腔内激光消融术治疗下肢静脉性溃疡临床分析

目的探讨腔内激光消融术(EVLA)治疗下肢静脉性溃疡(VULE)的疗效和安全性。方法 32例(36条患肢,42处溃疡)VULE患者,均行大隐静脉高位结扎+EVLA闭合曲张浅静脉及溃疡床周围穿通支静脉,术后穿循序弹力袜(20~30 mmHg)。结果手术时间30~90 min,平均50min;术中出血量2~20 ml,平均10 rnl;术后住院时间3~10 d,平均5 d。术后随访6~24个月,溃疡愈合率为90%(38/42),平均愈合时间为28 d(14~45 d),2年内累积溃疡复发率为7.9%(3/38)。患者生活质量较术前明显改善,无严重并发症。结论 EVLA能有效治疗VULE,具有损伤小、并发症少、安全性高、溃疡复发率低等优点。     

腔内激光消融联合泡沫硬化剂同期治疗大隐静脉瓣膜功能不全的对照研究

目的观察激光腔内消融(EVLA)同期联合属支曲张静脉泡沫硬化剂(FS)治疗大隐静脉瓣膜功能不全的可行性、安全性及临床疗效。方法 2015年7月至2016年12月,本院收治289例(452条患肢)大隐静脉瓣膜功能不全患者,经知情同意采用两种治疗方式:同期EVLA(主干)联合FS(属支)治疗组(203条患肢);单纯EVLA组(249条患肢)。比较两组患者主干闭合情况、术后并发症、生活质量评分及术后曲张静脉残留等指标。结果联合组的术后曲张静脉残留率及残留数量显著低于EVLA组(P0.05)。术后6个月联合组的生活质量改善程度显著优于EVLA组(P0.05),而技术成功率无明显差别(P0.05)。术后1个月联合组局部硬结、皮下淤血及静脉炎等并发症发生率显著高于EVLA组(P0.05),但在6个月时无明显差别(P0.05)。结论 EVLA联合同期属支FS治疗大隐静脉瓣膜功能不全是一种安全、可行、能极大减少曲张静脉残留且带来早期预后改善的治疗方式。     

大隐静脉高位结扎联合导管泡沫硬化剂治疗下肢静脉曲张

目的观察大隐静脉高位结扎联合数字减影血管造影(DSA)导管引导下的泡沫硬化剂治疗下肢静脉曲张的临床疗效。方法选取本院2012年10月至2013年4月下肢静脉曲张患者26例(26条患肢),大隐静脉高位结扎并在DSA导管引导下对患肢大隐静脉主干内注射1%聚桂醇泡沫硬化剂,观察大隐静脉主干的闭合情况。结果患者均在DSA导管引导下成功注射1%聚桂醇泡沫硬化剂,平均每条患肢应用26.5ml泡沫硬化剂。24例大隐静脉主干治疗后即可见反流消失。治疗2周及3个月后随诊下肢静脉超声示大隐静脉主干闭塞。患者下肢活动后酸胀、乏力感消失,大隐静脉走形迂曲、扩张、畸形静脉消失,无严重并发症发生。结论大隐静脉高位结扎联合DSA导管引导下泡沫硬化剂疗法是一种安全、有效、微创治疗大隐静脉曲张的方法,但其远期效果仍然需要进行进一步的随访观察。     

导管引导下泡沫硬化剂疗法治疗大隐静脉曲张

目的 探讨导管引导下的泡沫硬化剂疗法治疗下肢静脉曲张的临床效果.方法 选择2008年4月至8月间有微创治疗意愿的30例(条)中重度下肢静脉曲张患者.其中男性11例,女性19例;年龄34-85岁,平均年龄52岁.病史2～30年,平均20年.对其进行导管引导下患肢大隐静脉主干内注射1%聚桂醇泡沫硬化剂,观察大隐静脉主干的闭合情况.结果 30条患肢均在导管引导下成功注射硬化剂,平均每条患肢应用6.2 ml泡沫硬化剂,27条(90%)大隐静脉主干治疗后即刻可见反流消失.术后早期大隐静脉走行轻微浅静脉炎5例(条),2周内自行缓解,无严重的并发症发生.平均随访3个月,27例患者下肢活动后酸胀、乏力感消失,下肢明显的曲张畸形静脉消失;27条患肢(90%)于治疗后2周、3个月后复诊血管超声时大隐静脉主干闭塞.4例(条)患者(15%)仅有小腿局限的轻度曲张.结论 导管引导的泡沫硬化剂疗法治疗下肢静脉曲张的大隐静脉主干闭合率较高,是微创治疗下肢静脉曲张有效的新方法.     

