腔内射频闭合术联合旋切术治疗下肢静脉功能不全

目的 评价静脉腔内射频闭合术联合静脉旋切术(TriVex)治疗下肢静脉功能不全的疗效.方法 对392例原发性下肢静脉曲张患者共413条患肢的大隐静脉主干采用数控射频静脉闭合系统治疗,并联合TriVex术治疗属支曲张静脉.结果 下肢静脉曲张均临床治愈.随访12～48(平均32)个月,患者曲张静脉均未见复发.结论 腔内射频闭合术联合TriVex微创刨吸术是一种新的治疗下肢静脉曲张的方法,具有术式简单、微创、康复快且疗效可靠等优点.     

腔内射频消融闭合联合电凝术治疗下肢静脉曲张

目的 探讨腔内射频消融闭合联合电凝术治疗下肢静脉曲张的疗效及在肢体美容方面的应用价值.方法 自2008年3月至2009年2月,治疗了37例(43条患肢)原发性大隐静脉曲张患者,其中对大隐静脉主干曲张采用腔内射频消融闭合术,对属支静脉曲张采用电凝术.结果 37例患者的患肢无切口,平均住院1.5 d,手术均获成功.治疗后随访1～11个月,未出现复发及其他严重并发症.结论 腔内射频消融闭合术联合电凝术具有术式简便、微创、安全、疗效可靠及使患者康复快、住院时间短等优点,是治疗下肢静脉曲张并获得美观肢体的较好方法.     

大隐静脉曲张手术疗效比较

目的探讨不同方法治疗下肢静脉曲张的效果。方法2000年3月至2008年7月对108例下肢静脉曲张,分别采用大隐静脉高位结扎抽剥法75例,静脉腔内激光闭合术（EVLT）33例：结果108例随访3—36个月,平均15个月,随访患者疗效满意。结论2种方法有其各自的适应证,静脉腔内激光闭合术（EVLT）安全、有效、创伤小、并发症少,是治疗下肢浅静脉曲张的一种比较理想方法,但术前选择好病例比较重要。     

改良大隐静脉腔内闭合联合点状剥脱术治疗下肢浅静脉曲张的疗效观察

目的对比改良大隐静脉腔内闭合联合点状剥脱术与大隐静脉高位结扎加硬化剂注射术治疗下肢静脉曲张的临床疗效。方法回顾性分析2009年5月至2011年5月本院行改良大隐静脉腔内闭合联合点状剥脱术患者568例(676条患肢)和接受大隐静脉高位结扎加硬化剂注射术的患者487例(585条患肢),两组随访比较并发症及术后复发情况。结果两组患者静脉曲张均得到治愈。对照组出现皮下硬结57例,皮下瘀斑70例,血管血栓性浅静脉炎75例;改良组出现皮下硬结40例,皮下瘀斑55例,血管血栓性浅静脉炎60例。总体复发率两组间无统计学差异,但改良组大隐静脉主干复发率明显低于对照组。结论改良大隐静脉腔内闭合联合点状剥脱术对大隐静脉主干和大的分支行彻底剥脱临床效果佳,手术相对微创,大隐静脉主干复发率低,值得推广。     

腔内射频闭合术联合旋切术(Triex)治疗下肢静脉曲张(附392例报告)

目的 评价静脉腔内射频闭合术联合静脉旋切术(Triex)治疗下肢静脉曲张的疗效.方法 对 392例原发性下肢静脉曲张患者共413条患肢的大隐静脉主干采用数控射频静脉闭合系统治疗,联合Triex术治疗属支曲张静脉.结果 下肢静脉曲张均临床治愈.平均手术时间56min(40～62min),住院时间7.2d,随访12～48个月,平均32个月,所有患者曲张静脉均末见复发,疗效满意.结论 腔内射频闭合术联合Triex微创刨吸术是一种新的治疗下肢静脉曲张的方法,具有术式简单,微创,安全,美观且疗效可靠,康复快,住院时间短等优点.     

