Background: Previously, we analysed human varicose veins (VVs) tissues using imaging mass spectrometry (IMS) and identified abnormal accumulation of lipid molecules in VV wall, possibly due to the incompetent lipid drainage by lymphatic vessels. In this study, we recreated an animal model of lymphatic insufficiency to investigate the effect of incompetent lymph drainage on vein wall. Methods: Rat lymphatic collecting vessels surrounding the femoral vein were ligated, which caused local retention of lymphatic fluid in the perivascular tissue. Histological study was performed not only for the femoral vein but also the perivascular tissue. IMS was performed to analyse the distribution of lipid molecules in the perivascular tissue. Results: Fourteen days after the procedure, lymphatic vessels were significantly dilated. Furthermore, IMS revealed that composition of lipid molecules in the perivascular tissue altered. In rats with incompetent lymph drainage, lysophosphatidylcholine (LPC) (1-acyl 16:0), PC (16:0/20:4) and Triglyceride (52:3) were markedly accumulated in the perivascular tissue compared to control rats. Interestingly, the femoral vein wall of the model rats was significantly thicker than that of the control rats. TNFα-positive adipocytes increased in the perivascular tissues in the model rats. Conclusion: These results indicated that accumulation of lymphatic fluid due to the incompetence of lymph drainage may change the vein wall structure, which may be associated with chronic venous insufficiency.

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The research report on the long-term conservative treatment with compression bandage has not been found because of the difficulty for the patient to put the bandage on and to maintain the stable pressure with it. Meanwhile, the elasticstockings has characteristics such as stable compression and pressure gradient to put it on. This study is an observational study for the purpose of testing the efficacy and the limitations of the complex decongestive physiotherapy (CDP) based on a lymphatic function with the elastic stockings from the intensive drainage period and also the efficacy of the lymphaticovenous side-to-end anastomosis (LVSEA) combined with pre-and postoperative CDP by means of the change of the volume of the affected lower extremity. We evaluated the change in edema volume with the CDP for 44 patients with secondary lower extremity lymphedema through the Phase 1 to Phase 2 and also evaluated the change in treatment by LVSEA for 29 who underwent LVSEA among the 44 patients. The primary outcome measures are the rate of change by the reduction in affected limb volume (%) and the change of the volume before and after the treatment (ml). As for the rate of change in volume at Day 30 from initial visit in the period of intensive lymph drainage, it was 16.7% in the leg and 9.6% in the thigh. The rate of change in volume after / before LVSEA was 16.5%/19.8% in the leg and 10.6%/11.7% in the thigh. The use of the elastic stockings having stable compression and pressure gradient and the CDP adopted the severity of lymphatic function showed enough effects. It is July, 2013 from March, 2010 during the period targeted for the observation.

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As a rule, it is necessary to reduce increased venous pressure in soft skin tissue in the treatment of venous ulcers of the lower limbs. However, ulcer healing is not achieved in some patients, requiring soft skin tissue reconstruction. The patient was a 68-year-old male. He was referred to our department with the diagnosis of a recurrent venous ulcer of the right medial malleolus, which had repeatedly recurred during the past 5 years. The great and small saphenous veins had been removed to treat bilateral lower limb varices 30 years previously. Compression therapy and the application of an external preparation led to granulation. However, new punctate necrosis was observed in the granulation tissue. At the inferior floor, a calcified lesion was present beyond the ulcer and congestive skin lesion. It may have been primarily involved in a refractory condition. Extended extirpation of the ulcer, involving the calcified lesion, and congestive skin lesion, as well as soft skin tissue reconstruction, were performed. Healing was achieved. Histopathologically, ectopic ossification was suggested. Metaplasia related to phlebostasis-associated chronic inflammation may have been etiologically involved. The presence of bone may have caused a reduction in topical blood flow and secondary infection, delaying healing. Soft skin tissue reconstruction was effective.

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A 62-year-old woman visited our hospital because of recurrent hemoptysis. Enhanced computed tomography (CT) showed the thrombus in a right pulmonary artery and the bronchial artery-pulmonary artery fistula. Because pulmonary hypertension was measured in right heart catheterization, the patient was diagnosed chronic thromboembolic pulmonary hypertension. Since the thrombus in the pulmonary artery limited to the right pulmonary artery side and to be performed simultaneously operation of bronchial artery-pulmonary artery fistula considered to be the cause of a hemoptysis, we chose the approach under the right thoracotomy and performed pulmonary artery endarterectomy and ligation of bronchial artery.

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This prospective study conducted at a single unit examined the outcomes of a technique for treating varicose veins. Great saphenous varices in 1951 lower limbs of 1505 patients and small saphenous varices in 219 lower limbs in 205 patients were treated. Results were assessed by life table analysis of the occlusion rate and cox regression analysis for the influence of covariates on outcomes. The occlusion rate of the great saphenous vein (GSV) at 5 and 10 years were 85.0% and 52.1%, respectively. Cox regression analysis for the occlusion of GSV showed significantly worse results for 1% polidocanol compared to 3% polidocanol (hazard ratio [HR], 2.59; 95% confidence intervals [CI],1.29–5.20) and for body mass index (BMI) greater than 30 compared to BMI lower than 25 (HR, 3.21; 95%CI, 1.30–7.91). There were no significant differences in the GSV occlusion rate with respect to sex, side of the affected leg, age, clinical CEAP category, deep vein insufficiency, diameter of GSV and mixture gas (air or carbon dioxide). The occlusion rate of the saphenopopliteal junction (SPJ) at1 year was 85.5%. Cox regression analysis for the occlusion of SPJ showed significantly worse results for length of SPJ greater than 70 mm compared to lower than 30 mm (HR, 5.94; 95%CI, 1.03–34.4). There were no significant differences in the SPJ occlusion rate with respect to sex, side of affected leg, age, clinical CEAP category, deep vein insufficiency, diameter of SPJ and BMI. Trunk foam sclerotherapy combined with high ligation for GSV results in satisfactory long-term outcomes. Trunk foam sclerotherapy for SPJ gives good short-term benefits. Thus, further studies on the long-term benefits of SPJ occlusion are needed.

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