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静脈学Integral Travel Award 2023 Winner Presentation
IS-1-1 Investigation of Risk Points for the Great Saphenous Vein and
Saphenous Nerve in the Treatment of Lower Extremity Varicose
Veins
Katsushi Oda
Kochi Vein Care Clinic

In the treatment of lower limb varicose veins, saphenous nerve (SN) injury is the most concerning complication.
Historically, lower leg great saphenous vein (GSV) stripping has not been recommended due to the high incidenceof SN injury, while endovenous laser ablation (EVLA) is not widely performed because of concerns about thermal
injury causing neural damage. Since 2015, we have been performing lower leg laser ablation and has made efforts
to prevent SN injury during the procedure. In this study, we report on the adjacent risk point (RO) of SN andthe lower leg GSV that we investigated using ultrasonography. The study cohort included 501 patients (240 males
and 361 females) who underwent EVLA for GSV. During the preoperative marking, we identified the point where
SN and GSV first come into contact below the knee and defined this as the RO. We designated the inner malleolus
as point A, the RO as point B, and the inner knee as point C. Three individuals performed SN identification witha 12MHz probe using Aplio and measured the positions of the aforementioned points during preoperative marking.
Finally, the physician confirmed the final position using Aplio i700 with a 12MHz probe in the OR. There wasno statistically significant difference in the length of RO between the right and left limbs (right: A 35.6±2.4 B
27.3±5.2 C 20.5±5.2, left: A 35.5±2.4 B 26.7±5.4 C 20.0±5.2,: cm).
RO was located below the knee in most cases; however, we observed RO above the knee in four cases (five limbs,1%). In EVLA, we altered the ablation conditions relative to the proximal part of the RO to prevent neural injury,
and observed one limb (0.2%) with neural injury after the procedure. Measuring RO may improve the safety oflower leg laser ablation.

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EVF Prize 2023 Winner Presentation
IS-1-2 The Epidemiology And Risk Factors Of Chronic Venous Disease
And Superﬁcial Vein Reﬂux In A General Population In The
Netherlands -- Results From The Rotterdam Study
Eveline Scheerders
Erasmus MC, Rotterdam, Netherlands

Background: Chronic venous disease (CVD) of the lower extremities is a common health problem, accountable for 1-2% of thetotal health care costs in European countries. There are multiple studies on the prevalence of superficial venous incompetence
and chronic venous disease, varying widely in results.
Objective: The aim of this study was to investigate the prevalence of CVD and truncal reflux in a general population, and toassess possible risk factors.
Methods: This study is a cross sectional population-based study, embedded in the Rotterdam Study. Men and women aged atleast 40 years in a Rotterdam district were invited to participate. Of each participant baseline demographics, clinical signsof chronic venous disease (CEAP classification) and duplex ultrasound outcomes regarding superficial venous reflux and post
thrombotic damage were collected. Possible risk factors for having superficial venous reflux were analyzed by means ofmultivariable logistic regression analysis.
Results: A total of 2510 participants (1441 females; 1069 males) were examined, with an median age of 54.0 years. Using thehighest clinical stage, 84.2% participants were classified C0-1, 12.8% C2, 2.3% C3 and 0.7% C4-6. In 23.2% (95%CI 21.625.0) of all participants, reflux was present in at least one superficial venous trunk (great saphenous vein and/or small
saphenous vein). Female gender, age, height and a history of varicose vein treatments were associated with a higher prevalenceof truncal reflux and chronic venous insufficiency (C3-6).
Conclusion: This study shows a prevalence of superficial truncal vein reflux of 23.2% and a prevalence of 3.0% of chronic
venous disease in a general population in The Netherlands. Female gender, age, height and a history of varicose veinstreatments are risk factors for having superficial truncal reflux and CVD.

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IS-2-1

Genotype-phenotype analyses in patientswith Klippel-Trenaunay syndrome using
targeted next-generation sequencing fordetection of PIK3CA mutations

脈学IS-2-2

Anatomy of the Superﬁcial Collecting
Lymph Vessels: Lymphosome Revised

Department of Plastic and Reconstructive Surgery, National
Center for Global Health and Medicine, Tokyo, Japan

Hayahito Sakai, Toko Miyazaki, Maya Kanasaki,
Reiko Tsukuura, Takumi Yamamoto

Department of Plastic and Reconstructive Surgery, Faculty of
Medicine and Graduate School of Medicine, Hokkaido University, Japan

Kosuke Ishikawa, Yuki Sasaki, Kanako C Hatanaka, Yumiko Oyamada,
Yusuke Sakuhara, Tadashi Shimizu, Tatsuro Saito, Naoki Murao,
Tomohiro Onodera, Takahiro Miura, Taku Maeda, Emi Funayama,
Yutaka Hatanaka, PhD, Yuhei Yamamoto, and Satoru Sasaki

BACKGROUND: Klippel‒Trenaunay syndrome (KTS) isa rare slow-flow combined vascular malformation with limb
hypertrophy. KTS is thought to lie on the PIK3CArelated overgrowth spectrum, but reports are limited. We
aimed to demonstrate the clinical utility of targeted nextgeneration sequencing (NGS) in identifying PIK3CA
mosaicism in archival formalin-fixed paraffin-embedded(FFPE) tissues from patients with KTS.
METHODS: This retrospective study involved 14 patientswith vascular malformations with lower limb hypertrophy
who underwent resection of the vascular malformations
between 2011 and 2020. KTS was diagnosed based upon
the triad of capillary malformation, venous malformation,and hypertrophy of the affected limb. We used an order
panel to perform targeted sequencing of all PIK3CA genecoding sequences. The panel consisted of 64 amplicons
with an overall coverage of 87.9%.
RESULTS: Participants were 9 female and 5 malepatients with KTS diagnosed as capillaro-venous
malformation (CVM) or capillaro-lymphatico-venous
malformation (CLVM). Median age at resection was 14
years (range, 5‒57 years). Median archival period before
DNA extraction from FFPE tissues was 5.4 years (range,
3‒7 years). NGS-based sequencing of PIK3CA achieved
an amplicon mean coverage of 119,000x. PIK3CA missense
mutations were found in 12 of 14 patients (85.7%; 6/8
CVM and 6/6 CLVM), with 8 patients showing the hotspot
variants E542K, E545K, H1047R, and H1047L. The nonhotspot PIK3CA variants C420R, Q546K, and Q546R
were identified in 4 patients. Overall, the mean variant
allele frequency for identified PIK3CA variants was 6.9%
(range, 1.6%‒17.4%). All patients with geographic capillarymalformation, histopathological lymphatic malformation or
macrodactyly of the foot had PIK3CA variants. No
genotype‒phenotype association between hotspot and nonhotspot PIK3CA variants was found.
DISCUSSION: Amplicon-based targeted NGS could
identify low-level mosaicism from low-input DNA
extracted from FFPE tissues, potentially providing adiagnostic option for personalized medicine with inhibitorsof the PI3K/AKT/ mTOR signaling pathway.