点状静脉抽剥术治疗下肢静脉曲张

下肢静脉曲张多指下肢大隐静脉曲张，是外科四大常见病之一，传统的治疗方法是大隐静脉高位结扎、剥脱器抽剥和交通支结扎。我科自1997年以来，运用点状静脉抽剥术治疗192例(244条肢体)下肢静脉曲张病例，经5年随访，疗效良好，现报告如下。     

超声引导下腔内射频闭合术联合局部点剥治疗下肢静脉曲张

目的探讨超声引导下腔内射频闭合术(radiofrequency endovenous obliteration,RFO)联合局部点剥治疗下肢静脉曲张的近期疗效。方法 2016年2~10月我科采用RFO联合局部点剥治疗下肢静脉曲张218例共272条肢体。术前均行下肢静脉超声检查,明确存在隐静脉返流,返流时间大于500 ms,同时除外下肢静脉血栓形成。超声引导下21G穿刺针穿刺隐静脉主干,引入7F 11 cm鞘管。经鞘管导入射频治疗导管,超声定位位置准确后固定导管。超声引导下自大隐静脉置入鞘管部位至导管末端位置行膨胀麻醉。超声探头直视导管工作段,同时加压工作段所在区域隐静脉,打开射频行腔内射频闭合术。主干静脉处理完毕后,术前标记处1%利多卡因局麻,1~2 mm小切口行局部曲张静脉点状剥脱术。术后局部切口敷料覆盖。术后即刻穿医用循序减压弹力袜。结果手术成功率100%。术中并发症7例,其中6例为一过性心率加快、血压升高,1例为一过性心率减慢。术后2例并发症均为局部静脉剥脱切口术后活动性出血,均发生在术后1 h内。随访173例222条肢体,术后3个月复查,静脉曲张完全消失84条,临床分级降级136条,有效率99.1%(220/222)。结论超声引导下RFO联合局部点剥治疗单纯性下肢静脉曲张微创、安全、有效,近期疗效满意。     

腔内微波联合泡沫硬化剂治疗下肢静脉曲张

目的:探讨腔内微波结合泡沫硬化剂治疗下肢静脉曲张的疗效及其安全性。方法:采用微波凝固联合聚多卡醇泡沫硬化剂注射术腔内治疗下肢静脉曲张病例86例(106条),在彩超引导下行腔内微波消融闭合大隐静脉主干,注射3%聚多卡醇,一次性封闭大隐静脉主干及曲张静脉,术后2周、1个月、3个月、6个月、1年复查大隐静脉主干闭塞情况。结果:86例均成功经行腔内微波联合泡沫硬化剂注射治疗。2周随访,3例(3条肢体)大隐静脉主干处轻度皮下淤血血肿,用25%硫酸镁加温生理盐水湿敷1~2周缓解;局部轻微静脉炎症状5例,对症处理;3个月~1年随访,86例曲张静脉均闭合良好,未发现深静脉血栓、肺栓塞以及隐神经损伤等严重并发症。结论:腔内微波闭合联合泡沫硬化剂注射治疗下肢静脉曲张,微创、安全、有效。     

大隐静脉曲张治疗方法合理选择及评价

大隐静脉曲张是一种常见的下肢静脉疾病,发病率约占成年人的50%,是下肢静脉功能不全的表现。若不处理,可因长期淤血出现下肢皮肤色素沉着、静脉性溃疡、血栓性浅静脉炎等并发症。大隐静脉曲张长期以来的治疗方法是传统外科手术,即大隐静脉高位结扎、全程抽剥。近年来,随着腔内技术的发展,大隐静脉曲张也出现了多种腔内治疗方法,其治疗也有由开放向腔内转变的趋势。但腔内治疗的效果,尤其是对于重度大隐静脉曲张的远期疗效仍未有定论。     

腔内射频联合激光和手术治疗下肢静脉功能不全的初步报道

目的评价腔内射频联合激光和手术治疗下肢静脉功能不全的安全性和有效性。方法33例患者34条患肢,单纯性大隐静脉曲张10条,原发性深静脉瓣膜功能不全20条,左髂静脉受压综合征2条,下肢静脉畸形-骨肥大-皮肤血管瘤综合征2条。3种治疗方式：①大隐静脉主干射频闭锁联合股浅静脉瓣膜包窄术、大隐静脉高位结扎和曲张属支浅静脉腔内激光（EVLT）治疗4条肢体：②大隐静脉主干射频闭锁联合大隐静脉高位结扎和EVLT治疗28条肢体;③大隐静脉主干射频闭锁联合外侧畸形静脉高位结扎和EVLT治疗2条肢体。结果随访1～15个月,平均3．27个月,33例患者均取得满意的疗效。结论主干静脉腔内射频治疗下肢静脉功能不全操作简便、安全、有效、微创,联合EVLT和手术治疗,可扩大其应用范围。     

Radiofrequency Endovenous Obliteration versus Stripping of the Long Saphenous Vein in the Management of Primary Varicose Veins: 3-Year Outcome of a Randomized Study

