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.     

透视导引下泡沫硬化治疗下肢静脉曲张远期效果分析北大核心CSCD

目的 评价透视导引泡沫硬化剂治疗下肢静脉曲张的远期效果和不良反应。方法 收集2011年8月至2016年5月在镇江市中医院接受透视导引下泡沫硬化治疗的130例下肢静脉曲张患者(161条患肢)临床和影像资料。男68例,女62例,年龄(58.6±7.4)岁(35~85岁)。术后随访静脉疾病临床严重度评分(VCSS)、复发率,患者主观满意度、下肢临床表现-病因-解剖-病理生理学(CEAP)分级变化及不良反应。对复发病例进行单因素和多因素分析。结果 共有94例患者(119肢)进入随访,中位随访时间8年(6~11年),失访36例。手术前后VCSS分别为(7.03±2.38)分、(2.87±2.60)分,CEAP分级分别为(3.29±0.98)级、(1.18±0.79)级,差异有统计学意义(均P<0.01)。随访病例总体复发率为20.5%。单因素和多因素分析均未发现有增加复发风险的因素。患者术后总体主观满意度评分为(3.94±1.41)分。所有患者中皮肤色素沉着最长时间10年,色素沉着总体发生率为8.7%。结论 透视导引泡沫硬化治疗下肢静脉曲张远期效果确切。     

高位结扎剥脱及腔内激光联合治疗大隐静脉曲张97例

目的:比较高位结扎、剥脱及腔内激光联合治疗与传统高位结扎、曲张静脉剥脱术治疗大隐静脉曲张的结果.方法:对126例运用高位结扎并曲张静脉剥脱治疗大隐静脉曲张及97例运用高位结扎、部分严重曲张静脉剥脱并部分轻度曲张大隐静脉腔内激光烧灼治疗大隐静脉曲张患者的临床资料、治疗方法及疗效进行回顾性分析.结果:传统治疗组治愈154条患肢,治愈率93.33%;术后残留浅静脉曲张患肢11条,占6.67%.联合治疗组治愈116条患肢,治愈率95.87%;发现5条术肢残留静脉曲张,占4.13%.结论:联合运用高位结扎、部分严重曲张静脉剥脱及腔内激光治疗大隐静脉曲张,其治愈率和有效率与单纯运用高位结扎并静脉剥脱术无明显差别.但后者手术适应证宽,手术时间短,手术出血量小,术后恢复快,术后皮肤外表美观度均优于前者.     

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.     

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.     

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...     

透视引导下鱼肝油酸钠泡沫硬化剂治疗下肢静脉曲张30例

目的 探讨用国产鱼肝油酸钠自制泡沫硬化剂治疗下肢静脉曲张的临床效果.方法 选择河南开封市第一人民医院30例(39 条患肢)下肢静脉曲张患者,对其进行透视引导下曲张隐静脉注射自制鱼肝油酸钠泡沫硬化剂,观察大隐静脉的闭合情况.结果 39 条患肢均成功注射泡沫硬化剂,平均每条患肢使用5.9 ml泡沫硬化剂.35条(90%)大...     

不同疗法治疗下肢深静脉瓣膜功能不全伴Cockett综合征的效果探讨

【摘要】 目的 探讨不同联合治疗方法对下肢深静脉瓣膜功能不全伴Cockett综合征的疗效。方法 回顾性分析2016年6月至2018年6月上海市第九人民医院收治的120例左下肢深静脉瓣膜功能不全伴Cockett综合征患者临床资料。患者分为两组,A组（n=60）单纯行大隐静脉（GSV）高位结扎＋静脉腔内激光治疗（EVLT）＋硬化剂治疗,B组（n=60）行髂静脉支架植入术后再行GSV高扎＋EVLT＋硬化剂治疗。 结果 A、B组技术成功率均为100%。术后随访6～24个月,平均12个月。A组19例（31.7%）有不同程度患肢肿胀,7例（11.7%）色素沉着,4例（6.7%）足踝区溃疡形成,2例（3.3%）继发下肢深静脉血栓形成（DVT）;B组有2例（3.3%）患肢轻度肿胀,保守治疗后缓解。结论 GSV高位结扎＋EVLT＋硬化剂注射联合髂静脉球囊扩张和支架植入术治疗下肢深静脉瓣膜功能不全伴Cockett综合征效果确切,微创安全。     

