Now we can enjoy our lives for one hundred years, but many people may worry about life after age 65. After 15 years of retirement, we turn 80 and notice the death rate is pretty high. We may think about whether we should live simply or live an extravagant life. I would like to look back on the 15 years after my official retirement, which I mostly spent in academic fields. First of all, I chose to continue my academic life as much as possible so that I could finish the work left undone, including animal experiments. In these 15 years, I had a lot of discoveries and ideas, I collaborated on 4 phlebology papers (popliteal vein entrapment syndrome; echo evaluation of pelvic congestion syndrome; thoracic outlet syndrome focused on visualization of the compression sites; and migrating phlebitis) and another 4 papers for angiology (periodontal bacteremia in Buerger disease; periodontal bacteremia in the other vascular diseases or new born babies; corkscrew collateral pathway: anatomy and pathology; and the early changes of left iliac arterial lumen and treatment for professional cyclists). My many collaborators are named in the acknowledgements.

【Objective】To compare the outcomes of vascular access interventional therapy (VAIVT) for patients with clinical hemodialysis vascular access occlusion and to evaluate the importance of surveillance. 【Methods】We selected 280 hemodialysis patients whose hemodialysis vascular access were clinically diagnosed as obstruction and who underwent VAIVT between October, 2009 and November, 2020. We compared the 127 patients of complete occlusion confirmed by duplex at VAIVT (Occlusion group) and the 153 patients with near occlusion (Near occlusion group) with minimal blood flow were obsereved. All patients were monitored by duplex every 3 months. 【Results】The initial success rate was 96% in the Occlusion group and 99.3% in the Near occlusion group. The primary patency rates for the Occlusion and Near occlusion groups were not significantly different at 1 month (75.2% v.s. 87.7%), 1 year (28.9% v.s. 25.6%), 2 years (28.1% v.s. 19.8%), and 3 years (24.5% v.s. 15.6%), respectively (hazard ratio: 0.995, p=0.969). The assisted primary patency rates were better in the Near occlusion group at 1 month (75.2% v.s. 91.1%), 1 year (59.6% v.s. 77.4%), 2 years (56.3% v.s. 73.4%) and 3 years (53.9% v.s. 68.1%), respectively (hazard ratio: 0.764, p<0.05). 【Conclusion】 The outcomes of VAIVT for patients with clinical hemodialysis vascular access occlusion were acceptable, due to prompt VAIVT as possible in every 3-month follow-up. Among this clinical occlusion cohort, the assisted primary patency of near occlusion was better than that of complete occlusion, suggesting the importance of surveillance and prompt VAIVT treatment.

Objectives: The aim of this study was to determine the effectiveness of Lymphedema Hospitalization Program for Learning Self-care. Method: We performed a retrospective study for 17 patients (24 limbs) with leg lymphedema who underwent the hospitalization program. All were female with a mean age of 70.4 years. The mean duration of hospitalization was 24.5 days and the mean follow-up period was 8.2 months. Lymphedema therapists instructed the patients how to perform compression therapy after discharge and physiotherapists instructed them to exercise. Limb circumference and quadriceps muscle strength were evaluated. Results: The mean limb circumferences (sum of 6 points) decreased significantly from admission to discharge (240.3 cm and 214.3 cm, respectively, p<0.01), and were maintained after discharge (212.3 cm). The quadriceps femoris muscle strength increased significantly during hospitalization (p<0.01). Conclusions: Lymphedema Hospitalization Program for Learning Self-care showed positive results not only during hospitalization but also during the maintenance phase after discharge.

We consecutively operated 45 patients (age 64±14, male 19) for GSV insufficiency by cyanoacrylate closure (CAC) in 2020 and investigated 1-year result and the trend of closed end. We performed echography to measure the length from SFJ to the end of plugged GSV (A) just after CAC, on POD 1 and POD 7, and after 6 months and 1 year and computed tomography to measure the diameter of GSV and evaluate residual varicose veins after 6 months and 1 year and complications were investigated. Fifty-two legs were treated. The length of treatment was 18.1±5.3 cm. Occlusion rate was 100% on POD 7. Side effects were redness (7 cases), pain (3), tenderness (2), discomfort sense (2), itch (0), infection (0), DVT (0), EGITclass 3 (3). The A (6.4±2.2 cm) just after operation shortened to 4.5±1.9 cm on POD 1 and 2.7±2.4 cm on POD 7(P<0.001). Those of 6 month (4.3±2.9 cm) and 1 year (3.8±2.4 cm) were not different from that of POD 1 (N.S.). The shape of edge of thrombus was tongue-like on POD 1, and it changed to gulf-like, usually distal to superficial epigastric vein on POD 7. After 6 months and 1 year the diameter of GSV was shortened and crevasse opened centrally. One case (2.7%) had Recanalization. Another case was re-operated for insufficient perforator (2.7%). One-year result after CAC was acceptable.