Background: Although manual lymphatic drainage andlymphatic surgery are developed and performed based on
lymphatic anatomy, some descriptions in textbooks arereported incorrect. The aim of this study was to reveal thereal in-vivo superficial lymph flows.
Methods: Indocyanine green (ICG) lymphography findings
on non-lymphedematous limbs were reviewed. To visualize
all superficial lymph flows, ICG was subdermally injected
at multiple sites; lateral midline for lower extremity; tip ofthe coccygeal bone (H1), center of the gluteal fold (H3), andmidpoint between H1 and H3 (H2) for hip; in the mid-lateral
upper arm, at the levels of one (U1), two (U2), and three(U3) quarters from the lateral edge of the acromion to thelateral epicondyle for upper extremity; in the midline of theback, at every 3cm from 3cm cranial to the seventh cervicalspinous process (C7) to the level of the axillary crease (B16/8). Directions of the superficial lymph flows on ICG
lymphography were evaluated.
Results: 17 lower extremities and hips, 30 upper
extremities, and 19 backs were included. Lower extremity
ICG lymphography showed anteromedial pathways to theinguinal lymph nodes in 10 cases, and posteromedial
pathways in 11 cases. Hip ICG lymphography showed
anteromedial pathways from H1/2/3 to the inguinal lymph
nodes in 13/12/3, and posteromedial pathways in 0/10/12,
respectively. Upper extremity ICG lymphography showed
anteromedial pathways from U1/2/3 to the axial lymph nodein 27/24/6 upper extremities, and posteromedial pathways
in 4/19/28, respectively. Back ICG lymphography showed
pathways to the supraclavicular lymph nodes in 18, andthose to the axillary lymph nodes in 19.
Conclusions: This study revealed several points wherebidirectional lymph flows were visualized on ICG
lymphography,

representing

lymphosomes

different

the

from

real

textbookwatershedofdescriptions.

Lymphedema treatments should be performed based on thereal anatomy.

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IS-2-3

A Study of optimal pressure forcompression therapy ofKlippel-Trenaunay syndrome

Vascular Surgery, Aichi Medical University, Japan

Hiroki Mitsuoka, Takashi Ohta, Akio Kodama,
Yuki Orimoto, Yuki Maruyama, Takahiro Arima[BACKGROUND] Klippel-Trenaunay syndrome (KTS)
is associated with complex venous and lymphatic reflux
disorders, resulting in varicose veins and lymphedemaof the lower extremities. The basic treatment iscompression therapy using elastic stockings. However,
the optimal compression pressure for compression
therapy of the KTS limb is not clear. To investigate theeffect of different compression pressures of elastic
stockings on venous return, we performed Air
plethysmography (APG) with elastic stockings.
[METHODS] Patients diagnosed with KTS between
January 2016 and December 2023 and who performed
APG wearing 20 mmHg and 30 mmHg high sock-typeelastic stockings on the affected limb were included.
APG was performed in the following order: without
elastic stockings, with 20 mmHg elastic stockings, andwith 30 mmHg elastic stockings. Venous volume (VV)、venous filling index (VFI)、 ejection fraction (EF)、Residual Volume Fraction (RVF) were statisticallyexamined.
[RESULTS] Twenty patients (14 males and 6 females)
were measured, median age 32 years (13-59), and allaffected limbs were unilateral. The median APG results
when not wearing elastic stockings, 20 mmHg, and 30
mmHg were VV (241.8 ml, 177.9 ml, 189.0 ml), VFI (4.3
ml/sec, 2.9 ml/sec, 2.9 ml/sec), EF (39.5%, 42.6%,
42.2%), RVF ( 45.9%, 49.4%, 52.0%); VV and VFI weresignificantly different (p<0.001) between not worn and
20 mmHg and between worn and 30 mmHg.
[DISCUSSION]
Wearing elastic stockings significantly decreased VV
and VFI, and EF showed a trend toward improvement.
However, RVF tended to worsen, although notsignificantly, suggesting that the hemodynamics of deepveins may be different in KTS patients, and thatwearing elastic stockings may impair venous return andworsen RVF in patients whose venous return is mainly
to superficial veins. Wearing 20 mmHg elastic stockings
on the KTS limb improved VV and VFI, but wearing 30
mmHg elastic stockings did not improve them further.