We evaluated the 3-year outcome of a series of patients with primary varicose veins who were randomized to radiofrequency endovenous obliteration vs. stripping of the long saphenous vein (LSV). Twenty-eight patients were included in the study: 15 were randomized to the radiofrequency endovenous obliteration procedure and 13 to LSV stripping. At 3-year follow-up, five patients (33.3%) of the endovenous group had recurrent or residual varices and in three of them a reflux in the thigh veins was detected. None of the primarily occluded LSV segments was recanalized. In the stripping group, three patients (23.1%, p = 0.68) showed varicosities at clinical and duplex examinations. In one patient, a patent duplicate LSV trunk was detected. In the remaining two patients, no reflux in the thigh region was detected. According to the present results, radiofrequency endovenous obliteration of the LSV is associated with somewhat poorer short-term results compared with the stripping operation.     

Defining the role of extended saphenofemoral junction ligation: a prospective comparative study

OBJECTIVE: This study explores the added effect of extended saphenofemoral junction (SFJ) ligation when the greater saphenous vein (GSV) has been eliminated from participating in thigh reflux by means of endovenous obliteration. GSV obliteration, unlike surgical stripping, can be done with or without SFJ ligation to isolate and study SFJ ligation's specific contribution to treatment results. METHODS: Sixty limbs treated with SFJ ligation and 120 limbs treated without high ligation were selected from an ongoing, multicenter, endovenous obliteration trial on the basis of their having primary varicose veins, GSV reflux, and early treatment dates. RESULTS: Five (8%) high-ligation limbs and seven (6%) limbs without high ligation with patent veins at 6 weeks or less were excluded as unsuccessful obliterations. Treatment significantly reduced symptoms and CEAP clinical class in both groups (P =.0001). Recurrent reflux developed in one (2%) of 49 high-ligation limbs and eight (8%) of 97 limbs without high ligation by 6 months (P =.273). New instances of reflux did not appear thereafter in 57 limbs followed to 12 months. Recurrent varicose veins occurred in three high-ligation limbs and four limbs without high ligation by 6 months and in one additional high-ligation limb and two additional limbs without high ligation by 12 months. Actuarial recurrence curves were not statistically different with or without SFJ ligation (P >.156), predicting greater than 90% freedom from recurrent reflux and varicosities at 1 year for both groups. CONCLUSION: These early results suggest that extended SFJ ligation may add little to effective GSV obliteration, but our findings are not sufficiently robust to warrant abandonment of SFJ ligation as currently practiced in the management of primary varicose veins associated with GSV vein reflux.     

Endovascular obliteration of saphenous reflux: a multicenter study

OBJECTIVE: The objective of this study was to assess the differences in clinical outcomes in patients treated with endovenous saphenous vein obliteration with technical outcome of either complete occlusion (CO), near complete occlusion (NCO), defined as < or =5-cm segment of flow in treated vein, or recanalization, defined as >5-cm segment of flow in treated vein. STUDY DESIGN: The study was designed as a prospective registry with follow-up at intervals through 24 months. The subjects were 286 patients from 30 clinical sites with saphenous vein reflux as measured with duplex scanning. A total of 319 limb treatments were performed. Intervention included endovenous catheter obliteration of insufficient saphenous veins with temperature controlled radiofrequency heat, without high ligation of the saphenofemoral junction. The main outcome measures were status of occlusion of treated vein segments, presence of varicose veins and reflux, clinical symptoms scores, physician evaluation of procedure success, and patient satisfaction. RESULTS: At 12 months, 83.6% of treated limbs were classified as CO, 5.6% were categorized as NCO, and 10.8% were recanalized. At 24 months, 85.2% of treated veins were CO, 3.5% were NCO, and 11.3% were recanalized. Varicose veins were present in 95% of limbs before treatment. The presence of varicose veins in limbs with CO was 10.5%, 7.3%, 5.7%, and 8.3% at 1 week, 6 months, 12 months, and 24 months, respectively. The presence of varicose veins in NCO limbs was similar at each interval. Overall, 91.4% of 232 limbs followed to 12 months and 90.1% of 142 limbs at 24 months were free of saphenous vein reflux, regardless of technical outcome. Paresthesia was reported in 3.9% of limbs at 1 year and in 5.6% at 2 years. The pretreatment mean symptom severity score was 2.0. Mean posttreatment symptom scores decreased to 0.07, 0.0, and 0.50 for CO, NCO, and recanalized limbs, respectively, at 6 months. At 12 months, the mean scores were 0.06, 0.0, and 0.32 for CO, NCO, and recanalized limbs, respectively; at 24 months, the scores were at 0.10, 0.40, and 0.63. Patient satisfaction was achieved in 195 of 212 patients (92%) at 1 year and in 121 of 128 (94.5%) at 2 years. CONCLUSION: Endovenous vein obliteration without high ligation dramatically reduces the presence of varicosities and reflux and, when performed with the prescribed pull-back methodology, is comparable with vein stripping at 1 and 2 years. Patient satisfaction with the procedure is high at 2 years, regardless of technical outcome. At 2 years, the closure procedure is a viable alternative to stripping.     

