DSA引导下泡沫硬化治疗下肢静脉曲张的临床疗效

目的 探讨DSA引导下泡沫硬化治疗下肢静脉曲张的临床疗效.方法 利用Tessari法制作鱼肝油酸钠泡沫硬化剂,在DSA引导下硬化治疗20例(25条患肢)下肢静脉曲张患者,临床随访6个月,参照CEAP分级及临床症状、体征变化判断其临床疗效.结果 在DSA引导下对25条患肢成功实施曲张静脉的泡沫硬化治疗,技术成功率为100...     

DSA引导下经导管聚桂醇泡沫硬化剂治疗下肢静脉曲张性溃疡的临床疗效观察

目的 探讨DSA引导下经导管注入聚桂醇泡沫硬化剂治疗下肢静脉曲张性溃疡的技术方法、可行性、安全性和临床疗效.方法 选择36例(48条患肢)下肢静脉曲张伴溃疡的患者,患肢溃疡面平均为(3±1.5)cm2(1 ～7 cm2),均为内踝处溃疡.术中于腹股沟小切口高位结扎大隐静脉主干后,经大隐静脉远侧断端或经皮穿刺患肢内踝处大隐静脉,置入4F造影导管,DSA引导下经导管注入聚桂醇泡沫硬化剂,选择性硬化闭塞大隐静脉及交通静脉,术后患肢加压包扎、应用抗生素、局部换药.结果 在DSA引导下48条患肢均成功注入泡沫硬化剂,每条患肢平均注入6.5 ml(3.5～8.5 ml)泡沫硬化剂,无严重并发症发生.术后当日患者能下床活动.两周后,38条患肢(79.1％)下肢溃疡创面愈合,8条患肢(16.7％)溃疡创面明显缩小,2条患肢(4.16％)创面未扩大.6 ～12个月后随访:45条患肢(93.8％)曲张静脉及溃疡消失,3条患肢(6.25％)溃疡复发.结论 DSA引导下经导管注入聚桂醇泡沫硬化剂治疗下肢静脉曲张性溃疡临床疗效满意,是一种安全、有效的治疗下肢静脉曲张性溃疡的微创方法.     

下肢静脉曲张的泡沫硬化与腔内射频治疗的疗效观察与对比分析

目的 探讨泡沫硬化与腔内射频消融治疗下肢静脉曲张的疗效,并进行对比分析.方法 2007年至2011年收治44例下肢静脉曲张患者,分为对照组24例(30条下肢),行腔内射频消融治疗,试验组20例(25条下肢),行泡沫硬化治疗.回顾性分析两种方法治疗下肢静脉曲张的疗效并进行对比.结果 两种方法的技术成功率均为100％.对照组和试验组在住院期间分别有14条(46.7％)和13条(52％)患肢下肢曲张静脉消失,16条(53.3％)和12条(48％)患肢下肢曲张静脉明显减少.术后6个月时,血管超声和(或)血管造影复查显示对照组和试验组分别有25条(83.3％)和19条(76％)患肢大隐静脉主干闭塞,5条(16.7％)和6条(24％)患肢大隐静脉管腔变窄;28条(93.3％)和24条(96％)下肢酸胀感消失,2例和1例患者下肢酸胀感无明显改善,30条(100％)和25条(100％)患侧下肢皮肤瘙痒感均有改善或消失.试验组患者均无明显硬化治疗术后的严重并发症.两种方法治疗大隐静脉主干曲张病变的疗效差异无统计学意义(P＞0.05).结论 泡沫硬化与腔内射频消融比较,具有适应证广、操作简便、疗效好、经济、恢复快的优点,在下肢静脉曲张的微创治疗方面具有一定的优势及广泛的临床应用价值.     