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IS-3-1Comparison of endovenous surgeries
for incompetent great saphenous
veins using clinical scores

脈学

IS-3-2The Utility of Duplex UltrasoundWaveforms to Detect Iliac Venous
Obstruction

Kamagaya General Hospital/ Department of cardiovascular surgery,Japan

Department of Vascular Surgery, Straub Medical Center at
Hawai i Paciﬁc Health, United States

Yohei Kawatani, Takaki Hori

Aoi Ogawa, Elna Masuda[Background] It is crucial that the safety and efficacy ofendovenous procedures for saphenous vein incompetence

BACKGROUND

are thoroughly evaluated at the point of care utilizing

Iliac vein obstruction(IVO) is recognized as an important

objective scores and findings and consider the patient s

cause of chronic venous insufficiency and can be contributed

background.

to non-thrombotic venous lesions (NIVL) or post-thrombotic[Methods] All endovenous procedures performed between

syndrome (PTS). Although the pathologic abnormalities

August 2020 and July 2022 were included. Patients were

between the two are clearly different, the clinicalfollowed for 12 months. Ultrasound examinations weremanifestations can be identical(1). Duplex ultrasound is aconducted at post-operation clinic visits. C classification,commonly used initial test for IVO due to the accessibility

VDS, and rVCSS were assessed pre-operatively and 12

and the loss of respiratory variation in the femoral vein ismonths post-operatively. In cyanoacrylate closure (CAC)

traditionally used to detect iliocaval obstruction(2,3). This

procedures, phlebectomy was not performed concurrently

project aims to determine the utility of duplex ultrasounddue to the non-tumescent nature of the technique.

femoral venous phasicity in detecting IVO.

[Results] A total of 154 cases were included. Endovenous

METHODS

thermal ablation (ETA) was performed in 69 cases, while

Patients with clinically suspected IVO who underwent both

CAC was performed in 95 cases. The CAC group was older

duplex ultrasound and intravascular ultrasound (IVUS) werethan the ETA group (75±11 vs 68±14 years, p=0.005).

included. The IVUS criteria for significant IVO of  50%

No patient died during the observational period. No cases

was compared to presence or absence of respiratory variationof EHIT/EGIT class 3-4, deep venous thrombosis,

when examining the femoral veins by duplex scan.

recurrence of the incompetence in the treated vein, stroke,

RESULTSor

One

A total of 44 limbs (NIVL: 38 limbs, PTS: 6 limbs) were

hypersensitivity reaction and 3 cases of phlebitis occurred

included and 29 limbs had  50% stenosis by IVUS. The lackin the CAC group. Although there were no preoperativeof phasicity detecting  50% stenosis showed sensitivity ofdifferences, the C classification and rVCSS were lower in

27.6%, specificity of 86.7%, PPV of 80.0%, and NPV of

the ETA group than in the CAC group at the 12-month

38.2%. For those with NIVL, sensitivity was 16.7%,

postoperative evaluation (C classification: 0.92±0.02 vsspecificity was 85.7%, PPV was 66.7%, and NPV was 37.5%

1.51±1.4, p=0.054; rVCSS: 1.0±1.2 vs 2.3±2.6, p=0.013).

for detecting  50% stenosis.

The reductions in C classification and rVCSS were greater

DISCUSSION

in the ETA group than in the CAC group (C classification:

For patient clinically suspected to have IVO, the duplex

0.92±0.02 vs 1.51±1.4, p=0.054; rVCSS: 1.0±1.2 vsfinding of loss of respiratory phasicity showed a low

2.3±2.6, p=0.013).

sensitivity but high specificity in detecting  50% stenosis.

[Discussion] Both operative methods are equally safe and

The low sensitivity was especially notable in those witheffective as previously reported 1)2), which is not

NIVL. This could be explained by NIVL being focal thatconsistent with a recently published warning report3).

upstream obstruction cannot be detected by downstream

However, ETA was superior to CAC based on C

femoral vein test. In the setting of high clinical suspicion, theclassification and rVCSS. This superiority is assumed tolack of respiratory phasicity should not be used as a sole test

be due to the absence of phlebectomy in CAC.

to rule out IVO and other imaging modalities may be needed.

pulmonaryembolism

werereported.

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237

IS-4-1 Appropriateness for Chronic Venous Disease procedures
Sergio Gianesini
University of Ferrara, Italy / Uniformed Services University of Health Sciences, Bethesda, USA

Even recently published international guidelines on lower limb Chronic Venous Disease (CVD) procedures keepon showing similarities and controversies among documents delivered by different organizations. In line with whatalready reported in v-WINter 2019 Congress and v-WINter 2022 Congress documents on the related topic,
methodological flaws and biases, together with different socio-economic contexts can be involved in thisphenomenon. Moreover, the RCT- DUPLICATE initiative has demonstrated the lack of overlapping between
randomized comparative trials and real world data generation. This last aspect becomes of paramount importanceconsidering USA, UK and European regulatory bodies have clearly stated the pivotal role of real world evidence
in health policies determination. Conducting proper investigations is equally mandatory before the market releaseof a product and after: indeed, post-market surveillance has been showcasing the need of appropriate monitoringin order to avoid even severe complications in more than 40% of the notified files. The current technology andsoftware implementation facilitate the exponential growth of data collection, yet appropriate methodology must
be used to limit the bias and maximize the reliability of the acquired data, while avoiding time-consuming processes.
The herein presented wok reviews the appropriate approach toward chronic venous disease, focusing on outcome
measures not related just to the reflux suppression and on the methodology used to assess and report the sameoutcomes, with the final aim to optimize the vein-lymphatic patient care in a real world setting. In this scenario,
an innovative digital platform called

v-Registry

and designed to collect de-identified aggregated real world

data from all around the world is described and analyzed in its search, abolishing commonly involved biases invenous disease procedures performance assessment.
【Curriculum Vitae】
Dr. Sergio Gianesini is an associate professor of cardiovascular surgery at the University of Ferrara, Italy,
where he focuses on vein and lymphatic research and practice. He is involved in the School of Medicine, Vascular
Surgery Residency program, Physiotherapy courses, and the School of Dentistry. Additionally, he serves as an
adjunct associate professor at the Uniformed Services University of Health Sciences in the USA. Dr. Gianesini
holds a PhD in Vascular System Molecular Patho-physiology and contributes to the Advanced Therapies &Experimental Pharmacology PhD course. He is an invited professor at the University of Padova and Albania
University. He is the editor-in-chief of Vascular Insights and serves on various editorial boards. He has publishedover 80 scientiﬁc papers and delivered more than 380 lectures globally. He co-founded the v-WIN foundation andserved as UIP vice-president from 2018 to 2022, President-Elect from 2022 to 2023 and will serve as the UIP
President from 2023 to 2027