静脉腔内激光治疗下肢静脉曲张的疗效观察

目的　评价静脉腔内激光治疗下肢静脉曲张的疗效。方法　 46例患者共 5 4条患肢行单纯激光治疗或大隐静脉高位结扎加激光治疗。结果　所有患者的静脉曲张均闭塞。 19.5 %患者出现肢体淤斑 ,81.5 %患者肢体发生沿大隐静脉行程条索状硬结或硬块 ,11.1%患者皮肤局部麻木 ,1例患者发生皮肤浅表烧伤。所有患者均获随访 ,平均随访 6个月 (3～ 8个月 ) ,均痊愈。无深静脉血栓 ,无局部复发 ,疗效满意。结论　静脉腔内激光治疗是一种安全、有效、微创的治疗方法 ,选择大隐静脉高位结扎加激光治疗则更安全。     

Anatomical Patterns of the Above Knee Great Saphenous Vein and its Tributaries: Implications for Endovenous Treatment Strategy

Objective: The aim of the present study was to analyse the anatomical patterns of the above knee great saphenous vein (GSV) and its tributaries in limbs with varicose veins in view of potential suitability for endovenous treatment. Methods: Limbs of a consecutive series of new patients with varicose veins presenting at the phlebologic clinic during a 4 month period were studied. In 73 limbs of 56 patients with varicose veins and both saphenofemoral junction and GSV reflux, anatomical patterns of the above knee GSV were defined as :

-‘complete’ GSV: main trunk visualised within the saphenous compartment from the groin to the knee

-‘incomplete’ GSV: main trunk partially visualised from the groin to mid thigh with a non-refluxing mostly hypoplastic distal GSV and a superficial tributary vein (STV) parallel to the GSV.

Results: 51 limbs (70 %) had a ‘complete’ GSV. In 4 of these 51 limbs reflux passed from the main GSV trunk to a STV at mid thigh level leaving a non-refluxing part of the GSV from mid thigh to the knee.

Conclusion: In only 64% of limbs with varicose veins the entire above knee GSV was involved in the disease. This may have implications for endovenous treatment strategy.     

Treatment of primary varicose veins by endovenous obliteration with the VNUS closure system: results of a prospective multicentre study.

BACKGROUND: Radio frequency obliteration of the saphenous veins has been introduced as a less invasive alternative to traditional surgery for varicose veins. OBJECTIVE: To report the efficacy of obliteration and clinical outcomes following endovenous obliteration of the saphenous vein with limited follow-up to 3 years. MATERIALS AND METHODS: Radiofrequency obliteration (Closure system, VNUS Medical Technologies, San Jose, CA) was performed in 330 limbs of 294 patients in a prospective worldwide multicentre study with 31 participating sites. Follow-up duplex ultrasound and clinical examinations were performed at annual intervals. The main outcome measures were the completeness of occlusion of the treated vein segment, presence of reflux and presence of signs and symptoms of venous disease. RESULTS: Before treatment 3.9% of limbs were categorised as CEAP clinical class zero or one. This improved to 82.9% at 1 year, 83.1% at 2 years and 86.8% at 3 years following treatment. Varicose vein free rates were 1 year: 90.1%, 2 years: 87.2%, 3 years: 88.2%. Duplex ultrasound demonstrated a reflux-free rate of about 88% over 3 years. Total occlusion (TO) of veins was 1 year: 81%, 2 years: 80.4% and 3 years: 75%. Partial occlusion (PO, <5 cm open segment) was 1 year: 6.3%, 2 years: 7.4% and 3 years: 17.6%. Incomplete occlusion (IO, >5 cm open segment) was 1 year: 12.7%, 2 years: 12.2% and 3 years: 7.4%. Partial occlusion did not result in any differences in the symptom severity score, the number of symptom free limbs, or the varicose vein absence rates at any follow-up time point when compared to the total occlusion group. The varicose vein absence rates were significantly lower in the IO group comparing to the TO and PO groups. CONCLUSIONS: Radiofrequency saphenous vein obliteration improves the symptoms of varicose veins. The reflux-free rates in the treated veins remain constant over a 3 year follow-up period. There is no difference in clinical outcomes between the TO and the PO limbs, suggesting clinical effectiveness of the PO category. Greater than a 5 cm open segment in treated veins poses a risk of recurrence.     

