According to a new protocol with using radial slim-type fibers (diameter 1.27 mm), endovenous laser ablation was applied to consecutive 400 cases of great saphenous vein insufficiency. Above knee GSV was ablated by 7 W (LEED: 50–70 J/cm), below knee GSV was treated by 5 W (LEED: 20–25 J/cm), and tributary varices were ablated by 5 W (LEED: 30 J/cm). Postoperative complications significantly decreased from 6.7% (400 cases of the former protocol) to 2.4%. Saphenous nerve injuries were not noticed in any patients.

Of the 1082 patients with varicose vein surgery in the past 2 years, 15 cases of venous stasis ulcer (C6) were investigated. Six male and nine female patients had an average age of 64.8 years. In all cases, incompetent GSV was noticed, one of those was a combination of SSV insufficiency. The percentage of standing work was 10 (67%). Preoperative ultrasonography revealed that 8 (53%) had deep vein reflux. Endovenous laser ablation was performed within 1–2 months from the initial diagnosis, and the improvement of the skin lesion of all cases was obtained after the operation.

Anticoagulant therapy for venous thromboembolism (VTE) is performed on cancer patients and on patients with recurrence for a longer period. It is also necessary to consider anticoagulant therapy for patients with other thrombophilic predispositions. The active cancer was diagnosed using an appropriate method. Treatment with direct oral anticoagulant was performed, and 138 patients who were able to be followed up with were classified according to the presence or absence of the factor facile thrombosis. The ratio of easy thrombotic predisposition to VTE was 39 cases 23.2%, the active cancer (CAT group) 10 cases, antiphospholipid antibody syndrome (APS group) 19 cases, protein S deficiency (PS group) 7cases, and protein C deficiency (PC group) 3 cases. In the CAT group, 4 out of 10 patients died during the follow-up period. The recurrence rate of cases with the factor of facile thrombosis was 18.7%, and the recurrence rate of cases without the factor of facile thrombosis was 7.5%. Due to tend to be high recurrence rate for the treatment of cases with the predisposition to thrombosis, it seems necessary to consider each case such as the dosing period.

Objectives: Following endovenous laser ablation (EVLA) for varicose veins, the postoperative complications that require the most attention are thrombotic complications. We examined patients who developed venous thromboembolism (VTE) postoperatively at our hospital. Subjects: The subject sample included 1049 patients who underwent EVLA for saphenous varicose veins between May 2015 and January 2021. Results: Deep vein thrombosis (DVT) was observed in five patients, among whom three had concurrent pulmonary thromboembolism. In four out of the five patients with DVT onset, superficial vein thrombosis (SVT) was observed. Therefore, SVT was considered to be a significant risk factor for DVT. General anesthesia, bilateral EVLA, age, operative duration, the number of varices removed , and obesity were not risk factors for VTE onset. Conclusion: It was suggested that a history of SVT prior to surgery is a risk factor for VTE onset following EVLA.

To achieve less-invasive for varicose vein surgery, we performed foam sclerotherapy alone for residual incompetent tributaries after truncal vein surgery without phlebectomy. This study investigated 239 consecutive patients (140 women; mean age, 66.2±0.7 years) with varicose veins between April 2018 and December 2020. We performed endovenous therapy for truncal veins without phlebectomy, then sclerotherapy for incompetent tributary varicosities and the below-knee great saphenous vein (BKGSV) after 2–3 weeks. Among the 239 cases, 229 were treated with radiofrequency ablation and 10 with cyanoacrylate closure. No adverse events of nerve injury or thromboembolism were encounterd. Reflux in the BKGSV after endovenous therapy persisted in 67.0% (150/224). Sclerotherapy was performed once in 174 cases, two or more in 35, and not at all in 30. Mean follow-up period was 13.2±0.6 months (range, 0–32 months). Varicose veins recurred in only one case, due to development of anterior accessory saphenous vein incompetence, but no recurrence of BKGSV or tributaries was seen. Therapy with foam sclerotherapy alone for incompetent tributaries appears less invasive than phlebectomy, safe, and effective.

Ultrasonography is essential in the diagnosis of varicose veins and is performed according to guidelines. However, there are many ambiguities in the guidelines regarding whether the long-axis or short-axis method should be used for the ultrasonography of varicose veins. Three technicians recorded duplex scan images at three points (mid-thigh, peri-knee, and mid-lower leg) using the long-axis and short-axis methods in six consecutive cases, respectively, and measured the vein diameters. Their examination times were measured and compared. In all cases, reflux signals were observed at all sites for both methods, and the short-axis method had a shorter examination time in all 18 cases. The short-axis method is recommended for most measurement points. While for the sapheno-femoral junction, the long-axis method is most suitable for measurement reasons.

