In order to assess the effect of radical varicose vein surgery on the size of the foot, we measured calf perimeter in 1015 lower limbs while participants were barefoot before and 1 month after varicose vein operation. Postoperative calf perimeter was significantly decreased compared to that before the operation. A decrease of 2 cm or more after the operation was found in 23.4% (238 limbs) of cases. There was an inverse relationship between preoperative venous filling index (VFI) and postoperative calf perimeter; higher preoperative VFIs were associated with greater decreases in postoperative calf perimeter. Thus, for patients who continuously wear elastic compression stockings over the mid- to long-term after varicose vein surgery, physicians should be aware that the effective size of the compression stocking may change compared with the size of that worn preoperatively.

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A 89-year old male was referred for severe swelling of the right lower limb since a month before. Maximum right and left lower leg circumference was 40 cm and 32 cm respectively. Ultrasonography showed no thrombus in any veins and no retention of venous flows. There was no figure of tumor or enlarged lymph node on the abdominal and pelvic CT scan view. Instead of such predictable abnormal shadows, extremely distended bladder was detected. The condition of the right lower extremity was concluded as lymphedema. Continuous urethral catheterization was kept under the diagnosis of a neurogenic bladder. Then, 5 days after the catheterization, lymphedema disappeared completely. It seems that the chief cause of transient lymphedema can be the oppression of lymph plexus by distended bladder at the part of right external iliac artery and vein.

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Impalement injury is unusual and often requires emergency surgery. We present a case of impalement through the abdomen with injury to the femoral vein. In March 2014, as a result of an accident during lumber work, a 44-year-old man was impaled by a wooden stake in his left lower abdomen and was transported to the hospital via ambulance. On examination, a wooden stake (5×30×220 mm) was protruding from the left lower abdomen, but protrusion depth was unknown. His vital signs were stable, focused assessment with sonography for trauma (FAST) was negative, and computed tomography revealed damage to the right femoral artery and vein. During emergency surgery, no injury to the abdominal content was noted, but there was a penetrating injury to the right femoral vein, which we repaired directly. His postoperative course was uncomplicated, and was discharged on day 15. Postoperative deep vein thrombosis (DVT) or pulmonary embolism (PE) did not occur.

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Endovenous heat-induced thrombus (EHIT) is well known after endovenous laser ablation (EVLA) for varicose veins. We experienced two deep venous thrombosis (DVT) cases that caused after EVLA with no relation to EHIT. Case 1: a 52-year-old woman weighed 65 kg. We performed EVLA for her left great saphenous vein. EHIT was not found at postoperative day 1 and 7. She developed a fever caused by a cold on postoperative day 38, and her left lower limb was swelled in the next day. Since thrombi were found in her left common iliac-femoral veins by CT, she was diagnosed as DVT and was hospitalized. No pulmonary embolism (PE) was found. She received anticoagulant therapy after hospitalization, and was discharged. Case 2: a 49-year-old man weighted 95 kg. He received one-day EVLA for bilateral great saphenous veins at a vascular clinic. He developed dyspnea after he woke up on the next day of the surgery, and was transferred to our hospital by an ambulance. He was diagnosed as DVT for both lower limbs with massive PE by CT. No EHIT was found by Duplex ultrasound (DUS) examination. Fibrinolytic -anticoagulant therapy was greatly effective for him, and then he was discharged. It was considered that DVT might partially have attributed to EVLA in addition to risks of DVT including dehydration, bed rest, and obesity.

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[in Japanese]

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