Superficial vein surgery and SEPS for chronic venous insufficiency

Venous insufficiency in its severe forms leads to skin changes which, in turn may be treated by surgical therapy. Interventions are directed towards correction of the underlying abnormal venous physiology. This involves removal of varicose veins and ablation of incompetent axial veins and relevant perforating veins. In performing ablation of saphenous vein reflux, techniques include high ligation with stripping, radiofrequency ablation, endovenous laser therapy, and foam sclerotherapy. Incompetent perforator interruption can be accomplished surgically by subfascial endoscopic perforator surgery (SEPS) or controlled sclerotherapy using ultrasound. A variety of techniques have emerged to manage the varicose veins themselves. Surgical treatment of chronic venous insufficiency with high ligation in the groin and inversion stripping of the great saphenous vein to the knee combined with stab avulsion of varicose veins continues to be the standard in treatment of varicose veins. There are few comparisons of sclerotherapy of perforating veins with SEPS, but SEPS has become the most popular of surgical options.     

Selective stripping operation based on Doppler ultrasonic findings for primary varicose veins of the lower extremities

In 337 limbs (208 patients) with primary varicose veins, Doppler ultrasound was used to detect reverse flow in the saphenous veins caused by manual compression of the calf. According to the extent of reverse flow in the saphenous trunks, varicosities of the long saphenous vein were classified into five types and the short saphenous vein, into four types. Two hundred five (66.3%) of 309 limbs with varicosities of the long saphenous vein had reverse flow in the entire saphenous trunk from the groin to the ankle. In varicosities of the short saphenous vein, 37 (52.9%) of 70 limbs showed reverse flow from the popliteal fossa to the ankle. The other limbs demonstrated reverse flow only in some segments of the saphenous veins. On the basis of these Doppler ultrasonic findings, selective stripping operations were performed on 80 limbs, in which only the segments with venous reverse flow were selectively removed. Postoperative plethysmographic measurement of the venous reflux volume and follow-up studies showed that results of the selective stripping operations were as satisfactory as those of the standard stripping operations (189 limbs) in which the entire saphenous vein was removed. Furthermore, the selective stripping operation was advantageous in reducing the incidence of nerve injury.     

Update of endovenous treatment modalities for insufficient saphenous veins—A review of literature

Lower-limb venous insufficiency resulting from saphenous vein incompetence is a common disorder, increasing with age. For decades, surgical stripping of the great saphenous vein has been the gold standard in varicose vein treatment. The desire to optimize outcomes of treatment and reduce surgical trauma has led to the development of endovenous techniques. Today, several endovenous techniques are available to ablate the saphenous vein segments with abnormal vein valve function. In this review, we discuss the techniques, mechanisms of action, outcomes, and complications of all endovenous treatment modalities for the treatment of symptomatic lower-limb varicose veins.     

腔内激光联合Trivex 旋切术治疗重度下肢浅静脉曲张的临床效果

目的：探讨腔内激光治疗术联合Trivex旋切术治疗重度下肢浅静脉曲张的临床疗效。 方法：分析2012年7月—2013年10月收治的20例（26条肢体）重度下肢原发性下肢静脉曲张患者临床资料。患者均行腔内激光治疗术联合Trivex旋切术治疗。 结果：全部患者顺利完成手术。术后下肢静脉曲张均消失,色素沉着、瘙痒、湿疹、皮肤溃疡等并发症不同程度的减轻;并发皮下淤斑、局部肿胀4例,均在1个月内消失;1例出现患肢小腿外侧肿胀,穿刺抽吸积液并以弹力绷带加压包扎后肿胀消退;2例出现患肢皮肤麻木,2个月后消失;2例大隐静脉主干部位和曲张静脉烧灼处出现条索状硬结,并伴有局部轻中度疼痛,2~3周症状逐渐消失。术后平均随访8个月,无曲张静脉复发及小腿无明显瘢痕。 结论：腔内激光治疗术联合Trivex旋切术对原发性下肢静脉曲张具有良好的治疗效果治疗,且具有微创及美容效果好等优点。