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。     

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。     

大隐静脉曲张高位结扎剥脱术的疗效观察

目的:观察大隐静脉曲张伴原发性下肢深静脉瓣膜功能不全行单纯大隐静脉高位结扎剥脱术的疗效,探讨下肢浅静脉曲张伴原发性下肢深静脉瓣膜功能不全的合理治疗方式及二者的关系。方法:分析1996年4月至2003年9月间收治的单纯大隐静脉曲张(简称隐曲组)患者321例及大隐静脉曲张伴原发性下肢深静脉瓣膜功能不全(简称隐深组)患者 45例手术前后症状、体征、血流动力学的变化及复发率。结果:两组手术均成功;总随访率89．4％,平均随访6．04年。隐曲组复发率1．16％,隐深组无复发者,两组复发率无显著差异(P>0．05)。隐曲组的绝大部分症状、体征(除水肿外)均于术后得到明显改善,隐深组除疼痛、搔痒、湿疹外其余症状、体征均于术后得到明显改善(P<0．05),隐深组虽然术后仍存在着病理性返流,但较术前亦有明显的减轻(P<0．01),在返流程度方面手术前后亦无明显变化(P>0．05)。结论:对大隐静脉曲张伴原发性下肢深静脉瓣膜功能不全者,单纯行大隐静脉高位结扎剥脱术的疗效满意。     

Leiomyosarcoma of the great saphenous vein

Peripheral vascular leiomyosarcomas are rare. A case of leiomyosarcoma of the great saphenous vein diagnosed pre-surgically by MRI and fine-needle aspiration is presented. Characteristics of the tumour and imaging features are discussed.     

介入法腔内射频闭合术治疗大隐静脉曲张

目的探讨介入法腔内射频闭合术治疗大隐静脉曲张的疗效。方法在透视引导下,采用局麻下介入穿刺插管方法,对24例患者共计30条肢体曲张静脉进行膝上段大隐静脉腔内闭合治疗,射频导管将血管壁加热至85℃使血管腔闭合。结果30条肢体静脉曲张均成功完成腔内闭合治疗,技术成功率100%,平均每条肢体血管闭合治疗时间17.8min,平均住院时间4.9d。随访1周～9个月,所有患者下肢活动后酸痛、肿胀、乏力感明显减轻或消失;46.7%(14/30)小腿部明显迂曲扩张的静脉消失,53.3%(16/30)患者腿部曲张的浅静脉明显减少。8例患者小腿部皮肤色素沉着、皮肤增厚症状减轻,3例静脉性溃疡愈合。术后血管超声或血管造影复查,83.3%(25/30)大隐静脉主干闭塞,16.7%(5/30)血管内径减小,血流减慢。无下肢深静脉血栓形成,无皮下血肿、感染、麻醉意外等并发症。结论腔内射频闭合大隐静脉曲张具有创伤小、恢复快、腿部无瘢痕残留等优点,是一种可部分替代传统大隐静脉高位结扎剥脱术的有效方法。     

Endovenous laser treatment of incompetent below-knee great saphenous veins

PURPOSE: To test the hypotheses that below-knee great saphenous vein (GSV) reflux after successful ablation of the incompetent above-knee GSV is a cause of incomplete clinical success and that endovenous laser treatment (ELT) of the incompetent below-knee GSV can safely eliminate persistent symptoms. MATERIALS AND METHODS: The author evaluated 576 consecutive ELT procedures of the GSV. Fifty ELT procedures in incompetent calf GSVs were included in this study. Patients with reflux of the entire GSV were selected. All patients underwent clinical and ultrasonographic (US) follow-up. RESULTS: In 16 of the 50 procedures, ELT was performed in the GSV both above and below the knee in separate sessions. In 34 procedures, ELT of the GSV above and below the knee was performed at the same session. An 810-nm laser was used at 14 W. The mean energy was 82 j/cm (range, 56.4-114 j/cm; standard deviation [SD], 14 j/cm). The mean follow-up was 11 months (range, 0-28 months; SD, 7 months). Four paresthesias occurred. Medial ankle pain resolved in all patients, and swelling resolved in all but six limbs. No recanalization occurred. CONCLUSIONS: Patients with incompetence of the entire GSV treated with only ELT of the above-knee GSV experienced incomplete relief of medial ankle pain and swelling; however, symptomatic relief is obtained safely and effectively with additional ELT of the below-knee GSV.     

Endovenous laser therapy of the incompetent great saphenous vein

PURPOSE: The aim of this study was the development of a new, even less invasive technique, for the treatment of varicose veins of the lower limbs than traditional surgery (ligation with stripping of the saphenous vein). MATERIALS AND METHODS: The new interventional radiological procedure uses the 810- to 980-nm endovascular laser fibre proposed by Min et al. Our technique involves the superselective catheterisation of the great saphenous vein under fluoroscopy with contralateral venous access achieved by performing iliac crossover. Retrograde and anterograde phlebographies are performed with a needle cannula positioned in the dorsum of the foot. This enables accurate venous mapping during the procedure of laser photothermolysis. We treated 52 patients between June 2003 and June 2004, with a percentage of recanalisation of 7.5% at 1 year. RESULTS AND CONCLUSIONS: The contralateral approach allows greater control over the entire procedure, with a reduction in potential risks in relation to the saphenofemoral junction given that, unlike in the technique proposed by Min et al. the tip of the laser is directed at all times towards the saphenous vein and never towards the femoral vein. This more radical procedure offers a significant reduction in the possibility of relapse of varicose disease of the saphenofemoral junction.     