There are various standard options for treating typical saphenous vein lesions, including endovascular treatment, and the results are good. On the other hand, many atypical lesions are intractable, and the results following surgical treatment and sclerotherapy are often unsatisfactory. The slim laser fiber (LSO Medical, Lille, France) approved for use in Japan in 2018 by the Pharmaceutical Machinery Law from 2018 in Japan can be inserted through a 16–17 G cannula for short-distance linear reflux lesions at the fascial level or deep subcutaneous areas that are difficult to reach from 2- to 3-mm stab incisions. In this paper, four cases reports in which use of the slim laser fiber was very effective were presented, including two cases of recurrent varicose veins derived from the stump at deep venous junction after saphenous vein treatment, a case of side branch saccular aneurysm near deep venous junction, and a case percutaneous ablations for incompetent perforating veins (PAPs) with intractable leg ulcer and post-thrombotic syndrome which couldn’t be treated by subfascial endoscopic perforator surgery (SEPS) because of subfascial adhesion. Ablation with the slim laser fiber is expected to be a breakthrough in treatment for atypical intractable varicose vein lesions of the lower extremities.

We report seven cases of pelvic congestion syndrome (PCS) successfully treated with plug embolization of pelvic incompetent veins. All cases were PCS comorbid in patients with varicose veins of the lower extremities. The mean age was 64.1 years, and all patients had a delivery history and were postmenopausal. The symptoms of pelvic congestion worsened with prolonged standing. In all cases, the arterial phase of contrast-enhanced CT showed left ovarian veins dilated to more than 8 mm in diameter and associated pelvic varicose veins, indicating that dysfunction of the left ovarian vein was the main cause of PCS. In 4 of 7cases, selective venography in the upright position also showed dysfunction of the right ovarian vein and internal iliac vein. The incompetent veins were embolized with an average of 3.3 plugs per patient, and with plugs averaging 1.22 times the diameter of the target vein. The only complication was intraoperative venous injury in one case, and the bleeding stopped immediately after plug placement. There was no migration or deviation of the plug. The symptoms of pelvic congestion improved within one week after surgery in all patients, and no recurrence of pelvic varicose veins or symptoms has been observed for more than three years after surgery. Plug embolization is safe and effective endovascular treatment for pelvic congestion syndrome.

We reported a case of endovenous glue-induced thrombosis (EGIT) in treating small saphenous varicose veins using cyanoacrylate closure (CAC). The polymerized cyanoacrylate (CA) extended to the gastrocnemial vein (GCV), forming a fresh thrombus. The patient was an 80 yo woman and complained of frequent calf muscle cramping. Preoperative duplex scan findings showed reflux in the left below-knee great saphenous vein (GSV) and left small saphenous vein (SSV). CEAP classification and revised VCSS were (C3-S Ep As,p,d Pr GSVb, SSV) and 3, respectively. We used a total of 11 glue drops in SSV (15 cm) and below knee GSV (15 cm) during CAC. At two weeks after CAC, we confirmed the occlusion of left SSV and below knee GSV, and found the extension of the polymerized CA to GCV and the formation of thrombus. Because the patient complained of the mild tightness of the left leg at 23 days after CAC, we prescribed oral anticoagulant until 45 days after CAC, the day of the disappearance of thrombus. Since SSV often has various networks, preoperative anatomical diagnosis is essential. It is necessary to keep in mind that EGIT can occur in cases where GCV merges to SSV.

We report here a rare case of bleeding from the ulcer of the lower leg due to varicose vein. Case: Forty eight-year-old Indonesian male (at the time of initial diagnosis). He visited our hospital complaining of bleeding from the lower left leg. Skin ulcer 15×20 mm in diameter was recognized in front of the lower leg. Fortunately the bleeding was clotted. Ultrasonography revealed reflux of the left great saphenous vein by manual compression of the calf and the diameter was 10 mm. He strongly desired treatment with as little medical expenses as possible for reasons such as not joining health insurance. Foam sclerotherapy was performed prepared with 6 mL of air using 3% polydocanol (ethoxyscrerol) 2 mL by the Tessari method. Pressure continuation by elastic bandage was indicated until the next examination day. After 2, 4, and 7 days, the bandage was removed in the outpatient room, and treatment was added as before using 1% polydocanol at insufficient occlusion sites. It was confirmed by the ultrasonography that the varicose vein was almost diminished after 9 days. The ulcer healed 39 days after the first treatment. It was explained that there was a concern of the recurrence. He was advised to wear the elastic stockings. Five years after the initial diagnosis (53 years old), he visited our hospital. There was no recurrence of varicose veins and ulcers except for only mild pigmentation. Ultrasound confirmed the shrinkage of the great saphenous vein.

