The incidence of nerve injury after endovenous laser ablation (EVLA) was investigated. Patients with incompetent great saphenous veins (1513 legs) underwent EVLA using 1470 nm diode laser connecting with radial 2-ring fibers. Nerve injury is defined as if a patient feels any neurologic symptoms at 1 month after the surgery. Nerve injury was occurred in 47 legs (3.1%). The incidence was 1.3% when the ablation length was less than 40 cm, thus, 5.2% when it was over or equal to 40 cm. One year after the surgery, 92% of the patients revealed relief of neurological symptoms.

This study evaluated the prevalence and indicators of deep vein thrombosis (DVT) in psychiatric inpatients kept in isolation. In 39 consecutive patients admitted from January to December in 2019, the D-dimer level, gender, age, presence/absence of central venous catheter placement and so on were studied in relation to the prevalence of DVT assessed using ultrasonography. Eight cases with DVT (20.5%) were identified. No factors except age were associated with the presence of DVT. In conclusion, in psychiatric inpatients kept in isolation, the prevalence of DVT was high and substantially higher in elderly patients.

Rivaroxaban is the first drug available in Japan as a single drug approach for the treatment of Venous thrombo-embolism (VTE). This study aimed to assess the efficacy of rivaroxaban in the treatment of deep vein thrombus (DVT). The subjects were 178 patients who underwent anticoagulation treatment with rivaroxaban between 2013 and 2018. Eleven proximal type DVT and 3 Pulmonary embolism were included. Of the 178 cases, 30 underwent maintenance therapy following one-week intensive therapy (30 mg per day), 114 underwent maintenance therapy (15 mg per day) from the beginning and 34 received a dose of 10 mg per day. In the 30, 15 and 10 mg groups, respectively, the thrombus resolution rate was 73.3%, 78.9%, 79.4%; the number of days until thrombus resolution was 29.0, 26.7, 22.9 (days); and the rate of clinical hemorrhage was 6.7%, 5.3%, 0% in each group. Thus, rivaroxaban showed good applicability as DVT treatment with wide range from intensive therapy to maintenance therapy. In all groups Rivaroxaban showed good efficacy and safety.

Several large-scale epidemiological studies have reported that the incidence of peripheral artery disease (PAD) increases over time in patients with varicose veins, but the association between varicose veins and PAD is not realized in clinical practice. In this study, 421 patients with varicose veins, who were over 65 years of age, were examined to determine the relationship between severity of varicose veins and atherosclerosis parameters. Their preoperative venous filling index (VFI), and atherosclerosis parameters like ankle-brachial index (ABI) and pulse wave velocity (PWV) were measured. There were no significant correlations seen between VFI and ABI, and between VFI and PWV in male or female. The patients were divided in two groups based on the Clinical, Etiological, Anatomical, and Pathophysiological classification (CEAP), namely, mild (C2-C3) and severe (C4-C6) groups. The values of ABI and PWV of the two groups were compared, and no significant differences were observed. In addition, ABI and PWV were also compared between the operated limb group and the healthy limb group in 238 patients who had undergone unilateral surgery. Again, no significant difference was found between the groups. Therefore, no clear association was found between varicose vein severity and atherosclerosis parameters, and the confounding factors between varicose veins and the risk of developing PAD shown in the epidemiological study could not be determined. However, elucidating the related mechanisms and confounding factors is important in daily clinical practice, and further research is desired.

Photo-plethysmography (PPG), a venous functional test, was performed before and after radiofrequency ablation (RFA) for varicose veins to evaluate improvements in venous function. Venous refilling time (VRT) was measured in 141 limbs of 105 patients who underwent RFA between April 2015 and March 2018 and who underwent PPG up to 12 months after the surgery. Before surgery and at 1, 6 and 12 months after surgery, mean VRT was 13.9±8.2, 24.1±10.0, 24.6±9.7, and 25.1±10.7 sec, respectively, indicating improvements in VRT in the first month and maintaining such improvements until 12 months after surgery (P<0.0001). Patients were also subdivided into groups of those who worked while standing and those who did not, and those who did or did not continue compression therapy at 12 months after surgery, and those who did. And the differences between each of these two groups were compared. However, no significant differences were found during the entire study period. Improvements in venous function by RFA were confirmed as being maintained until 12 months after surgery according to venous functional tests performed by PPG.

Endovenous laser ablation with ELVeS radial 2ring slim fiber (diameter 1.27 mm) was performed on 44 patients with great saphenous vein insufficiency with varicose veins ≥5 mm in diameter. A varicose vein was punctured with a 16 G needle, a fiber was inserted into the lumen, and laser ablation was performed at 5 W. In 93% of cases, more than 90% of varicose veins disappeared, and no adverse events such as thrombophlebitis and skin burns were observed.

