A questionnaire survey was conducted by a committee of the Japanese Society of Phlebology to clarify the current status and management of venous leg ulcers in Japan. Among 520 suspected cases, 513 cases were correctly diagnosed as true venous leg ulcers. A total of 31,827 patients with chronic venous insufficiency were evaluated in 2016. Duplex ultrasound examination alone was used to diagnose 94.4% of venous ulcer cases. All ulcer cases were divided into 4 groups: primary varicose veins (group A: 500 limbs), postthrombotic syndrome (group B: 29 limbs), functional chronic venous insufficiency (group C: 43 limbs), and non-venous disease (group D: 15 limbs). The venous clinical severity score (mean±SD) in clinical class 6 in CEAP classification was significantly greater (15.3±4.3) than in clinical class 5 (9.6±3.3) in CEAP classification. . All limbs of clinical class 5 in CEAP classification were in group A. Outpatient treatment alone was performed to manage 56.8% of ulcer cases. Endovenous thermal ablation was performed in 73.4%, while stripping surgery was performed in 23.2% to abolish saphenous vein reflux. Direct ligation of perforators and subfascial endoscopic perforator surgery (SEPS) was performed in 28.9% and 26.8% of limbs, respectively, for incompetent perforators. When the current survey results were compared with those from 2004, the rates of endovenous thermal ablation and SEPS were markedly increased (73.4% vs. 0.0%, and 26.8% vs. 16.1%, respectively). Compression therapy was not adequately performed before presentation in 66% of legs. The specialized institution started compression therapy in 94.0% of all limbs with ulcers. Although 78.0% of active venous ulcers were cured by March 2017, the time until healing showed a wide range. It may be important to improve patient compliance with compression therapy.

Background: Recently, we are aggressively using DOACs for the treatment of deep vein thrombosis(DVT) and pulmonary embolism(PE) as replacements of unfractionated heparin/warfarin. However, knowledge pertaining to the clinical use of these therapies in Japan remains insufficient.

Objectives: We examined the usefulness of DOACs, especially its efficacy and safety in DVT patients.

Methods: We investigated 39 consecutive patients with acute DVT(13 patients had PE) between January, 2015 and December, 2016. Their mean age was 66.4±16 years, and 56.4% patients had active cancer. Mean follow-up was 4 months. Two-thirds of patients were found asymptomatic. Among these 39 patients, thrombus sizes were monitored in 29 patients.

Results: DOACs included edoxaban(n=20), rivaroxaban(n=9), and apixaban(n=10). In the Edoxaban group, 5 patients(25%) switched from heparin. Consequently, 34 patients were treated for the single-drug approach. 10 patients (6 were taking rivaroxaban and 4 were taking apixaban) were treated using initial intensified treatment. In total, 7 out of 9 PE patients revealed the disappearance of thrombus, which was not significantly different between the three DOAC group and the end of initial intensified treatment. Event-free rate of major hemorrhage was 96.3% at 3 months and 87.5% at 6 months. Event-free rate of major adverse events was 77.1% at 3 months and 70.1% at 6 months. All 8 adverse events were occurred within 4 months. Conclusion: We revealed that DOACs could be beneficial and safe for the treatment of venous thromboembolism, which usefulness was not different between the three DOAC groups and among the patients with or without the initial loading dose. However, necessity of strict follow up was suggested within 4 month after DOAC introduction due to high occurrence of adverse events .

Background: Direct oral anticoagulant (DOAC) became available for treatment of venous thromboembolism (VTE), and options for treatment of VTE were expanded. Therefore, we used three kinds of DOAC and obtained useful knowledge. Method: The patients were divided into 3 groups, group E (29 cases, 29 limbs) was treated with edoxaban, group R (28 cases, 30 limbs) was treated with rivaroxaban, group A (8 cases, 8 limbs) was treated with apixaban. Results: In the cases where follow-up observation could be performed, the time to regression was 27.3±4.5 weeks in group E (n=14), 7.5±1.5 weeks in group R (n=14), and 6.8±2.0 weeks in group A (n=6) respectively. The time to regression was significantly shorter in group R and group A than in group E. There is no significant difference between group R and group A. Conclusion: Treatment of VTE with DOACs could be performed without any problems. Rivaroxaban and apixaban had similar thrombotic regression effects. DOACs seems to be safe for use if the dosage and administration method were selected for each case respectively.

Backgrounds: Pulmonary thromboembolism (PTE) is severe complication which may arise during all medical service. The purpose of this study is to evaluate inpatient symptomatic PTE.

Materials and methods: From 2005 to 2016, we experienced 75 symptomatic PTE patients among 600 venous thromboembolism patients. According to the place of occurrence, patients were divided to inpatient group and outpatient group. We further divided inpatient group to surgical group and non-surgical group.

Results: Inpatients group, 38 had PTE (Surgical: 23, non-surgical: 15). Outpatients group, 37 had PTE (with medical practice: 22, without medical practice: 15). Severity of PTE were follows; cardiac arrest 2, massive 13, sub-massive 18, non-massive 42. In surgical group, anticoagulation had been used in 3/23 (13.6%), intermittent pneumatic compression had been used in 16/23 (72.9%), compression stockings had been used in 20/23 (90.9%). In non-surgical group, no anticoagulation had not been used, intermittent pneumatic compression had been used in 2/15 (13.3%), compression stockings had been used in 2/15 (13.3%).

Conclusion: As PTE prophylaxis, anticoagulation had been scarcely used in surgical group. Delayed anticoagulation may decrease symptomatic PTE in surgical patients. Despite adequate prophylaxis, PTE cannot be prevented completely. Medical staff and patients should recognize the risk of PTE together.

Objectives: Compression therapy with elastic stockings is widely used for a certain period in patients after undergoing surgery for varicose veins. The aim of this study was to define an adequate period of compression therapy by examining the relationship between postoperative venous filling index (VFI) and body mass index (BMI). Results: One month after primary varicose vein surgery, patients’ VFI values increased proportionally to their BMI values. VFI values in 54 cases (4.5%) exceeded the mean+2SD values of VFI in groups classified on the basis of BMI, and among these, 24 cases (44.4%) had residual venous insufficiency. Conclusion: When postoperative VFI values greatly exceed the scale-categorized mean values of each BMI group, residual venous insufficiency causes prolonged congestion in patients. In such cases, it is recommended that patients wear the elastic compression stockings for a longer duration.

A 30-year-old woman visited our hospital with slight pain at rt. dorsal foot. We diagnosed the venous aneurysm at her dorsal foot, we performed resection of the venous aneurysm without reconstruction. Post operative course was uneventful, her symptom was gone.

Recently we encounter the patients who have widely scattered venous varices (CEAP classification >C2) of lower extremity. They require complete resolution of varices that have scattered wide lesion occasionaly. For these cases, at first with patient in prone posture we start operation from calf with stab avulsion, pin stripping and radiofrequency (laser) ablation appropriately except case involved lesion of great saphenous vein. After then knee joint is depended, we complete total varicectomy of pretibial region, lateral side of lower leg, ankle joint and pedal. Depending knee joint position under prone posture provide with easy situation for total varicectomy.