X线透视引导下下肢静脉曲张泡沫硬化治疗的技术方法和疗效观察

目的 探讨在X线透视引导下使用泡沫硬化剂治疗下肢静脉曲张的技术方法、可行性、安全性和临床效果.方法 16例下肢静脉曲张患者的21条下肢.使用鱼肝油酸钠溶液按Tessari法制作泡沫硬化剂(液体气体比为1∶4)进行硬化治疗.所有患者直接在局部穿刺行曲张静脉造影,在X线透视引导下,见低密度的泡沫硬化剂完全置换曲张浅静脉内的对比剂和(或)泡沫即将进入相交通的浅、深静脉时立即停止注射.术后使用弹力绷带压迫24 h再改穿弹力袜2周.临床疗效评价标准分为治疗成功、部分成功和未成功.并发症分为轻微并发症和严重并发症.结果 所有患者均成功地完成了经皮穿刺泡沫硬化治疗.治疗后平均随访6.0个月(3.0～17.0个月),随访期内17条下肢(81.0%)获得治疗成功,4条下肢(19.0%)获得部分治疗成功.所有患者发生的早期轻微并发症均为自限性,包括术后早期沿曲张静脉走行的条索状硬结(21条)、色素沉着(11条)、局部疼痛(7条)和浅表性静脉炎(1条),未发生严重并发症和全身并发症.结论 X线透视引导下使用泡沫硬化剂治疗下肢静脉曲张是安全、有效的.     

DSA引导下注射聚多卡醇和鱼肝油酸钠硬化剂对比格犬隐静脉的影响

目的：比较DSA引导下注射两种常用泡沫硬化剂聚多卡醇和鱼肝油酸钠对比格犬下肢隐静脉血管璧的组织学损伤。 方法：成年健康比格犬12只,随机分为聚多卡醇组和鱼肝油酸钠组,每组6只。DSA透视下行隐静脉造影,聚多卡醇组于左前、左后、右后肢注射1%聚多卡醇泡沫硬化剂,鱼肝油酸钠组于左前、左后、右后肢注射5%鱼肝油酸钠泡沫硬化剂。注射后30 min、2 d及28 d,采集隐静脉标本进行HE和Massion染色,光镜下对比观察犬隐静脉血管壁内皮及中膜的组织学变化。 结果：两种泡沫硬化剂均可致犬隐静脉血管内皮损伤和中膜增厚;注射后30 min,两组病理上均可见内皮细胞部分丢失,中膜层平滑肌增厚,组织学未见明显差异;注射后2 d,聚多卡醇组的中膜损伤率高于鱼肝油酸钠组[（63.6±9.4）% vs.（49.2±4.4）%],差异有统计学意义（P<0.05）。注射后28 d,两组的内皮细胞完全脱落,中膜层平滑肌增厚,甚至延伸至外膜。聚多卡醇组血管壁内皮脱失率随时间延长无明显变化,中膜厚度随时间延长增大,鱼肝油酸钠组血管壁内皮脱失率随时间延长而加重,中膜厚度随时间延长增大。 结论：聚多卡醇和鱼肝油酸钠均可对血管内皮和中膜造成损伤,长期对血管作用均产生胶原纤维化,聚多卡醇对血管产生纤维化的作用较鱼肝油酸钠大。     

经大隐静脉插管栓塞术治疗下肢静脉曲张的临床价值

目的评价X线监视下经导管注入无水乙醇治疗下肢静脉曲张的远期疗效及安全性。资料与方法对69例(78条患肢)下肢静脉曲张患者行穿刺或切开内踝上方大隐静脉插入导管,在X线及对比剂监视下注入无水乙醇栓塞治疗。结果 75条(96.%)患肢均一次性栓塞成功;75条患肢于术后7天～3个月多普勒超声显示栓塞的大隐静脉未探及血流信号。随访3～55个月(平均31.2个月),术后3～7天曲张的静脉均塌陷,2～3周临床症状明显减轻或消失,7条小腿溃疡于术后4～6周愈合。13例(18.8%)术后出现咳嗽、胸闷,5～10 min内消失;7条患肢(9.0%)术后肢体出现迟发性感觉异常,2～3周内恢复正常;31条(39.7%)患肢术后第2天出现轻度肿胀,1～2周内均消失;3条(3.8%)患肢于术后12个月内出现小腿浅静脉局限性轻度曲张,无1例深静脉血栓等严重并发症发生。结论经大隐静脉插管注入无水乙醇治疗下肢静脉曲张安全、并发症少,远期疗效肯定;有望成为下肢静脉曲张新的治疗方法之一。     

