Recent studies established a novel mouse model of deep vein thrombosis (DVT) induced by flow restriction, closely resembling the time course and histological features of DVT in humans. Detailed analysis of this model revealed that venous thrombi were formed by more elegant biological reactions than expected. In this model, the compromised venous blood flow induced endothelial cell activation initiating expression of adhesive ligands and generation of inflammatory cytokines, resulting in recruitment of monocytes, neutrophils, and platelets. Recruited monocytes trigger the extrinsic coagulation cascade via monocyte-derived tissue factor. Neutrophils released their nuclear substances decorated with granular proteins (NETs) which in turn trigger the FXII-initiated intrinsic coagulation cascade. Platelets support leukocyte accumulation and strongly promote NETs formation. These findings suggest that inhibition of FXII and NETs may be promising strategies for the treatment of DVT. Unraveling the molecular mechanism of DVT would help better understanding of the characteristics of current anti-thrombotic drugs and pave the way to the development of novel anti-thrombotic drugs with selective and safe profiles.

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Objectives: The aim of this retrospective study is to assess the efficacy and cosmetic outcome of endovenous laser ablation (EVLA) and delayed sclerotherapy for the treatment of great saphenous vein (GSV) incompetence. Methods: The study enrolled 300 limbs with saphenofemoral junction reflux associated saphenous vein incompetence. Patients were treated with EVLA, and followed up by ultrasound assessment at one day, one week, one month and 6 months after EVLA. At one month after EVLA, the patients with below knee GSV incompetence and noticeable varicosities were treated with foam sclerotherapy. Results: Complete recanalization was found in 4 limbs and they were treated with ultrasound-guided foam sclerotherapy. One hundred and ninety-nine limbs (66.3%) were spontaneously resolved after EVLA alone. Ninety-seven limbs (32.3%) were treated with sclerotherapy for residual varicosities after EVLA. Conclusion: Combined endovenous laser ablation and tributary sclerotherapy was less invasive, effective, and cosmetically-good.

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We have enforced prophylaxis of PE, DVT since in January 2007. In this paper, we describe the results and problems of survey of prophylaxis for inpatient venous thromboembolism (VTE). Materials and Methods: Survey of prophylaxis of VTE for newly hospitalized patients went into effect in January and October 2007 and in October from 2008 to 2012 (total 2751 patients). Prophylaxis (elastic stocking, intermittent pneumatic compression and anticoagulant) put into practice as instructed risk level (low, moderate, high and very high) in the ward including intensive care unit and operation theater. We also provided further consideration on nosocomical cases. Results: Inpatient average rates of risk levels in the wards, except for operation theater during 7 years were 25.3% (low), 32.1% (moderate), 7.2% (high), 1.6% (very high), 33.8% (not indicated), respectively. Rates of not indicated patients decreased by 14.0%, but became a rising trend after 2010. Average rates for each preventive method were 49.3% (elastic stocking), 22.0% (intermittent pneumatic compression) and 10.7% (anticoagulant), 36.6% (not indicated). On the other hand, in operation theater, that of risk levels were 28.2% (low), 39.2% (moderate), 12.5% (high), 5.4% (very high), 14.7% (not indicated), respectively. Average rates for each preventive method were 74.7% (elastic stocking), 61.2% (intermittent pneumatic compression) and 5.7% (anticoagurant), 9.6% (not indicated). Twenty-six inpatients with VTE who were treated with thrombolytic therapy using IVC filters were introduced by neurosurgery and neurology patients following prolonged bed rest. General and thoracic surgery in patients with cancer were second largest. On another front, the number of severe VTE cases belonging to orthopedics and gynecology were relatively little. Half of them (14 inpatients, 53.8%) were treated with no prophylaxis. In recent years, numbers of suspicious VTE patients have increased and in each department. Results of thrombolitic therapy were acceptable. Conclusion: To increase the average rate for prophylaxis, it is very important to simplify the preventive procedure and produce changes in the way of thinking by the doctors and staff. Furthermore, diagnosis of preoperative DVT will be a subject of future investigation.