高位结扎联合泡沫硬化剂治疗原发性大隐静脉曲张的初步疗效

目的探讨高位结扎联合泡沫硬化剂治疗原发性大隐静脉曲张的临床效果。方法收集2016年1月至12月中山大学孙逸仙纪念医院的病例60例,按大隐静脉主干的处理方式分成两组:主干硬化剂组共26例,30条患肢;剥脱组共34例,共37条患肢。记录2组患者手术方式、手术时间、小腿部硬化剂用量,术后于站立位静脉曲张的复通率和局部不良反应(局部皮肤坏死、溃疡)。结果在大腿部位的大隐静脉主干应用3%泡沫硬化剂,硬化剂组显示手术时间和住院时间较剥脱组明显的缩短,差异有统计学意义[(50.41±2.12)min vs(59.73±1.47)min,(1.96±0.11)d vs(4.53±1.07)d,t=22.862、12.221,均P0.001],并且小腿曲张静脉1%泡沫硬化剂用量显著减少[(3.53±0.31)ml vs(5.84±0.31)ml,t=28.425,P0.01]。2组在一期复通率、浅静脉炎及色素沉着的并发症发生率上,差异没有统计学意义。结论高位结扎联合3%泡沫硬化剂治疗原发性大隐静脉曲张的疗效稳定且可靠,安全而且操作更为简洁、微创,在一定恢复时期内可以恢复下肢的美容状态,更符合快速康复医学理念,是可以推广的一种手术方式。     

腔内射频联合溃疡周围透光直视旋切术治疗下肢静脉性溃疡

目的评价腔内射频联合透光直视旋切术(TriVex)治疗下肢静脉性溃疡的疗效。方法回顾性分析了173例(208条患肢)下肢静脉性溃疡患者行大隐静脉腔内射频闭合术和溃疡周围TriVex刨吸术的临床资料。结果所有患肢术后溃疡面渗出明显减少,溃疡周围皮肤色素沉着明显减轻,其中共203条患肢经术后伤口换药能达到一期愈合,愈合时间为10～65天;其余5条肢体术后溃疡面积明显缩小,创面逐渐长出新鲜肉芽,术后3个月经植皮术后溃疡愈合。结论腔内射频联合溃疡周围TriVex刨吸术治疗下肢静脉性溃疡安全有效。     

腔镜深筋膜下交通静脉离断术治疗下肢静脉性溃疡

目的:探讨腔镜深筋膜下交通静脉离断术(SEPS)治疗下肢静脉性溃疡(VLU)的临床效果。方法:回顾性分析3年半内收治的70例(76条患肢)下肢静脉功能不全患者的临床资料。按CEAP临床分类,其中C4级38例(41条患肢),C5级18例(18条患肢),C6级14例(17条患肢)。18例(18条患肢)C4级患者行大隐静脉高位结扎分段剥脱术(传统组),其余患者采用SEPS联合大隐静脉高位结扎分段剥脱术(SEPS组)。分析患肢手术前后的CEAP临床评分及患肢溃疡愈合时间和复发情况。结果:SEPS组患者术后曲张静脉团消失,患肢酸胀及沉重感逐渐减轻,局部瘙痒及创面疼痛缓解;C5级患者溃疡愈合区色素沉着及硬化明显改善,皮炎消失;C6级患者足靴区活动性溃疡在术后10~60 d(平均47.3 d)愈合;术后患肢的CEAP临床评分均低于术前(均P<0.05);平均随访15个月,无复发患者。SEPS组C4级患者与传统组患者术后各项评分均无统计学差异(均P>0.05)。结论:SEPS是治疗重度下肢静脉功能不全合并VLU的有效方法。     

腔内激光闭合术纠正局部血流动力学紊乱治疗继发性静脉性溃疡

目的探讨腔内激光闭合(EVLA)膝下及溃疡床周围浅静脉反流治疗继发性静脉性溃疡(SVU)的疗效。方法回顾性分析2005年1月～2008年12月在我科就诊的51例(54条患肢,72个溃疡面)SVU患者的临床资料,EVLA闭合膝下段及溃疡床周围浅静脉反流,保留膝上段大隐静脉,术后穿循序弹力袜(20～30 mmHg)。术后记录溃疡愈合率、临床症状改善情况及生活质量评分。结果术后随访6～47(平均25)个月,术后半年、1年及2年溃疡愈合率分别为81.9%(57/72)、71.4%(45/63)和69.1%(37/55)。患肢肿胀和疼痛缓解率分别为76.9%(40/52)和90%(27/30),患者生活质量较术前明显改善,且无严重并发症的发生。结论 SVU多由膝下段浅静脉反流所致,EVLA膝下段及溃疡床周围浅静脉反流纠正溃疡周围血流动力学紊乱治疗SVU安全有效。     

