especially for the feeder vein for combined telangiectasia that are often invisible to the naked eye. Visualized sclerotherapy using V-V-F might be safe treatment with excellent results compared with the conventional methods.

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From 2014, the radiofrequency ablation (RFA) was approved as the new therapy for patients with varicose veins in Japan. It will be one of the standard operations ranged with endovenous laser ablation (EVLA). Although the two minimally invasive techniques have same purpose to control the reflux of the saphenous vein, there are some differences in the detail of the two methods. The objective of this review is to inform the RFA indication, procedure, efficacy, and complications comparing with EVLA.

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