Factor XII (FXII) deficiency is a rare coagulation disorder, and its potential relationship with venous thrombosis was reported. Here we present a case of a 67-year-old woman with FXII deficiency who ...successfully underwent endovenous thermal ablation (ETA) for primary varicose vein due to the incompetent great saphenous vein (GSV). The FXII deficiency was revealed through preoperative examinations, and the patient underwent ETA as a day surgery. For prophylaxis of thrombosis, she received compression therapy alone. Her postoperative course was uneventful, without any kind of thrombosis. In the presence of FXII deficiency, ETA could be safely performed.
In our varicose vein center, on a trial basis, among the patients with asymptomatic calf deep vein thrombosis (CDVT) we carefully selected the patients for varicose vein surgery using the ...requirements as follows; 1) the patients had varicose veins with incompetent saphenous veins, 2) sequential examination including DUS confirmed stability and clinical insignificance of asymptomatic CDVT, 3) the patients do not have any risk factors for DVT such as a coagulation profile disorder (antithrombin deficiency, protein C deficiency, protein S deficiency, or antiphospholipid syndrome) or malignancies, 4) surgery is possible under local anesthesia alone, and 5) the patients can understand the concept of asymptomatic CDVT and undergo the surgery on their own will and informed consent. The patients who fulfilled these conditions underwent the varicose vein surgery. Twenty-eight patients with 30 limbs with varicose veins had asymptomatic CDVT, found by preoperative duplex ultrasonography (DUS). Among CDVT, 91% of CDVT existed in the soleal veins. After the diagnosis of the asymptomatic CDVT, serial DUS was performed and showed no changes in the status of the thrombus. Then varicose vein surgery (high ligation of the saphenous junctions either with or without stripping of the saphenous veins) was performed. After the surgery, the CDVT was re-evaluated by DUS. In 27 limbs, CDVT did not show any changes in the status of the thrombus, and in 3 limbs the CDVT was partially resolved. These data suggest that, at least, as far as the patients fulfilled these conditions, varicose vein surgery did not worsen the asymptomatic CDVT. (This is a translation of Jpn J Phlebol 2016; 27: 405–412.)
In Japanese guideline for endovenous treatment of varicose vein patients, compression therapy by elastic stockings (ES) are recommended after endovenous laser ablation (EVLA). A few randomized ...controlled trial (RCT) reported that wearing ES reduced significantly postprocedural pain at 1 week after EVLA, although the level of evidences were weak and the effect of ES on preventing postprocedural deep vein thrombosis (DVT) was unclear. Currently, we suggest that compression therapy by ES is necessary after EVLA. Further RCT in Japan is warranted to clarify whether wearing ES prevent DVT after EVLA.
While endovenous thermal ablation (ETA) become first choice of treatment for varicose veins, overuse of ETA for the inappropriate indication is growing problem. ETA is performed not only on varicose ...cases without symptom but also non diseased cases with segmental reflux of saphenous veins or no reflux. Indications of ETA was demonstrated in “the Clinical Practice Guidelines for ETA for Varicose Veins 2019” by Japanese Society of Phlebology. Purpose of this supplement is description of basics of correct indication for ETA. We also demonstrate the typical case of overuse of ETA for wrong indication. (This is a translation of Jpn J Phlebol 2020; 31: 39–43.)
The author previously reported that, on a trial basis, varicose vein surgery (high ligation of the saphenous junctions either with or without stripping of the saphenous veins) did not worsen the ...status of incidental distal deep vein thrombosis (IDDVT) as far as patients with varicose veins fulfilled the following criteria; 1) the patient has varicose veins due to the incompetent saphenous veins, 2) serial duplex ultrasound (DUS) confirms stability and clinical insignificance of IDDVT, 3) the patient dose not have any risk factors for DVT such as a coagulation profile disorders (antithrombin III deficiency, protein C deficiency, protein S deficiency, or antiphospholipid syndrome) or malignancies, 4) surgery is possible under local anesthesia alone, and 5) the patient can understand the concept of IDDVT and undergo the surgery on their own will with informed consent. Here, to clarify whether endovenous thermal ablation (ETA) is feasible for the patients with incompetent saphenous veins and IDDVT, the author reviewed the records of 137 patients with the varicose veins due to the saphenous veins incompetence at the varicose vein center from June to December 2017. Among 137 patients, DVT was incidentally detected in 8; 1 with the linear-shaped thrombus in the common femoral vein, 1 with the organized thrombus in the popliteal vein, and 6 with IDDVT. Among 6 cases with IDDVT, serial DUS for 3 months disclosed resolution of IDDVT in 3 cases, no change in 2 cases, and an extension in 1 case. For 5 patients with IDDVT diagnosed as resolution and no change, ETA was performed for the incompetent saphenous veins. In the postoperative course for 1 month, serial DUS revealed none of these patients worsened or had a relapse of IDDVT after ETA. These results suggest that, at least, as far as the patients fulfilled the criteria above, ETA did not worsen the IDDVT. The number of cases that the study was conducted on is rather low and although more studies are to be conducted, the results so far are promising.
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