We reported a case of recurrent varices after surgery (REVAS) of the lateral small saphenous vein just near the nerve treated with cyanoacrylate closure to avoid nerve damage. The patient was 52y/o, female. Although she had a left small saphenous vein (SSV) stripping 9 years ago, she had a recurrent varicose vein at the same side popliteal region and complained fatigue(C2r, 3-S Ep As Pr SSV severity classification VCSS; 5). It is considered that a varicose vein was formed by incompetent lateral SSV of the double SSV. The lateral SSV was close to the lateral sural cutaneous nerve. The varicose veins were treated with cyanoacrylate closure, varicectomy and additional sclerotherapy (1% polidocanol) later. After the treatment, the varicose veins disappeared without perceptual impairment, and her subjective symptoms obviously improved. Nerve damage is often a concern in the operation of varicose veins around SSV. Nevertheless the method of cyanoacrylate closure may treat the incompetent vein just near nerves without complications.

The patient, a 39-year-old woman who was a cook by occupation, presented to the gynecology department with abnormal uterine bleeding and was diagnosed with endometrial cancer. At the time of admission, she was noted to have swelling of her right upper extremity and was referred to our department on suspicion of lymphedema due to subclavian lymph node metastasis. The venous phase of a contrast-enhanced CT showed a thrombus in the right subclavian vein, located between the clavicle and the first rib. We diagnosed this as a case of cancer associated venous thrombosis caused by endometrial cancer: the upper extremity deep vein thrombosis may also have been caused by chronic irritation as seen in Paget-Schroetter syndrome. Although anticoagulant or antithrombotic therapy was considered as the first choice of treatment, continued abnormal uterine bleeding precluded its use: therefore, total hysterectomy was performed first. The pain and swelling in the right upper extremity decreased before the surgery, even without anticoagulation. Postoperatively, anticoagulant therapy with apixaban was administered, and the swelling of the right upper extremity markedly improved. Presently, the patient is on maintenance therapy with apixaban.

Venous aneurysm of the hand has been scarcely reported. We report here a rare case of this disorder. Case; Seventy three-year-old female. She noticed a mass on the back of her left hand several years ago without any history of trauma or puncture. It increased in size gradually and she consulted our hospital. Pulsation was not palpable, however, it was incompressible and didn’t decrease in size by raising the arm. Color Doppler ultrasonography showed a well-defined mass connecting with superficial vein. It measured 16×13×5 mm in diameter. These findings suggested partially thrombosed superficial venous aneurysm of the hand. The patient wanted the resection of the mass because of cosmetic problems. Enbloc resection of the mass was performed under local anesthesia with ligation of the connecting veins. Interestingly, there were no clots in the resected vessels. Hisotopathological analysis confirmed a venous aneurysm with thickening of smooth muscle both of the internal and median layer. Postoperative course was uneventful. There are only ten reported cases of venous aneurysm of the hand in the Japanese literature in recent 40 years. A brief review was discussed.

Early ambulation is one of the most important methods for preventing postoperative venous thromboembolism. Preoperative assessment in preoperative rehabilitation may be useful for the assessment of predictive factors that influence early ambulation prognosis in patients after surgery, thereby reducing postoperative complications. In this case series, we investigated whether patients could walk early after surgery and whether on the onset of deep vein thrombosis in 10 patients who underwent preoperative rehabilitation. Lower limb muscle strength, exercise tolerance, respiratory function, mental function, and postoperative general condition were assessed. Results showed that patients with good preoperative physical function were able to walk early following surgery. However, two patients with a decreased 6-minute walking distance required intensive postoperative management, including prolonged mechanical ventilation. Moreover, these patients did not achieve early ambulation. Calf vein thrombosis was detected in one of these patients and who was decreased physical function, mental function, and anemia. In conclusion, the preoperative assessment of physical function, mental function, and anemia is effective in predicting early postoperative ambulation.