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IS-4-2 Revised Venous Clinical Severity Score: Visual Language and Clinical
Michael A. Vasquez
Venous Institute of Buﬀalo【Curriculum Vitae】
The Venous Institute of Buﬀalo is devoted to promoting vein health. Michael A. Vasquez MD, RVT, is a diplomateof the American Board of Surgery and the American Board of Venous & Lymphatic Medicine. He is nationallyand internationally recognized for his expertise, teaching and research in outcomes following treatment of venous
reﬂux disease. He specializes in chronic venous insuﬃciency treatments including the VenaSeal procedure,endothermal radiofrequency ablation using the ClosureFast catheter, Varithena polidocanol microfoam chemical
ablation, ultrasound-guided foam sclerotherapy and microphlebectomy.

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IS-4-3 Sclerotherapy of stages C2 and above: from recommendations togood practice.
Matthieu Josnin
French Society of Phlebology, France

Sclerotherapy is the most widely used non-thermal non-tumescent treatment in the world. In the recent years, thanks
to the introduction of ultrasound guided sclerotherapy and the diffusion of the foam form, it has been extended tonumerous indications in the treatment of varicose veins.
The aim of sclerotherapy is to damage the venous endothelium by injecting a sclerosing agent, resulting in fibrosisof the vein.
Recent publications of European (2022) and North American (2023) guidelines have shown the importance and placeof this technique and repositioned it in relation to other techniques.
Despite this, a number of prerequisites still need to be met, the key word being standardisation, an issue we will
return to throughout this presentation. Compliance with contraindications and local regulations is essential.
We will look at the use of sclerotherapy in the treatment of varicose ulcers.
We will look at practical examples.
It should always be kept in mind, however, that the saphenous trunks account for no more than a third of varicose
veins, and that this gives sclerotherapy its full legitimacy.
【Curriculum Vitae】
Dr Matthieu Josnin is a specialist in vascular medicine. He is the founder and head of an interventional phlebology
centre. The clinic is also a university-accredited training centre for residents and post-graduate training.
Dr Matthieu Josnin is immediate past president and vice-president of the French Society of Phlebology and an
associate member of the French National Academy of Surgery. He remains very active in teaching, particularlyas part of the University Degree in Phlebology and Endovenous Techniques at Paris Sorbonne University. He is
also actively involved in continuing medical and nursing education, and is involved in studies and publications. He
is a member of the Education Committee of the International Union of Phlebology. Honorary member of theCanadian Society of Phlebology. He is a member of the American Venous and Lymphatic Society, the American
Venous Forum and the European Venous Forum. He is an associate member of the French College of Teachersof Vascular Medicine.

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IS-4-4 Venous & Lymphatic Disease: My 30 years Experiences(1994 〜 2024)
Dong-ik Kim
Div. of Vascular Surgery, Sungkyunkwan Univ., Samsung Medical Center, Seoul, Korea

My History of Venous and Lymphatic Surgery
・Varicose vein surgery: (1) Conventional surgery (HL, Stripping, VS) (2) Valvuloplasty (External Banding Technique)(3) Transilluminated Powered Phlebectomy (4) EVLA (5) RFA (6) Sclerotherapy
・Lymphatic surgery: 1) Lymphovenous anastomosis2) Homan s surgery
・Iliac vein thrombosis (Palma operation )・CVM (congenital venous malformation)
・Renal vein transposition on Nutcracker syndrome
Articles related with Varicose vein (DI Kim)
・1st & corresponding author: 8 Corresponding authors : 3
Articles related with Lymphedema (DI Kim)
・1st & corresponding author: 3 Corresponding authors : 6
Articles related with miscellaneous disease (DI Kim)
・1st & corresponding author : 2 Corresponding authors : 3
Articles related with CVM (DI Kim)
・1st & corresponding author: 5 Corresponding authors : 22
【Curriculum Vitae】
Current Status
1) Professor, Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University
2) Fellow, National Academy of Medicine of Korea
3) (Past) Vice President, Union of International Phlebology (2018-2023)
4) (Past) President, Asian Venous Forum (2012-2015)5) Congress President, 2015 Seoul UIP (2015)6) (Past) President, Korean Society for Phlebology (2011-2013)
7) (Past) President, Korean Society for Vascular Surgery (2016-2018)8) (Past) President, Korean Society for Stem Cell Research (2018-2020)
Education
Mar.1978 - Feb.1984 : College of Medicine, Hanyang University, Seoul, Korea (M.D.)
Mar.1992 - Jul.1995 : Graduate School, Hanyang University, Seoul, Korea (Ph.D.)
Societies and Memberships
Fellow, American College of Surgeons
Member, Society for Vascular Surgery
Member, European Society for Vascular Surgery
Member, International Union of Angiology
Member, International Society of Lymphology
Member, International Society for the Study of Vascular Anomalies
Articles
1. Published articles in International Journal : 190 papers
2. Published articles in Domestic Journal : 100 papers

