Misnomers, erroneous or inappropriate designations, are a common occurrence in the medical field, often leading to confusion, misdiagnosis, and misguided treatment approaches. Within the realm of venous diseases, misnomers frequently arise in the form of inaccurate names assigned to conditions or clinical findings. The use of accurate terminology becomes essential in facilitating effective communication between venous specialists and patients. Employing precise and descriptive language improves the accuracy of diagnoses, enabling the implementation of appropriate treatment strategies and reduces cost and use of staff resources. This article aims to present prevalent misnomers in venous disease and to rectify them by employing the correct terminology, thereby enhancing patient care.

Objective: We evaluated the effects of diaphragmatic deep breathing (DB) on venous return in symptomatic patients.
Methods: A prospective study was conducted on volunteers with venous symptoms. After ultrasound confirmation of deep vein patency, the blood flow velocity (peak systolic velocity, PSV) and volume in the common femoral vein (CFV) with duplex ultrasound and wash-out time of ⁹⁹Technetium-macroaggregated albumin (⁹⁹Tc-MAA) with radioisotope (RI) venography were measured in supine and standing positions. After practicing DB for a month, the blood flow volume, velocity, and wash-out time of ⁹⁹Tc-MAA were rechecked.
Results: In the supine position, the PSV of both CFVs and the flow volume of the right CFV were significantly increased after DB (p=0.043, all), while the flow volume of the left CFV did not show a significant change after DB (p=0.138). In the standing position, the PSV of the left CFV significantly increased (p=0.029). The time-to-peak and wash-out times of ⁹⁹Tc-MAA for both CFVs were significantly shorter with DB than with normal breathing (all, p＜0.05).
Conclusion: DB may have a beneficial effect on venous return in patients with symptomatic chronic venous disease. Further research is required to evaluate whether this could be an alternative therapeutic approach.

Objective: This study aimed to determine the correlation between nocturnal leg cramps and duplex ultrasound scanning (DUS) findings in patients with lower-extremity chronic venous disease with incompetent saphenous veins.
Methods: A total of 1668 limbs from 888 patients with signs and symptoms of chronic venous disease (CVD) were evaluated using DUS from April 2017 to December 2020. Limbs with saphenous vein reflux were selected for this study. Patients with a history of treatment for varicose veins, including sclerotherapy, were excluded from the study. The clinical data and DUS results were obtained retrospectively from medical records and analyzed.
Results: Nine hundred and forty limbs from 582 patients were included in this study, 66% were female patients, and the mean age was 55 (19∼86) years. There were no statistically significant differences in the distribution of sex, laterality, and CEAP clinical stage between the legs with or without nocturnal leg cramps. Age and body mass index were significantly different between legs with and without nocturnal leg cramps (p=0.02 for age and p=0.03 for BMI), but the correlations were weak (Cramer’s V=0.11 for age and 0.08 for BMI). The distribution of incompetent saphenous veins, deep vein insufficiency, and the diameter and reflux duration of incompetent saphenous veins did not correlate with nocturnal leg cramps.
Conclusion: Nocturnal leg cramps were not correlated with the distribution of valve failure in the venous system of the lower extremities.

Objective: Edema of the lower extremities can occur in various situations. We aim to identify the causes of edema commonly encountered in clinical practice and determine the role of vascular specialists in lower extremity edema.
Methods: From January 1, 2019, to September 30, 2019, 112 medical records were reviewed retrospectively. We referred to the algorithm for leg edema. We proposed a final diagnosis based on the medical history, physical examination, laboratory tests, imaging studies, and consultation with other specialists.
Results: Among the 112 patients, 42 (37.5%) patients were diagnosed with chronic vascular disease. Overall, 28 (25%) patients had no clearly identified causes and were considered idiopathic. Another 28 (25%) patients had musculoskeletal disorders and 10 (2.9%) patients had medical disease. There were 4 isolated cases of dermatitis, insect bites, pregnancy, and morbid obesity. 24 cases (21.4%) of the 112 patients were diagnosed with lower-extremity varicose veins, with 17 (15.2%) patients showing reflux in the saphenous vein on Doppler ultrasound.
Conclusion: In this study, various leg edema indicated the need for interdisciplinary consultations and differential diagnoses. Chronic venous disease treatment does not seem to have an absolute significance in lower extremity edema. But, vascular specialists play the role of a control tower in diagnosing lower extremity edema.

Objective: Most causes of lower extremity varicose veins are associated with saphenous veins. However, there are several unusual causes of varicose veins that are not related to the saphenous veins. This study reports rare cases of varicose veins originating from intraosseous perforating vein incompetence. The purpose of this study is to examine the clinical manifestations, diagnostic methods, and appropriate treatments.
Methods: A total of 5,481 patients with lower extremity varicose veins visited our clinic from June 2016 to October 2021. Among them, seven patients were identified to have intraosseous perforating vein incompetence. Color Doppler ultrasound was performed to diagnose reflux at the site of the perforating vein through the tibial cortex.
Results: Varicose veins were observed in the pretibial area, and they were connected to the tibial perforating vein with venous reflux. The patients experienced common symptoms associated with lower extremity varicose veins, such as heaviness, cramping, tingling, swelling and discomfort. However, in our cases, there were no localized symptoms specifically related to the tibia area. The surgical procedure performed involved perforating vein ligation and phlebectomy with an incision under local anesthesia.
Conclusion: Intraosseous perforating vein incompetence is a very rare cause of pretibial varices, primarily observed on the anteromedial side of the mid-shaft of the tibia. It is easily overlooked due to its rarity. However, with sufficient knowledge, intraosseous perforating vein incompetence can be accurately diagnosed using Doppler ultrasound alone, and it can be easily treated through perforating vein ligation and phlebectomy.