超声监测下泡沫硬化剂治疗中度以上下肢静脉曲张疗效分析

目的 评价超声监测下泡沫硬化剂对中度以上下肢静脉曲张的治疗效果.方法 对32例临床分级C4～C6的患者实施大隐静脉高位结扎+腔镜下小腿交通静脉结扎+超声监视下大隐静脉主干及小腿曲张静脉泡沫硬化剂注射,通过随访评估症状的改善程度并用血管彩色多普勒超声对静脉闭塞情况进行观察.结果 32例患者共32条肢体(C4～C6)接受治疗.平均结扎小腿交通静脉3.2(1～5)条,每条肢体平均使用泡沫硬化剂27.5 ml.1例术后出现轻度胸闷但CT排除肺栓塞,4例曲张静脉附近呈现明显的炎性反应,3例局部存留迂曲静脉团块但超声多普勒检查未见血流信号,无脑缺血等严重并发症.术后平均随访4.8(1～10)个月,所有患肢术后静脉曲张消失,临床症状明显缓解.C5期9条患肢的溃疡均于术后3个月内愈合.结论 泡沫硬化剂注射可有效治疗中度以上下肢静脉曲张,联合腔镜下交通静脉结扎及大隐静脉高位结扎可以增加治疗的安全性.     

下肢慢性静脉溃疡的综合治疗

目的探讨下肢慢性静脉溃疡的综合治疗方法。方法回顾性分析2012年7月~2013年1月我科收治的10例下肢慢性静脉溃疡患者（10条患肢）的临床资料,均采用大隐静脉高位结扎加抽剥并联合应用透光曲张静脉刨吸术、泡沫硬化剂注射、腔镜深筋膜下交通静脉结扎术等方法处理小腿病灶。分别在术前及术后3个月对临床症状的改善情况采集数据,按临床严重程度评分（VCSS）方法进行评估。结果患者均成功实施联合手术治疗方案,在术后的VCSS评分项目中得到改善[（12.3±2.06）v s （9.6±1.71）]。随访（6.70±1.45）个月,疼痛较前均有缓解,未发现患肢有曲张浅静脉残余或复发,8例溃疡基本愈合,仅有2例还有残余溃疡,但都控制在2 cm内,已愈合的溃疡未见复发。结论下肢慢性静脉溃疡经正确选择联合治疗方案进行处理后的效果是理想且安全的,而且其短期效果稳定。     

冷光源引导下泡沫硬化剂注射小腿曲张浅静脉在下肢静脉溃疡治疗中的应用探讨

目的探讨冷光源引导下泡沫硬化剂注射小腿曲张浅静脉联合腔镜深筋膜下交通支静脉离断术(SEPS)及大隐静脉高位结扎抽剥术治疗下肢交通静脉功能不全所致的静脉溃疡中的作用效果。 方法选取2012年6月至2013年5月就诊的42例(46条患肢)小腿交通静脉功能不全合并浅静脉曲张的静脉溃疡患者,行SEPS术及大隐静脉高位结扎抽剥术,并在SEPS术的冷光源引导下行小腿曲张静脉泡沫硬化剂注射术。 结果共注射263条曲张浅表静脉。随访期间所有患者静脉溃疡均愈合。9例患者的9条下肢(9/46,19.57%)在术后4周内出现局部疼痛,口服止疼药可缓解。22例患者的24条下肢(24/46,52.17%)共46条静脉(46/263,17.49%)在术后1 ~ 2周出现沿治疗曲张静脉行程的黄褐色色素沉着,于3 ~ 6个月内自行消失。3例患者3条下肢(3/46,6.52%)共11条静脉(11/263, 4.18%)在治疗后1周出现沿曲张静脉分布的红、热、痛和压痛,诊断为浅表性静脉炎,外用多磺酸黏多糖乳膏后缓解。经过注射的263条曲张静脉中,245条(245/263,93.16%)达到治疗成功标准,18条(18/263,6.84%)达到部分成功标准,无一条静脉未成功注射。 结论冷光源引导下的小腿曲张静脉泡沫硬化剂注射联合SEPS术及大隐静脉高位结扎抽剥术是良好的治疗交通静脉功能不全所致静脉溃疡的方法,其长期作用效果有待进一步观察。     

Validation of a new duplex derived haemodynamic effectiveness score, the saphenous treatment score, in quantifying varicose vein treatments