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IS-4-5 Clinical Experience of Recurrent Deep Vein Thrombosis (DVT)
after Endovascular Treatment (EVT) for ﬁrst Venous
Thromboembolism Event
Sun Choel Park, Jang Yong Kim
Division of Transplant and Vascular Surgery, Department of Surgery, Seoul St. Mary s Hospital, The Catholic
University of Korea
Background: Recurrent DVT(RDVT) after EVT is not uncommon. Recurrent DVT after EVT are caused by patient comorbidities,
EVT techniques and medication. This paper reviews our experience in Recurrent DVT after Endovascular treatment for DVT.
Methods: This is retrospective study of patients, who had recurrent DVT after EVT for DVT in St. Mary Hospital from 2018 to2023. We reviewed clinical characteristics and treatment s results and evaluated technical success and overall mortality.
Results: Of the 134 EVTs for DVT, 26(19.4%) had RDVT. A single event was more frequent in left lower limb DVT (p=0.01),
while RDVT cases had more bilateral DVT (p=0.01). E-Luminexx, Wall stent, Venovo stent were used. There was the 1strecurrence (11), 2nd recurrence (7) and 3rd recurrence (1). DVT recurred in right (5)/ left (16)/ both (5) and recurred in ipsilateralleg(21)/ contralateral or IVC(5). Technical failure was found in 22 cases (84.6%): table 1) Poor compliance or hypercoagulability
in 3 cases. In addition, obesity, abnormal coagulation, and prior history of PE and bilateral DVT were found to be independent
predictors of RDVT.
Conclusions: RDVT can happen and are frequently associated with technical problem. These findings should help identifying highrisk patients and set effective preventive measures for RDVT that may revise the duration of anticoagulation.
Key words: DVT, PE, deep vein thrombosis, Endovascular procedure

Table 1) Causes of Recurrent DVT【Curriculum Vitae】

Academic Qualifications:M. D.; 1996()838 Feb/1997 College of Medicine, The Catholic University of Korea
Master of Medical Science;
2002()087 Feb/2003 Graduate School, College of Medicine, The Catholic University of Korea
Doctor of Philosophy in Medical Science/General Surgery, Ph.D.;2008()046 Feb/2009 Graduate School, College of Medicine, The Catholic University of Korea
Training and Current and Previous Relevant Positions:Mar. 2018 〜 present Professor, Seoul St. Mary s Hospital, The Catholic Univ. of Korea.
Mar. 2021 〜 present director of the organ transplantation center, Seoul St. Mary s Hospital.
Sep. 2023 〜 present chief of the surgery, Dept. of Surgery. Seoul St. Mary s Hospital.
Nov. 2023 〜 present Chairman of the Board of Directors, The Korean Society of Phlebology.
License / ID Number:Mar. 1997: Korean Medical License (M.D): 60278
Mar. 2002: Korean Board Certificate of General Surgery: 4901
Dec. 2015: Korean Board Certificate of Vascular Surgery: 043
2011: RVT (Registered Vascular Technologist),
RPVI (Registered Physician in Vascular Interpretation): 151111
In Korea Membership
Membership of Korean Surgical Society
Membership of Korean Society for Vascular Surgery
Membership of Korean Society for Transplantation
Membership of The Korean Society of Phlebology
Membership of The Korean Society for Hemodialysis Access
ARDMS member (151111) - American Registry for Diagnostic Medical Sonography
TTS member - The Transplantation Society
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IS-P1-1

Relationship between sarcopenia andedema in patients undergoingendovascular treatment for primaryvaricose veins.

脈学IS-P1-2

Vascular Surgery, Aichi Medical University, Japan

Comparison of Chronic Eﬀects
between Balloon Dilation Alone andAdditional Stenting for Acute Deep
Vein Thrombosis with Iliac Vein
Compression Lesion

Hiroki Mitsuoka, Akio Kodama, Yuki Orimoto,
Yuki Maruyama, Takahiro Arima, Miki Shima

Division of Pulmonary Circulation, Department of Cardiovascular
Medicine, National Cerebral & Cardiovascular Centre, Suita,
Osaka, Japan[BACKGROUND]
The incidence of primary varicose veins increases with age,
and with age-related decline in physical function (sarcopenia[SP]), leg edema is frequently observed in elderly patients.
Endovascular treatment for primary varicose veins is
minimally invasive and is performed in the elderly, but thedegree of frailty in patients who have undergone surgery is
unknown. InBody can evaluate SP and edema at the same time.
We investigated the relationship between SP and edema inpatients undergoing endovascular treatment for primaryvaricose veins using InBody.
[METHODS]
Patients who underwent laser ablation for primary varicose
veins between July 2023 and January 2024 and had
preoperative InBody measurements were included. The
evaluation items were skeletal muscle mass index (SMI) andextracellular water to total body water ratio (ECW/TBW).
SMI less than 7.0 in men and 5.7 in women were defined ashaving SP, and ECW/TBW greater than 0.39 was defined
as having edema. In cases where InBody was measured again
between 2 and 4 weeks postoperatively, the relationshipbetween pre- and postoperative ECW/TBW andpreoperative SMI was statistically evaluated.
[RESULTS]
The median age was 69 (31-84) years for males and 72 (5287) years for females. 2 males (9.5%) had a SMI of less than
7.0 and 12 females (48.0%) had a SMI of less than 5.7.
Preoperative ECW/TBW was greater than 0.39 in 25 males(73.5%) and 36 females (90.0%). Preoperative ECW/TBW
was 0.399 in the SP group and 0.394 in the non-SP group,
and was significantly greater in the SP group (p <0.001).
Postoperatively, InBody was measured in 33 patients with
54 limbs (15 males with 26 limbs and 18 females with 28
limbs). Postoperative ECW/TBW was 0.401 in the SP groupand 0.393 in the non-SP group, and was significantly greaterin the SP group (p<0.001). Pre- and postoperative
ECW/TBW improved significantly in males (p=0.044) but
not in females (p=0.154).
[DISCUSSION]
ECW/TBW improved significantly in men after surgery, butthere was no significant difference in women. SP was
observed more frequently in women, and SP may have
prevented the improvement of postoperative edema(ECW/TBW).