A 63-year-old woman was admitted to the emergency department of nearby hospital for dyspnea. A computed tomography scan revealed pulmonary embolism, and anticoagulant therapy (rivaroxaban 30 mg/day) started in hospital. Also, an echo of lower extremities showed a popliteal venous aneurysm with thrombus (28×20 mm). After discharge, she was referred to our department for surgical treatment while continuing to the drug (rivaroxaban 15 mg/day). Once the thrombus in the aneurysm disappeared, it recurred before this operation. We resected the aneurysm and repaired popliteal vein with venous patch using great saphenous vein. There were no postoperative complications. After operation, she remained on the anticoagulant therapy (rivaroxaban 15 mg/day) for one year. At the two years after stopping the oral anticoagulant, no recurrence of venous aneurysm and intravenous thrombus was observed.

Varicose veins in the upper extremity are extremely rare. We present a case of 46-years old woman with this unusual condition and discuss cause, diagnosis and treatment. Ultrasonography revealed varicose veins in the right upper arm, and contrast enhanced CT revealed possibility of arteriovenous fistula as a cause of varicose veins. Endovascular laser ablation was performed for varicose veins. After treatment, her symptoms are completely improved.

Reports of treatment of varicose veins of the anterior accessory saphenous vein (AASV) alone without greater saphenous varicose veins are limited, and most cases are adults. We here report a rare case of what appears to be congenital AASV varicose veins. Case: A 69-year-old woman. She had a mass in her left knee after birth, but the bulge naturally decreased. When she was 18 years old, she visited the department of plastic surgery at a university hospital. She was offered treatment with myodermal flap, but she did not want to do so and subsequently left it untreated. About 50 years later she visited our department for treatment. The anterior surface of the left knee was depressed, and superficial varicose veins matched the site. Ultrasonography and contrast-enhanced CT scan were performed. No abnormalities in deep veins or arteries were observed, and varicose veins with valvular insufficiency of the left AASV were diagnosed. Endovascular radiofrequency ablation of the left AASV was performed. Foam sclerotherapy with 1% polidocasclerol was added after 1 month. Although the detailed course of childhood is unknown, it is considered to be a rare varicose vein in which the hemangioma from birth partially degenerates and shrinks spontaneously with growth.

Two cases of postpartum ovarian thrombosis (POVT) are reported Case 1: A 40-years-old woman with twin pregnancy was underwent caesarean delivery on 36 weeks’ gestation. She developed wound pain and fever up on day 6 and underwent contrast-enhanced computed tomography (CE-CT), which revealed thrombosis of left ovarian and renal vein and pulmonary embolism. Case 2: A 26-years-old woman with twin pregnancy was underwent caesarean delivery on 37 weeks’ gestation. She complained of chest pain on day 2 and underwent CE-CT witch revealed right ovarian vein thrombosis extended into inferior vena cava. It is difficult to infer POVT from symptoms. The diagnosis of POVT can be made accurately with CE-CT.

We developed a new endovascular laser ablation (EVLA) method for saphenous vein insufficiency. The clinical results of the recent 963 cases are reported. A Biolitec laser equipment with a wavelength of 1470 nm was used connecting to a slim-type radial 2ring fiber with a diameter of 1.27 mm. The incompetent saphenous veins and tributary varicose veins were treated by the EVLA system. Anesthesia was a combination of TLA and intravenous anesthesia. All veins were accessed by puncturing with a 16 G venule needle. The small saphenous vein and above-knee great saphenous vein (GSV) were ablated at 7 W (LEED 50–70 J/cm). If the below-knee GSV had reflux, it was ablated at 5 W (LEED 20–25 J/cm). Tributary varices were treated at 5 W (LEED 30 J/cm). All patients completed their scheduled EVLA and walked home within 30 minutes after the treatment. Ultrasonography at the first postoperative month revealed complete occlusion in all treated veins. Nerve injury or skin burns were not observed after varicose ablation. Nerve injury was not noticed after below-knee GSV ablation, also. There were no complications such as bleeding, hematoma, lymphatic injury, or wound healing failure. Our new EVLA protocol was minimally invasive with less incidence of adverse events. EVLA of tributary varicose veins can be a useful alternative to cover the weak points of stab avulsion phlebectomy.