先日、ウクライナの外科医の方からメールが届きました。
International Heart J.という学会誌に発表した論文を読んで問い合わせてくれたようです。（論文の和約はこちら）
下記にその質問をご紹介します。
thank you so much for excellent paper by your team in Int Heart Journal, 2016 “Safety and Effectiveness….”
Just I have to prepare a short presentation concerning varicose vein management in different countries. For this reason I’d be very grateful if you find time to answer few questions for short survey.
1/ What kind of speciality is engaged in varicose management (surgeons, vascular surgeons, dermatologists, etc) If you can, put less or more percentage?
2/ Do they need a special courses/ qualification exams to manage such pts?
3/ What is percentage of varicose veins treated in private/ state clinics (more or less)?
4/ What is preferable method in your country (EVLA, RFA, stripping, Varady’s miniplebectomy, sclero etc) and by you yourself?
5/ Do operator perform ultrasound screening and mapping himself (percentage)?
6/ What is mean price for procedure in your country and who pay for treatment (insurance, pt himself, etc)?
7/ Are there any Guidelines, Protocols and Statements in your country according to which pts with varicose veins should be treated? Do you use international ones?
それに対して,
1/ In Japan most of the treatment for varicose vein is engaged in vascular surgeons. At the hospital where there is no vascular surgeon, general surgeons may take part in the treatment, but it is relatively rare.
2/ They do not need a special course to perform conventional therapy such as stripping and phlebectomy, but need authorization from the executive committee for endovascular abrasion to obtain the materials to perform endovascular abrasion for varicose vein.
3/ I suppose more than 50 % of varicose veins have been treated in private clinic recently, but the public medical institutions providing this treatment will increase in future.
4/EVLA has been most preferable, but RFA has rapidly been popular these past 1-2 years. As for me, I use EVLA and RFA properly by a case.
5/I suppose in almost all medical facilities the operator himself perform ultrasound screening and mapping.
6/The Japanese medical care is carried out under public health insurance as a general. Therefore almost all medical treatments are performed in an official price. The cost of EVLA or RFA for a single leg is about 150,000 Japanese yen.
7/As already explained, in Japan there is a guideline for endo-venous abrasion for varicose vein prescribed by the executive committee.
と答えました。
すると、
Domo arigatou godzaimashita と返信したうえで、さらに
As far as I understood from your paper, you usually perform crossectomy even if EVLA is used. So am I, because we think, that risk for DVT and recurrent varices are lower. However many my collegues that used EVLA double radiant fiber say that it is not necessary at all.
What is your own opinion and sityation among most japanease surgeons?
と質問されたので
We have engaged in EVLA with 1320 nm wave length laser since 2005 and had performed it with high ligation in general until 2010 to avoid both of thrombus’ scattering toward central side and recanalization. Since 2011 we have applied 2000nm wavelength laser to perform EVLA and found that high ligation is not necessary to prevent thrombus progression and recurrence of varicose vein. Moreover since 2014 we have also applied 1470 nm wavelength laser with radial 2-ring fiber and have been convinced once again that high ligation needs not to be added to all treatments for varicose vein but to be applied to large sized varicose vein over 15-20mm in diameter and complicated type of varicose vein with countercurrent prevention valve insufficiency of plural tributaries.
と返信しました。
私たちが投げかけたテーマについて、
遠い国で注目され、このような会話が生まれたということを嬉しく思います。