Hiroya Hayashi, Akihiro Tsuji, Shinya Fujisaki,
Ryo Takano, Mitsumasa Akao, Hiroyuki Endo,
Naruhiro Nishi, Takatoyo Kiko, Ryotaro Asano, Jin Ueda,
Takeshi Ogo
BACKGROUND: Catheter intervention for acute proximal
deep vein thrombosis (DVT) is an invasive therapeutic option
for the prevention of post thrombotic syndrome (PTS).
However, the efficacy of balloon dilatation alone andadditional stenting for acute proximal DVT complicated withiliac vein compression lesion (ICL), has not been fully
investigated.
METHODS: We performed catheter interventions for 202
patients with DVT from 2014 to 2021. The efficacy oftreatment was assessed by the incidence of PTS with theVillalta scale and ICL patency after two years. The ICL
patency was defined by the presence of venous flow by venous
echography.
RESULTS: Thirty-six patients with ICL were treated withballoon dilation or additional stenting in addition to catheter
directed thrombolysis/thrombus aspiration in acute phase.
Twenty-seven patients were enrolled in this study, excluding
nine patients with missing the chronic phase data. The study
patients were divided into two groups: patients with balloon
dilation alone group (n=19) and additional stenting group(n=8). There were no significant differences in the Villalta
scale at baseline (11.2 ± 3.9 vs10.9 ± 4.7; p=0.95). After
two years, there were no significant differences between thetwo groups in the Villalta scale (1.5 (0.8-2.3) vs 0 (0-1.3),
p=0.13) and the ICL patency rates (62.5% vs 100%, p=0.08).
The incidence of the PTS was 6.3% in the balloon dilation
alone group and 0% in the additional stenting group (p=0.53).
DISCUSSION: Although the additional stenting grouptended to effective for prevention of PTS in chronic phasethan the treated with balloon dilation alone group, there wasno significant statistically difference between these groups.
On the other hand, the incidence of PTS was extremely low
in both groups during the chronic phase. Therefore, it isnecessary to carefully consider which patients would benefit
from additional stenting.

136

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2024 Vol. 35 No.2

IS-P1-3

Clinical manifestations of varicose
veins associated with the insuﬃciencyof lateral sural cutaneous nerve veins

IS-P1-4

Yamamoto Vein Clinic

Development of a novel analysis
method for lower extremity varicose
veins using photoacoustic imaging

Department of Radiology, Keio University School of Medicine,Japan

Takashi Yamamoto

Moemi Urano, Kenichi Nagae, Sachiko Matsuda,
Kentaro Matsubara, Nobuaki Imanishi, Hideaki Obara,
Masahiro Jinzaki, Sadakazu Aiso

BACKGROUND: A certain amounts of varicose veins

Background: Photoacoustic imaging devices are expected(VVs) over the popliteal fossa arise from perforators

as diagnostic imaging tools that can visualize blood vessels

unrelated to small saphenous vein (SSV). Most of those

non-invasively. Although patient interviews, palpation, andechography are commonly employed in the diagnosis ofperforators are connected to accompanying veins ofvaricose veins in the lower extremities, these methods are

sciatic nerve, common peroneal nerve and caudally

susceptible to the influence of the practitioner s skill andlateral sural cutaneous nerve. However, the detailed

subjectivity. Consequently, there is a pressing need for

information of nerve-related varicose veins is lacking.

the establishment of objective evaluation criteria. In thisOBJECTIVE: To describe the prevalence, clinicalstudy, we aimed to visualize and quantitatively assess thesymptoms, and backgrounds of VVs related to thevascular morphology of lower extremity varicose veinsaccompanying vein of lateral sural cutaneous nerve

using a high-resolution, non-invasive photoacoustic(LSCNV). METHODS: Information on 4,166 patients

imaging system.

(8,332 limbs) attending for outpatient consultation are

Methods: Seven patients with lower extremity varicose

retrospectively reviewed. The imcompetence of LSCNV

veins were included in the study. In addition to

was defined as a reflux more than 0.5 sec, 3 mm inconventional interviews, visual inspection, palpation, anddiameter, and 5 cm in length. The limbs with LSCNV

echography, the lower extremities were photographedusing a photoacoustic imaging system. The blood presence

imcompetence were classified in two groups, group A,

density in areas diagnosed with varicose veins and non-without previous treatment on SSV, and group B,

varicose regions was calculated from the captured images.

received previous treatment on SSV. Freaquency of

The blood presence density was defined as the amount of

occurrence, age, sex, right and left, origin, and VCSS

blood vessels per unit area exceeding a specific brightness.

scores were compared between the two groups.

Results: Images of the lower limbs obtained with the

RESULTS: The numerical value of the groups were
described as follows

total (group A : group B)

photoacoustic imaging system were able to depict the.

details in three dimensions, including fine blood vessels.

LSCNV imcompetence was identified on 53 (42 : 11)

The regions identified with varicose veins exhibited alimbs (0.64%). The average age was 59.1±14.6

markedly intricate vascular morphology compared to(56.0&plusmn;15.7 : 69.9±13.7). Female sex account forother areas. Furthermore, upon calculating the blood

50 (41 : 9) (94.3% (97.6% : 81.8%)). Right limbs occupied

presence density, it was discernible that the regions

30 (24 : 6) (56.6% (57.1% : 54.5%)). Origins were defineddiagnosed with varicose veins possessed a significantly
elevated vascular density relative to the surrounding

according to the identified origin of the imcompetence,tissue.

high, along the sciatic nerve and common peroneal nerve,

Discussion:

low, direct perforator from popliteal vein. High origin

Visualizing

blood

vesselswiththephotoacoustic imaging system enabled detailed three-were observed 27 (25 : 2) (50.3% (59.5% : 18.2%)).

dimensional observation of the vascular morphology of

Average VCSS score was 5.26±3.40 (5.31±3.14 :lower

5.09±4.43).

extremity

varicoseveins.

In

additiontomorphological observation of vessels, numerical evaluation

CONCLUSION: LSCNV imcompetence was identified

is also expected. This study demonstrated the potential

on 0.64% of the patients, most of them were female andfor more accurate assistance in the visual diagnosis of

their origins were tend to high on group A ,and low onlower extremity varicose veins.

group B.