Objective: This study aimed to determine the clinicopathological characteristics of cancer-associated venous thromboembolism (CAT-VTE).

Methods: A total of 47 cases of lethal pulmonary thromboembolism (PTE) with active cancer were investigated by autopsy records.

Results: We studied 22 men and 25 women who were deceased at a mean age of 66±11 years. Nine (19%) patients had recently undergone cancer resection, 14 (30%) were undergoing clinical treatment for cancer, and 24 (51%) were autopsy-proven CAT-VTE. The colon (eight cases), lungs (seven cases), and ovaries (six cases) were frequent sites of a tumor. There were 29 (62%) cases of acute PTE and 18 (38%) of recurrent PTE. The embolic source was detected in 36/39 (92%) cases. Among them, 33 cases were leg deep vein thrombosis (DVT) and 31 were calf-type DVT. Three cases were isolated vena cava thrombi that were present near the tumor. Twenty-three (64%) cases were recurrent DVT.

Conclusion: Most of the lethal CAT-VTE cases were induced by the same mechanism as non-CAT-VTE that originated from calf-type DVT with proximal propagation. However, the finding that patients had tumor-related vena cava thrombi suggested that prevention of CAT-VTE requires individualized treatment of patients according to their pathological condition.

Purpose: The purpose of this study is to evaluate the short-term outcomes of cyanoacrylate embolization, evaluate the safety of the procedure, and compare the ultrasonography images of cyanoacrylate embolization and ablation cases. Cyanoacrylate embolization has been covered by insurance since 2019 and has become the new therapeutic option. We started using cyanoacrylate embolization in January 2020. Subjects and methods: The study included 26 limbs of 18 patients who underwent cyanoacrylate embolization for primary varicose veins between January and March 2020. The target vessels for treatment were the great and small saphenous veins. Varicectomy was not performed; elastic stockings were not used postoperatively. Anatomical, clinical, and safety evaluations were performed prospectively immediately and at 1 week, 1 month, and 3 months postoperatively. For the anatomical examination, the occlusion rate of the treated target vessels was evaluated using ultrasonography. The clinical examination included assessment of the visual analog scale (VAS) score for postoperative pain, venous clinical severity score (VCSS), and Aberdeen Varicose Vein Questionnaire (AVVQ) for the quality of life and safety evaluation. Results and discussion: The complete occlusion rate was 92.0% at 3 months postoperatively. The postoperative pain was mild, with a mean VAS score of 0.6±0.7. The mean VCSS improved from 2.1±1.3 at baseline to 0 within 3 month (p<0.001) . The mean AVVQ score improved from 8.0±9.0 at baseline to 1.2±3.3 within 3 month (p=0.002). Adverse events, namely, phlebitis, hypersensitivity, and hematoma rupture, occurred in 1 patient each. Conclusion: Cyanoacrylate embolization yielded favorable outcomes. As the surgery is performed without tumescent local anesthesia or the main body of the therapeutic device, it may be widely used in the future.

【Background】Improving the prognosis of patients with malignant tumors is increasing the number of patients who develop venous thromboembolism. We examined the characteristics and prognostic factors of VTE patients with cancer. 【Methods】We diagnosed 725 VTE patients from April 2005 to March 2018. There were 322 cancer associated patients (CAT) and 403 non-cancer associated patients (nonCAT). We examined characteristics and prognostic factors of VTE in CAT patients. 【Results】There were 156 women and 166 men in CAT, and 132 women and 271 men in nonCAT. There was no significant difference in the location of proximal portion of thrombus. When locations were divided into left leg, right leg, and bilateral legs, bilateral cases were more common in CAT group. Comparing the overall survival after VTE diagnosis in the CAT group, the prognosis was poor in patients with high D-dimer level (≧ 6 µg/mL) along with cancer metastasis and recurrence. 【Conclusions】Various VTE factors predict prognosis in CAT patients, and CAT is important in the treatment of cancer patients.

We report here on a case of left common iliac vein occlusion in which a femorofemoral crossover bypass was effective. A 79-year-old woman had swelling in her lower left limb for a year, redness for the most recent six months of that year, and finally began to feel pain in her lower left limb. A physical exam showed pigmentation in the left lower leg. The circumference of the lower left leg was 5 cm larger than the right leg and 8 cm larger at the thigh. D-dimer values were normal. Ultrasonography showed no reflux in the lower limb veins. The obstruction was determined to be left iliac vein thrombosis. A contrast-enhanced CT showed an arteriovenous fistula and left iliac vein occlusion from the left internal iliac artery. A stent graft was implanted for the arteriovenous fistula, and the pain in the lower leg was alleviated. However, the left lower limb pain recurred 5 months later, so a femorofemoral crossover bypass operation was performed. After the bypass, the pain in the left lower limb was relieved, and eight months after the operation, no difference was observed between the right and left lower limbs.