Prospective evaluation of higher energy great saphenous vein endovenous laser treatment

PURPOSE: In this study, the hypothesis that higher energy dose improves procedural success without increasing complications was prospectively evaluated by performing endovenous laser therapy (ELT) at energies greater than 80 J/cm. MATERIALS AND METHODS: One hundred consecutive great saphenous (GSV), anterior accessory great saphenous (AAGSV), or posterior accessory great saphenous (PAGSV) veins were treated with the intent to deliver an energy dose of greater than 80 J/cm. Eighty-one patients (64 women, 17 men) were treated. Mean age was 49 years (range, 25-77 years; SD, 12 years). Ultrasound (US) and clinical follow-up was performed at 1 week, 3, 6, 9, and 12 months until all veins had at least 3 months of follow-up. Success was defined as absence of reflux throughout the entire treated segment on follow-up US and clinical resolution of symptoms. Incomplete vein ablation was defined as US evidence of flow in a segment of a treated vein at any point during the follow-up period. RESULTS: One hundred veins were treated with an average energy of 95 J/cm (range, 57-145 J/cm; SD, 16 J/cm). Follow-up and success at 1 week was 100%. Four veins could not be followed up beyond 1 week. Of the 96 remaining veins all had 3 months follow-up with an average follow-up of 9 months (range, 3-13 months; SD, 4 months). There were five failures and 91 successes for a success rate of 95%. Four of the treatment successes demonstrated segmental patency but no reflux on US for a complete vein ablation rate of 91%. No major complications occurred. The treatment failures occurred at an average energy dose of 98 J/cm. Two of the three failures were AAGSVs, one was a GSV ipsilateral to one of the failed AAGSVs, and two were bilateral GSVs treated during the same procedure. Average body mass index (BMI) was 30 for the successes and 46 for the failures. This difference was statistically significant (P = .0009). The mean length of the failed treatments from the saphenofemoral junction to their termination into a varicose tributary was 10.9 (range, 8-15 cm; SD, 3.7 cm). This was significantly less than the length of the successful treatments (P = .000003). CONCLUSION: Higher energy GSV ELT is safe and highly successful.     

Cutaneous thermal injury after endovenous laser ablation of the great saphenous vein

Herein a case of cutaneous thermal injury in the leg of a patient who underwent endovenous laser (EVL) ablation of an incompetent great saphenous vein (GSV) is reported. Follow-up ultrasonography (US) of the site of skin burn showed that the burn was directly over thrombosed superficial tributaries originating from the GSV, but medial to the treated GSV. At the level of skin burn, the thrombosed GSV was 22 mm deep, but the tributaries were 1 mm deep. In addition, US showed echogenic fat surrounding and conforming to the superficial thrombosed tributaries. Based on the clinical scenario and follow-up US findings, it was concluded that the cutaneous thermal injury resulted from heated blood traveling from the 22-mm-deep GSV to the superficial tributaries directly beneath the site of skin burn.     

两种方法治疗大隐静脉曲张疗效比较

目的比较腔内半导体激光和手术治疗大隐静脉曲张的临床疗效。方法 220例（310条腿）大隐静脉曲张患者中,120例（160条腿）行腔内D-980半导体激光治疗（激光组）,其余均行手术治疗（手术组）,比较两组平均手术时间、出血量、住院时间及并发症等。结果与手术组比较,激光组手术时间短、出血量少、住院时间短,恢复快,组织创伤小,创面无瘢痕。结论腔內激光治疗大隐静脉曲张较传统手术有明显优势。     

大隐静脉-隐神经营养血管蒂逆行岛状皮瓣的临床应用

目的 探讨大隐静脉-隐神经营养血管蒂逆行岛状皮瓣修复足踝部软组织缺损的临床应用.方法 2002年5月-2006年1月,对26例踝关节周围及足背软组织缺损患者行大隐静脉-隐神经营养血管蒂逆行岛状皮瓣转移修复术.皮瓣面积最大为14 cm×7 cm,最小为6.5 cm×5.5 cm,平均9.3 cm×6.1 cm;蒂长3～7 cm,蒂宽3～4 cm,表面均保留1.5～2 cm宽的皮桥行明道转移.结果 25例皮瓣成活,随访6～18个月,皮瓣质地满意;1例皮肤坏死,但皮下组织部分存活,经游离皮片移植后创面愈合良好.结论 大隐静脉-隐神经营养血管蒂逆行岛状皮瓣是修复下肢远端软组织缺损的一种良好方法.