Lymphedema is a chronic progressive condition caused by insufficient lymphatic drainage and subsequent stasis of protein-rich interstitial fluid. When it occurs, the lymphatic fluid becomes stagnant, causing tissue fibrosis, hypertrophic fat, and lymphatic vessel destruction, ultimately leading to skin ulceration and infection. Lymphedema can be a debilitating disease in patients and has a dramatic negative effect on their quality of life. Invasive reductive procedures such as the Charles operation were previously performed, but this resulted in extensive scarring and substantial morbidity, including significant blood loss or infection. Therefore, in recent years, physiologic surgeries such as lymphaticovenular anastomosis and vascularized lymph node transfer have become increasingly popular. This article reviews recent trends in the surgical management of lymphedema from physiologic surgery to preventive lymphatic reconstruction.

Objective: Radiofrequency thermal ablation is an effective and safe treatment for varicose veins. Existing radiofrequency thermal ablation devices in Korea detect the temperature of the catheter to adjust the radiofrequency output. In contrast, VENISTAR^Ⓡ, a new radiofrequency thermal ablation device, detects the resistance of the vein wall during ablation to adjust the radiofrequency output. Herein, the safety and effects of VENISTAR^Ⓡ were assessed.
Methods: A total of 60 patients with varicose veins who were treated using VENISTAR^Ⓡ from January 2021 to September 2022 at our institution were retrospectively analyzed. In this study, 60 patients (41 males and 19 females) were treated with VENISTAR^Ⓡ.
Results: The mean age was 46.2±11.7 years for males and 52.7±14.2 years for females. CEAP classification was as follows: 28, 26, 4, and 2 patients had C2, C3, C4a, and C4c, respectively. A total of 89 truncal veins were treated, including 79 cases of the great saphenous vein and 10 cases of the small saphenous vein. The mean follow-up period was 190±130 days, and the success rate of treatment with VENISTAR^Ⓡ was 97.7%. Complications included 20 cases of bruising, 3 cases of phlebitis, 2 cases of recanalization, and 1 case of neovascularization.
Conclusion: VENISTAR^Ⓡ, the new radiofrequency thermal ablation device, was effective and safe for treatment of varicose veins. However, as the follow up duration of the participants was relatively short, generalization of the findings was limited. In the future, long-term studies must be conducted.

The objectives of ultrasound follow-up encompass several critical aspects. Primarily, ultrasound is employed post-surgery to assess the efficacy of the treatment and ascertain the potential occurrence of complications and recurrence. Furthermore, the gathered data serves as valuable material for research and facilitates outcome analysis. Fundamentally, long-term follow-up aids in comprehending the natural progression of varicose veins. Immediate postoperative observation is typically conducted within a week to a month following surgery, with the primary aim of verifying the success of the ablation procedure. Late follow-up, typically conducted after one month, focuses on varicose vein recurrence and assesses the long-term outcomes of the surgery. Short-term recurrence (occurring in less than one year), often serves as a predictor for long-term recurrence, extending beyond five years. Given the low incidence of deep vein thrombosis after saphenous ablation, routine surveillance may not be deemed cost-effective. While long-term follow-up may be conducted as needed, it serves a dual purpose of not only monitoring treatment effectiveness and potential recurrences but also contributing to our understanding of the natural course of chronic venous disease, which is often associated with aging.

Non-saphenous veins refer to veins other than the great saphenous vein or small saphenous vein. Emerging evidence suggests that non-saphenous vein reflux may be more prevalent than previously thought, occurring in 9∼35% of patients with chronic venous disease. We purposed to review the anatomical distribution, diagnostic methods, and treatment options for non-saphenous vein reflux and the importance of differentiating it from saphenous vein reflux in clinical practice. Various types of non-saphenous vein reflux are discussed, including posterolateral thigh perforator vein reflux, vulvar vein reflux, gluteal vein reflux, sciatic nerve/tibial nerve vein reflux, popliteal fossa vein reflux, and knee perforator vein reflux. Individualized treatment approaches are recommended, with sclerotherapy and phlebectomy being common options. Increasing awareness and understanding of non-saphenous vein reflux can lead to improved diagnosis, management, and outcomes for patients with venous disease.

Iliofemoral venous outflow obstruction, arising from nonthrombotic iliac vein lesions (NIVLs) or post-thrombotic disease (PTs), is a frequent culprit behind chronic venous signs and symptoms. In response, the adoption of deep venous stenting has gained traction, demonstrating commendable technical success and acceptable complication rates in the management of both acute and chronic venous obstruction. However, the focus on venous stent failure has intensified due to concerns related to in-stent restenosis or thrombosis. Such complications elevate the risks of symptom recurrence and thrombosis relapse, necessitating a judicious approach. The identified contributors to venous stent failure encompass multifaceted factors, including insufficient coverage of the affected area, inadequate vein inflow, inappropriate stent sizing, suboptimal drug therapy, patient non-compliance, stent migration, or fracture. This paper provides a comprehensive exploration of these factors associated with venous stent failure, shedding light on the complexities surrounding the efficacy and longevity of deep venous stenting in the context of iliofemoral venous outflow obstruction.