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Introduction: Two major sources of heat in endovenous thermal ablation (EVTA) for the treatment of saphenous vein insufficiency are radio frequency and laser. A morphological comparison of the treated veins was made between the Endovenous Closure System (RF) and the Radial-2Ring fiber connected to 1470 nm generator (2R) both are the latest models accepted by Japanese national health insurance in 2014. Methods: The experiment was conducted in a system which reproduces physiologic conditions of saphenous veins during EVTA procedure. 2R-experiment was performed under two different settings. In one group, the output of the laser was set at 60 J/cm (2R-60), and in the other group the output was set at 90 J/cm (2R-90). The heated vessels were observed morphologically, in detail morphological changes were classified into three groups: low-temperature changes, indicated by swelling of the smooth muscle or elastic fibers; mid-temperature changes, including fusion or vacuolization of elastic fibers; high-temperature changes, including tissue carbonization. Thickness of the respective changes were measured. Results: In the 2R groups, carbonization, vacuolization and swelling were observed in order from superficial to deep layers. In the 2R-60 group, the thicknesses of the changes were 17±3.2 μm (carbonization), 42±10.5 μm (vacuolization), 190±14.6 μm (swelling) (mean ± standard deviation) respectively. In the 2R-90 group, they were 14±4.0 μm, 105±64.2 μm, 363±71.3 μm respectively. In the RF group, only the swelling of the elastic fibers were observed with the thickness of 251±72.6 μm. Conclusions: RF devices were able to heat the vessels more efficiently with the heat sensor mounted at the tip of the catheters.

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Objective: This study was designed to assess the effect of the subject position during venous ultrasonography on venous diameter of normal or insufficient saphenous vein. Methods: From November 2013 to March 2014, 19 patients (19 limbs) with primary varicose veins for the insufficient great saphenous vein, 12 men and 7 women, mean age 60 years old, and 10 limbs with normal great saphenous vein as control, 0 men and 5 women, mean age 40 years old. We change the examining table from 0 degree to 80 degree reverse Trendelenburg and evaluated venous diameter change at upper thigh, knee and ankle. Results: The venous diameter in control appears to be plateau at RT-30 and it of insufficient saphenous vein at RT-50. In each case the changing rate of venous diameter is more remarkable at knee than at upper thigh. Conclusion: We should make subject with insufficient saphenous vein to be RT-50 and controls to be RT-30 to get the same venous dilatation that we make subject keep standing.

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Objective: Endovenous laser ablation (EVLA) using the 980 nm diode laser and a bare-tip fiber has been covered by the Japanese National Health system since 2011. However pain and bruising were common adverse effects after treatment. To reduce the major complication such as pain, bruising and recanalization after EVLA, various laser wavelength and fibers had reported. A radial 2ring fiber (ELVeS Radial 2ring^TM fiber, CeramOptec GmbH, Germany) emits the laser energy radially from two prisms at the tip, 6 mm apart to the venous wall. The aim of this study was to investigate efficacy and safety of a radial 2ring fiber and the 1470 nm diode laser (Ceralas E1470/15 W, CeramOptec GmbH, Germany). Methods: From March 2012 to April 2014, 68 patients (75 limbs) with primary varicose veins treated with 1470 nm diode laser using a radial 2ring fiber were studied. Laser energy was administered at 10 W of power with constant pullback of the laser fiber under tumescent local anesthesia. The patients were assessed by clinical examination and venous duplex ultrasonography at 24–48 hours, one month and one year follow-up. Results: Mean operating time and linear endovenous laser energy were 36 minutes and 86 J/cm, respectively. Major complications such as deep vein thrombosis, bruising and skin burns were not seen. One limb (1.3%) had involving pain. At average follow-up period of seven month, all treated veins remained occluded. Conclusion: EVLA for primary varicose vein using 1470 nm diode laser and a radial 2ring fiber is safe and effective.

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Background: The purpose of this study was to observe the direct reactions that occur between peripheral vascular and oral bacteria, such as Porphyromonas gingivalis (Pg) and Treponema denticola (Td). Materials and Methods: Beagle dogs were given direct injections of Pg and Td in different doses. Each leg vein was exposed, and the exposed vessels were ligated at the proximal and distal sites, with the injection of bacteria diluted with sterile saline. The collected vascular tissue was examined microscopically, and the vascular tissue and blood were cultured according to the polymerase chain reaction (PCR) method in order to detect bacterial DNA. Results: No genes of the injected bacteria were detected in the Td inoculation samples collected two weeks later with the blood and vascular tissue. The Pg gene was also not detected in the blood samples collected four weeks later, although it was detected in the vascular tissue using the PCR method. The microscopic findings showed that inflammatory reactions in the perivascular tissue were increased in a dose-dependent relationship to the injected bacteria, as expected. Conclusions: We found a direct reaction between oral bacteria and vascular tissue. Further studies are needed to investigate the correlations between oral bacteria and systemic diseases.

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