137

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IS-P1-5

Experience with Endovenous Laser
Ablation for Lower Limb Varicose
Veins Using an Automatic Ablation
System脈学

Kochi Vein Care Clinic, Japan

Katsushi Oda

Background: Endovenous laser ablation (EVLA) using
manual traction is a common technique for treating lower
limb varicose veins. However, it has drawbacks such as
the need for skill acquisition and increased operator
burden for multiple or lengthy ablation procedures. To
solve such problems, we have been performing EVLA with
an automatic ablation program (AEVLA). This study
aimed to report the early outcomes of AEVLA.
Methods: From May 2023, AEVLA using the Venolaser
1470 system (Unitac, Japan) was performed in 435 cases(513 great saphenous veins [GSV] and 198 small
saphenous veins [SSV]). while the control group (C)included 496 cases treated with manual traction EVLA
from October 2022 to May 2023 (690 GSV and 192 SSV).
The AEVLA utilized a 1470 nm laser and a traction
device. Input parameters included the length of ablationfrom the puncture site to the risk point where the GSV
meets the adjacent nerve, as well as the desirable central
intense ablation length. A continuous ablation was carriedout based on predetermined conditions, and ablation was
terminated upon reaching the planned ablation length.
Concurrent tumescent local anesthesia (TLA) was
performed during ablation. The GSV treatment speed,
represented as the treatment length divided by thetreatment time (L/T), was compared between the twogroups.
Results: Comparisons between group A and C yielded thefollowing mean±SD values. Treatment length (cm): GSV
50.2±17.2 vs. 54.2±15.6, SSV 12.9±4.1 vs. 14.3±4.7;
Treatment time (minutes): GSV 16.0±6.0 vs. 15.5±5.4,
SSV

7.4±2.2 vs. 6.8±5.4; The L/T ratio wassignificantly different between the two groups (0.37±0.07
vs. 0.32±0.04, p<0.05).
Conclusion: AEVLA has the potential to offer consistenttreatment outcomes with reduced operator variability. It
also demonstrates the potential for shortened treatment
time. AEVLA may improved treatment efficacy andefficiency.

1382024 Vol. 35 No.2

IS-P2-1

Eﬃcacy of using a vessel dilator
during surgery to evaluate veindiameter and predict radiocephalicarteriovenous ﬁstula maturation andpatency

IS-P2-2

Department of Cardiovascular Surgery, Higashiosaka City
Medical Center, Higashiosaka, Osaka, Japan

245

Adverse Reactions to Endovascular
Treatment for Varicose Veins- Thermal Ablation (TA) versus
Nonthermal Ablation (NTA) with
Cyanoalylate

Kannai medical clinic, Japan

Mitsumi Yamashita, Masayuki Sou, Satoshi Itoh,
Takaya Murayama

Kanako Takai, Takehisa Nojima, Nobuyuki Takai, Hidehiko
Taguchi, Kosei Hasegawa, Takashi Yamauchi

Background:

Background: We routinely use vessel dilators to assess

Adverse reactions to Endovascular

Treatment for Varicose Veins are known. There havethe diameter of the target vein during surgery forbeen reports of refractory cutaneous and systemicarteriovenous fistula (AVF) creation in hemodialysis

symptoms. However, its pathogenesis is not fully

patients. This study investigates the efficacy of using vein

understood. We compared the postoperative adverse

diameter as measured using vessel dilators versus that asreactions of TA with radiofrequency and laser and thosemeasured on preoperative ultrasonography to predictof NTA with Cyanoaclylate.

postoperative complications and patency.

Methods: A total of 98 cases of TA and 97 cases of

Methods: Sixty-three patients who underwent creation of

NTA for incompetent large and small saphenous veinsahadwere performed in our clinic between June andmeasurements of preoperative ultrasonographic vein

December 2023 and August 2021 and August 2023,

diameter (UD) and vein diameter during surgery (SD)respectively. We retrospectively analyzed medical

were retrospectively analyzed. Optimal cutoff values forrecords to examine skin symptoms, frequency ofradiocephalicarteriovenous

fistulaandoccurrence, and timing of occurrence. Skin symptoms

UD and SD regarding complications were determined

were classified into three categories: mild (symptoms

using receiver operating characteristic curve analysis andlocalized to the treated area), moderate (symptoms

used to dichotomize the patients into high and low groups

beyond the treated area), and severe (symptoms notfor comparisons. Patency was evaluated using the Kaplan‒relieved by medical treatment and requiring surgical

Meier method.

excision).

Results: The 2-year primary and secondary patency rates

Results: The incidence of cutaneous adverse reactions

overall were 66.5% and 88.9%, respectively. The optimal

was 20.4% for TA (mild 9.2%, moderate 11.2%, severe

UD and SD cutoff values were 2.4 and 3.5 mm,0%) and 20.6% for NTA (mild 18.6%, moderate 1.0%,

respectively. The 2-year primary patency rate was higher

severe 1.0%). No severe systemic symptoms werein the high SD group than the low SD group (88.2% vs.

observed. The time of onset was 82.1% within one week,

58.6%; P = 0.0426). The 2-year secondary patency rate

14.3% within one month, 3.6% within two months for TA,

was significantly higher in the high UD/high SD group32.0% within one week, 66.4% within one month, andthan the low UD/low SD group (91.7% vs. 68.4%; P =15.6% within two months for NTA. Numbness was

0.0067).

present in 5 patients with TA and in 0 patients with

Conclusion: Intraoperative measurement of vein diameter

NTA.

using vessel dilators when performing AVF surgery might

Discussion: The incidence of cutaneous adverse

be a useful method of predicting postoperative patency,

reactions was 20% for both TA and NTA. However,particularly when SD is used in combination with UD.

NTA was observed later, with a higher proportion ofmild cases than TA. Foreign body granulomas are afeature of NTA. The adverse reactions of both types
were predicted to have different underlying factors.
Postoperative neuropathy was absent in NTA. NTA
appears to be a useful treatment, especially for leg
lesions with potential for neuropathy.