透视下聚多卡醇硬化治疗C 5~C 6期下肢静脉性溃疡的疗效

目的：探究透视引导下经浅表静脉注入聚多卡醇泡沫硬化剂治疗C₅~C₆期下肢静脉性溃疡的疗效。 方法：选取2014年9月—2015年8月在广州市番禺中心医院诊治的下肢静脉曲张达C₅~C₆期患者51例,共64条患肢,按国际静脉联盟分级（CEAP）标准进行评级,C₆期患肢28条;C₅期患肢36条。应用不同浓度聚多卡醇进行硬化治疗。于术后2周、3个月、6个月对患者进行门诊随访,评价患者疗效、症状改善及不良反应发生情况。 结果：64条患肢均注射成功,平均每条患肢泡沫硬化剂用量（16.35±1.36）ml。术后2周、3个月和6个月随访中,C₆期（28条）患肢溃疡逐渐愈合,C₅期（36条）患肢溃疡周围皮肤张力下降,所有患者症状有不同程度改善,色素沉着明显减轻。 结论：透视引导下聚多卡醇泡沫硬化剂治疗C₅~C₆期下肢静脉曲张安全,疗效可靠,无严重并发症。     

彩色多普勒超声在腔内钬激光治疗大隐静脉曲张中的应用价值

目的探讨彩色多普勒超声在腔内钬激光治疗大隐静脉曲张中的应用价值。资料与方法术前对76例大隐静脉曲张患者的85条下肢进行超声检查,筛选出适合行腔内钬激光治疗术的大隐静脉曲张54条,术后复查彩超观察疗效。结果 85条患肢,单纯性大隐静脉曲张10条(11.8%),合并下肢深静脉瓣膜功能不全75条(88.2%),其中Ⅰ级18条(21.2%),Ⅱ级26条(30.6%),Ⅲ级20条(23.5%),Ⅳ级11条(12.9%),同时合并下肢深静脉血栓2条(2.4%),血栓再通治疗后1条。术后所有患者曲张静脉消失,患肢沉重酸胀感缓解,色素沉着减轻,溃疡逐渐愈合。术后1周彩超检查,大隐静脉出现不同程度的血栓形成;术后1个月复查彩超,大隐静脉主干均出现血栓性闭塞;术后6个月复查,1名患者出现血管腔再通,再次用激光治愈。结论彩色多普勒超声对大隐静脉及下肢深静脉检查具有无创、可重复和较高的敏感性、特异性,在腔内激光治疗大隐静脉曲张中具有重要的应用价值。     

5%鱼肝油酸钠注射治疗下肢静脉曲张122例

1998年 7月～ 2 0 0 0年 3月 ,我们采用 5 %鱼肝油酸钠注射治疗单纯下肢静脉曲张 12 2例 ,疗效良好。1　临床资料1 1　一般情况　 12 2例中 ,男 6 7例 ,女 5 5例 ;年龄 2 9～ 81岁。病程 6～ 34年。其中术后复发 2 4例。均有小腿浅静脉隆起、扩张、弯曲或卷曲成团 ,站立时加重 ,感下肢沉重、发胀等。1 2　治疗方法　通过深静脉功能试验 (Ｐｅｒｔｈｅｓ试验 )确认下肢深静脉回流良好。嘱头高足低斜卧位 ,穿刺曲张静脉有回血后改平卧 ,抬高患肢 ,待曲张静脉空虚后 ,于大腿根部扎止血带 ,放平患肢 ,于曲张的静脉内注入 5 %鱼肝油酸钠 5～10ｍ…     

激光治疗大隐静脉曲张疾病

目的 探讨应用静脉腔内激光治疗大隐静脉曲张疾病的适应证和手术方法.方法 420例(525条肢体)分别采用单纯激光治疗、激光加小切口静脉团点状剥脱和激光治疗联合股浅静脉戴戒术.结果 术后患者恢复良好.患肢无切口的有126条(24%);小腿仅有1～3个1.0～2.0 cm小切口的216条(41.1%);大腿根部有切口的183条(34.9%).随访3～40个月,共随访330例(78.6%),单纯性大隐静脉曲张者术后有16例(27条)复发(复发率3.8%).下肢深静脉瓣膜功能不全者术后有5例确定为术后复发(复发率1.2%).结论 激光治疗大隐静脉曲张疾病,手术简单,创伤小,基本不影响下肢的美观,更容易被患者接受.但是,外科医生应掌握好手术适应证,合理地选择手术方法.     