Inferior vena cava filter (IVCF) is widely used as a complementary medical device for venous thromboembolism (VTE) treatment. Although complications of IVCF placement are rare, tilting, migration and penetration of IVCF or perforation of IVC have been reported. In addition to these complications, there are concerns about fracture or thrombus of IVCF, especially in the case of permanent placement. Therefore, the current guidelines recommend that a retrievable IVCF should be selected and an insertion period should be minimized. We report a case of IVCF thrombus due to venous thromboembolism after seven years of IVCF insertion under continuous warfarin therapy. Warfarin therapy were discontinued and replaced by rivaroxaban. IVCF thrombus disappeared one month later.

Primary subclavian vein thrombosis is a rare disease, and this thrombosis often involves stenosis of the subclavian vein in costsubclavical space. Many studies demonstrated that arm elevation and rest coupled with=anticoagulation alone resulted in significant recurrence rates and persistent upper extremity symptoms in more than 50% of cases. Although catheter direct thrombolysis (CDT) for these thrombosis in early onset cases are said to be good result, therefore, CDT is performed as the first treatment. However it often recurs due to central organic stenosis. In this report, we experienced a case of surgery for residual subclavian venous stenosis due to thoracic outlet syndrome after CDT for thrombotic subclavian vein occlusion. The case was a 46Y woman. She visited the hospital with swelling and tightness of the left upper limb that appeared during running. Contrast-enhanced CT and left upper limb venography revealed primary subclavian vein thrombosis. Although CDT was performed and the thrombus disappeared, but stenosis was found on the central side. However she was discharged with taking warfarin(WF) without first rib resection. After she stopped taking WF, subclavian vein thrombosis recurred. We performed surgery following the second CDT. At last, she was taken a surgery, which was infra-subclavian approach, the first rib resection and the patch angioplasty. Although anticoagulant therapy (WF) was discontinued for 6 months after the operation, there was no recurrence of venous thrombosis. Conclusion: The thrombolysis following CDT for primary subclavian vein thrombosis is effective. However, for the patients with stenosis in central side of subclavian vein, the first rib resection and patch angioplasty using the infra-subclavian approach are useful for improving hemodynamics and preventing recurrence of thrombosis and eliminating venous stasis symptoms.

Varicose veins of leg present various symptoms, but it is considered there are few cases of hemorrhagic shock due to bleeding. However we experienced a case of bleeding from varicose veins with hemorrhagic shock although it was diagnosed at another hospital. Surgical treatments such as vein removal, high-level ligation and intravascular cauterization are performed as curative treatments. However, because it is a benign disease, appropriate treatment is not performed even though it is diagnosed. Some factors can make varicose vein rupture fatal, so it needs proper patient education and treatment. Anticoagulant are risk of death for patient with varicose vein, but varicose veins of leg can be treated while taking anticoagulant.

Ultrasonographic examination is essential for assessing varicose veins and deep venous thrombosis. Patients maintain a standing position during a lower extremity venous duplex scanning to put their weight on the examined limb, leaning against a wall or a bed. In the case of prolonged examination, patients find it difficult to keep the position, with safety issues raised especially in elderly patients. To secure safety in senior people during the lower extremity venous duplex scanning, we modified a step ladder with handrail, a nursing care equipment. As a result, security was improved and the physical load on patients was lightened. Additionally, the examination time was shortened, and the stable standing position of the patients contributed to the improvement of examination accuracy. Safety in patients and the examination accuracy during the lower extremity venous duplex scanning are expected by spreading this newly-designed step ladder with handrail.

Cyanoacrylate closure (CAC) is one of non-thermal non-tumescent treatments for varicose veins, and the VenaSeal Closure System, a commercially available CAC, was approved by national health insurance in Japan in 2019. This consensus guidelines was made by a group of experts in the field of endovenous thermal ablation for varicose veins under the auspices of the Guideline Committee of the Japanese Society of Phlebology. Symptomatic primary varicose veins are a good indication for CAC, and a history of hypersensitivity to cyanoacrylate is an absolute contraindication to CAC. Phlebitis due to delayed-type hypersensitivity or foreign body reaction is reported in 6.3% of patients as CAC specific complications. CAC is a minimally invasive method for treatment of primary varicose veins though further collection of evidence and clinical data are required to establish the long-term result.