139

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静

IS-P2-3

Early results of a retrospective study on
cyanoacrylate closure for incompetentsaphenous veins

脈学IS-P2-4

Osaka Vein Clinic, JapanThe outcomes of radiofrequency
ablation for varicose veins in terms of
postoperative complications

1
Department of Cardiovascular Surgery, Ako Central Hospital,
Ako, Japan2
Department of Cardiovascular Surgery, Hakuhokai Central
Hospital, Amagasaki, Japan

Xiaoning Tong

Atsushi Kitagawa1,2, Yukio Yamada1, Toshihiko Nagao1

Background: To elucidate the outcomes of radiofrequency
ablation (RFA) for varicose veins of lower extremities, inBackgroundterms of postoperative complications.

Cyanoacrylate closure(CAC) for saphenous veins is a

Methods: A two-center prospective RFA trial enrolled

relatively new modality, which was introduced to Japan580 legs in 484 patients with varicose veins (mean age 68

as a treatment covered by national health insurance inyears, 372 legs in female) from 2014-2023. There were2019. We report early clinical results and patient

461 legs of GSV, 125 of small SSV and 12 of ASV.

satisfaction outcomes after intervention.

According to the CEAP classification, there were 299

Methods
200 patientslegs (52%) of C2, 168 (29%) of C3, 90 (15%) of C4, 23

with incompetent saphenous veins were(4%) of C5/6. The Closure-FAST catheter (Medtronic-

underwent CAC between January 2022 and July 2023.

Covidien) was used for RFA treatment. Outcome analyses

Post-procedure evaluations included Numerical Rating

included 1) the perioperative symptoms (day 1,7, 30, 90):

Score, patient satisfaction, time to return to work,

pain (P: scale 0-10), tenderness (T: scale 0-10) andrevised Venous Clinical Severity Scores(rVCSS) andecchymosis (E: scale 0-5) based on RECOVERY study. 2)

HSR.

the other adverse events (DVT, PTE, allergic reaction,

Results

thrombophlebitis and sensory nerve disturbance) and 3)

There were 64 male and 136 female patients. HSR was

EHIT (endovenous heat-induced thrombosis) related tofound in 19 of 236(8.1%) limbs, which occurred 8.2±0.7

GSV cases using the postoperative duplex scan.

days after CAC. Patients̀ tracking rate was 100%, andResults: 1) The perioperative symptoms (pain, tenderness

mean tracking period was 91±12 days.

and ecchymosis) were not almost severe:

Discussion

Day 1: P 0 +/-0.1(0-2), T 0.2+/-0.5(0-3), E 0.1 +/-0.3 (0-CAC is an effective way to block refluxing saphenous2), day 7: P 0 +/-0.2(0-2), T 0.3+/-0.6(0-5), E 0.1 +/-0.4

veins at early follow-up. Patients are highly satisfied(0-4), day 30: P 0 +/-0.1(0-2), T 0.1+/-0.4(0-3), E 0 +/-and report low postoperative pain, and thermal-

0.1 (0-1) and day 90: P 0 +/-0.1(0), T 0+/-0.2(0-1), E 0

associated complication was avoided. Early results are+/-0 (0). There were neither of DVT/PTE nor allergic

encouraging, but we await further prospective long-term

reaction. There were two cases of thrombophlebitis andfollow-up from the study.

two of sensory nerve disturbance, both of which wereresolved at day 90. The ratio of EHIT (> class 2) was
6.3 % (29 out of 461 legs), all of which were resolved
without DVT/PTE.
Discussion: There were tiny numbers of postoperative
adverse events: thrombophlebitis and sensory nerve
disturbance after RFA treatment. Also, there was no
DVT/PTE, although EHIT happened occasionally. RFA
is thought to be a safe treatment modality for varicose
veins of lower extremities.

1402024 Vol. 35 No.2

IS-P2-5

Short-term results of subfascial PAPs
for the treatment of large cases of
IPV.

Harukas KAWASAKI Clinic, Japan

Hiroshi Kawasaki, Kosuke Fujii<Background> We would report a novel procedure,
Subfascial PAPs (percutaneous ablation of perforators)(SAPs) against IPVs with short-term results. We
improved on PAPs to make higher curability.
<Methods> 129 cases (159 IPVs) of SAPs were
performed for 12 months in 2023.
Age: 25˜88yrs, average 67 ± 1.2, Gender: Male 52(62)Female 77(97), Postoperative follow up periods: 4.5 ± 0.3
months, Operation sites: A) GSV in lower leg 130 (82%),B) SSV 16 (10%), C) back site in thigh 11 (7%), D) GSV
in lower thigh 2 (1%)
IPVs are located A) 12 ± 0.6 cm, B) 13 ± 2 cm above
ankle joints.
IPVs: perforating point diameter 3.5 ± 0.3 mm, reflux
5.8 ± 0.3 cm/sec), Surgical procedure: local anesthesia+ TLA +/- venous anesthesia (Flunitrazepam), directpuncture under US guide, Endothermelaser (LSO
MEDICAL),

Ringlight™

Fiber

Probe,

burning

condition; pulse mode, output 7 wats, duration 7 sec,interval 0.5 sec, SAPs: Transluminal technique, shortaxis puncture, guide wire, Burning in lower leg GSV;
SAPs burning length (subfascial/total) 32 ± 0.7/ 63 ± 1mm, energy 372 ± 12 Jules, time 56 ± 1.9 sec, LEED
59.0 J/cm,<Results> pain (≧1M) 0, nerve injury 0, arteriovenous
fistula 0, patent IPV with reflux 7<Discussion> Improved points of procedure aresuggested more important as follows,1)Transluminal technique definitely with best direction,
guidewire and well burning2)Burning of perforating point3)Adequate length burning can prevent nerve injury withlots of TLA<Conclusion> Effectiveness and safety of subfascial
PAPs (SAPs) against IPVs are proofed with short-term
results due to improved surgical techniques.
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