DSA引导下泡沫硬化术与大隐静脉高位结扎联合血管腔内激光术治疗下肢静脉曲张的疗效观察

目的探讨DSA引导下聚多卡醇泡沫硬化术与大隐静脉高位结扎术联合血管腔内激光术治疗下肢静脉曲张的临床疗效。 方法选取60例下肢静脉曲张患者（共66条腿）,随机分为DSA引导下聚多卡醇泡沫硬化术组（A组,30例共33条腿）及大隐静脉高位结扎术联合血管腔内激光术组（B组,30例共33条腿）。分别对两组患者手术时间、住院费用、术后并发症、治疗效果进行对比评价。 结果A组患者手术时间、住院费用明显低于B组（均P<0.01）;A组患者术后皮下瘀血、感觉麻木、皮下脂肪液化感染、皮肤灼伤的发生率均显著低于B组（均P<0.01）;两组患者静脉炎的发生率差异无统计学意义（P>0.05）;两组患者出院时及术后3个月、6个月、1年治疗效果比较差异均无统计学意义（均P>0.05）。 结论DSA引导下聚多卡醇泡沫硬化剂治疗下肢静脉曲张是一项创伤小、并发症少、安全、有效的治疗方法。     

食管静脉曲张出血内镜下硬化治疗的临床应用

目的总结食管静脉曲张出血患者在内镜下采用改进静脉内注射法行硬化治疗的经验。方法对85例食管静脉曲张出血患者在内镜下采用改进静脉内注射法注射5%鱼肝油酸钠进行止血治疗。结果急诊内镜下硬化治疗55次,急诊止血成功53次,急诊止血成功率96.4%;非急诊内镜下硬化治疗176次;治疗结束后复查胃镜,静脉曲张消失44例,基本消失29例,消失和基本消失占85.9%。内镜下硬化治疗发生并发症9例(占10.6%);住院期间非内镜下硬化治疗发生并发症死亡5例(占5.9%)。治疗2周后复查胃镜42例(占49.4%)出现浅溃疡,经治疗后痊愈;治疗1个月后3例出现食道狭窄,经分次扩张后改善。结论在内镜下采用改进静脉内注射法注射5%鱼肝油酸钠是治疗食管静脉曲张出血的安全、有效、简便方法。     

Varicocele: the effects of sclerotherapy on hemodynamics and spermatogenesis

Between January 1984 and July 1988, percutaneous retrograde sclerotherapy of varicocele was successfully performed on 267 patients. A 5% solution of sodium morrhuate and benzylic alcohol (Varicocid) was administered through a coaxial balloon catheter inserted into the spermatic vein. Nine of the patients had relapses after surgery. Long-term follow up was available for 248 patients. Three of them had incomplete relapses after sclerotherapy. In terms of spermatologic improvement, sclerotherapy appeared to be effective in the treatment of varicoceles. In our experience, sclerotherapy is a safe and effective procedure to be preferred to surgery in the management of varicocele.     

Evaluation of portosystemic collaterals by SPECT imaging after endoscopic variceal sclerotherapy: usefulness for predicting recurrence.

Bleeding from esophageal varices is a major cause of morbidity and mortality in cirrhotic patients. Identification of patients at high risk for bleeding is particularly important. The aim of this study was to determine whether detection of portosystemic collaterals by SPECT could predict the outcome of endoscopic injection sclerotherapy of esophageal varices and be useful for selecting appropriate therapy. METHODS: Sixty-two patients with liver cirrhosis who were considered at high risk of bleeding were treated with endoscopic injection sclerotherapy. Endoscopy was performed every 3 mo after therapy or until bleeding occurred. Before and within 2 wk after therapy, tomographic images of intra-abdominal blood pool were constructed by SPECT. RESULTS: Before therapy, the following portosystemic collateral routes were observed: coronary veins in 53 (85.5%) of 62 patients, short gastric veins in 8 patients (12.9%), splenorenal shunts in 10 patients (16.1%), and paraumbilical veins in 6 patients (9.7%). Patients positive for imaging of coronary veins were divided into 3 groups on the basis of changes in images after therapy: complete responders (n = 17), whose coronary vein images disappeared completely; partial responders (n = 18), whose images became smaller; and nonresponders (n = 18), whose images did not change significantly before or after therapy. The rates of recurrence after endoscopic injection sclerotherapy until 6 mo in complete responders (4/17, 23.5%) and partial responders (7/18, 38.9%) were significantly less (P < 0.05) than that in nonresponders (11/13, 84.6%). The rate of recurrence of esophageal varices until 6 mo in nonresponders treated with additional submucosal injection sclerotherapy (1/5, 20.0%) was significantly less (P < 0.05) than that in nonresponders without additional submucosal injection sclerotherapy (11/13, 84.6%). CONCLUSION: Abdominal blood-pool SPECT, a noninvasive method, is useful for evaluating the therapeutic effectiveness of endoscopic sclerotherapy, for predicting the recurrence of varices, and for selecting appropriate management after sclerotherapy.     

Intervencionismo venoso guiado por ecografía

Although ultrasound-guided interventional procedures have resulted in great advances in many fields of medicine, this approach has revolutionized endovascular procedures.This paper aims to review the basic principles to develop a strategy to follow in ultrasound-guided treatments of varices in the lower limbs, as well as to provide a brief overview of the main endovenous techniques available nowadays.We divide these techniques into those that use catheters to occlude straight saphenous axes (thermal / non-thermal ablation) and other options, such as foam sclerotherapy, which can be used in all types of varices, even in those originating in the pelvis.     

Foam sclerotherapy using polidocanol for balloon-occluded retrograde transvenous obliteration (BRTO)

Purpose  

To evaluate the clinical safety and effectiveness of foam sclerotherapy using polidocanol for the treatment of gastric fundal varices by balloon-occluded retrograde transvenous obliteration (BRTO).     

Pleural and mediastinal changes following endoscopic injection sclerotherapy of esophageal varices

Postero-anterior and lateral chest radiographs of patients undergoing endoscopic injection sclerotherapy of esophageal varices were reviewed. Radiographs were obtained prior to and within 48 hours of treatment. Following sclerotherapy, pleural effusions and densities were commonly seen at the azygoesophageal reflection and the posterior wall of the bronchus intermedius; however, on follow-up they had resolved. Most patients were asymptomatic, and morbidity was low. These findings suggest that inflammation developing after endoscopic injection sclerotherapy extends beyond the esophageal wall into the mediastinum and pleural space.     

Percutaneous Transportal Sclerotherapy with N-Butyl-2-Cyanoacrylate for Gastric Varices: Technique and Clinical Efficacy

Objective

This study was deigned to evaluate the technique and clinical efficacy of the use of percutaneous transportal sclerotherapy with N-butyl-2-cyanoacrylate (NBCA) for patients with gastric varices.

Materials and Methods

Seven patients were treated by transportal sclerotherapy with the use of NBCA. For transportal sclerotherapy, portal vein catheterization was performed with a 6-Fr sheath by the transhepatic approach. A 5-Fr catheter was introduced into the afferent gastric vein and a microcatheter was advanced through the 5-Fr catheter into the varices. NBCA was injected through the microcatheter in the varices by use of the continuous single-column injection technique. After the procedure, postcontrast computed tomography (CT) was performed on the next day and then every six months. Gastroendoscopy was performed at one week, three months, and then every six months after the procedure.

Results

The technical success rate of the procedure was 88%. In six patients, gastric varices were successfully obliterated with 1-8 mL (mean, 5.4 mL) of a NBCA-Lipiodol mixture injected via a microcatheter. No complications related to the procedure were encountered. As seen on the follow-up endoscopy and CT imaging performed after six months, the presence of gastric varcies was not seen in any of the patients after treatment with the NBCA-Lipiodol mixture and the use of microcoils. Recurrence of gastric varices was not observed during the follow-up period. Worsening of esophageal varices occurred in four patients after transportal sclerotherapy. The serum albumin level increased, the ammonia level decreased and the prothrombin time increased at six months after the procedure (p < 0.05).

Conclusion

Percutaneous transportal sclerotherapy with NBCA is useful to obliterate gastric varices if it is not possible to perform balloon-occluded retrograde transvenous obliteration.