ObjectivesTo evaluate a duplex-derived score for varicose vein treatments using numerical values of haemodynamic effectiveness.DesignThe saphenous treatment score (STS) was developed prospectively to compare the effect of endovenous treatments on reflux within saphenous segments.PatientsSixty-six patients were randomised to endovenous laser ablation (EVLA) or ultrasound-guided foam sclerotherapy (UGFS) to the great saphenous vein (GSV).MethodsAssessments included the Aberdeen varicose vein severity score (AVVSS), the venous clinical severity score (VCSS), the venous filling index (VFI) and the STS.ResultsA mean STS of 5.70 decreased to 3.30, P < .0005, post-treatment. The median (IQR) AVVSS, VCSS and VFI (ml/sec) decreased from 21.52(15.48) to 18.86(11.27), P = .14, from 6(4) to 3(4), P < .0005 and from 7.1(6.9) to 1.9(.9) P < .0005, respectively. In 15 patients requiring additional UGFS the mean STS values decreased from 5.8 to 4.13 and then to 2.6 P < .0005, respectively. The individual above and below knee mean treatment differences in STS on 38 EVLA and 28 UGFS patients were 1.92 and .87 (EVLA) compared to 1.57and .29 (UGFS) P = .001, respectively.ConclusionsThe STS has been shown to grade the haemodynamic effects of different treatments as well as ongoing treatments on the GSV.     

Endovenous laser ablation: Does standard above-knee great saphenous vein ablation provide optimum results in patients with both above- and below-knee reflux? A randomized controlled trial

BACKGROUND: Following above-knee (AK) great saphenous vein (GSV) endovenous laser ablation (EVLA) 40% to 50% patients have residual varicosities. This randomized controlled trial (RCT) assesses whether more extensive GSV ablation enhances their resolution and influences symptom improvement. METHOD: Sixty-eight limbs (65 patients) with varicosities and above and below-knee GSV reflux were randomized to Group A: AK-EVLA (n = 23); Group B: EVLA mid-calf to groin (n = 23); and Group C: AK-EVLA, concomitant below-knee GSV foam sclerotherapy (n = 22). Primary outcomes were residual varicosities requiring sclerotherapy (6 weeks), improvement in Aberdeen varicose vein severity scores (AVVSS, 12 weeks), patient satisfaction, and complication rates. RESULTS: EVLA ablated the treated GSV in all limbs. Sclerotherapy requirements were Group A: 14/23 (61%); Group B: 4/23 (17%); and Group C: 8/22 (36%); chi2 = 9.3 (2 df) P = .01 with P(A-B) = 0.006; P(B-C) = 0.19; P(A-C) = 0.14. AVVSS scores improved in all groups as follows: A: 14.8 (9.3-22.6) to 6.4 (3.2-9.1), (P < .001); B: 15.8 (10.2-24.5) to 2.5 (1.1-3.7), (P < .001); and C: 15.1 (9.0-23.1) to 4.1 (2.3-6.8), (P < .001) and P(A-B) = 0.011, P(A -C) = 0.042. Patient satisfaction was highest in Group B. BK-EVLA was not associated with saphenous nerve injury. CONCLUSIONS: Extended EVLA is safe, increases spontaneous resolution of varicosities, and has a greater impact on symptom reduction. Similar benefits occurred after concomitant BK-GSV foam sclerotherapy.     

Prospective randomised comparative study of visual foam sclerotherapy alone or in combination with ultrasound-guided foam sclerotherapy for treatment of superficial venous insufficiency: preliminary report

ObjectiveThe aim of the study is to compare ultrasound-guided foam sclerotherapy (UGFS: injection of foam sclerosant under ultrasound guidance) of the great saphenous vein (GSV) combined with visual foam sclerotherapy (VFS: injection of foam sclerosant under visual control) for varicose tributary veins and VFS alone in the treatment of GSV reflux.Design and methodsA total of 133 limbs in 97 patients with GSV reflux were randomised to receive either VFS alone or VFS combined with UGFS. In both groups, 1% polidocanol foam was used. Assessments included duplex ultrasonography, evaluation of Venous Clinical Severity Scores (VCSS) and CEAP (clinical, etiologic, anatomic, and pathophysiologic) scores. Ultrasonographic inspection of the foam in the GSV was carried out during 5 min before compression was applied. The primary ‘end’ point of the study was obliteration of the GSV at 6 months.ResultsA total of 51 limbs in 48 patients were treated with UGFS + VFS and the remaining 52 limbs in 49 patients were treated with VFS alone. There were no significant inter-group differences in patient age, male: female ratio, height, weight, body mass index, CEAP clinical scores or VCSS. The GSV diameter was 6.0 ± 1.7 mm (median ± interquartile range) in the UGFS + VFS group and 5.7 ± 1.6 mm in the VFS group (p = 0.419). The mean injected volume of foam for varicose tributary veins was 4 ± 2 ml in the UGFS + VFS group and 6 ± 2 ml in the VFS group, a significantly higher amount of foam being used in the latter (p < 0.001). However, the mean total amount of foam was greater in limbs treated with UFGS + VFS than in those treated with VFS alone (p = 0.017). Ultrasonographic inspection revealed complete vasospasm of the GSV in 37 (72.5%) limbs in the UGFS + VFS group and 29 (55.8%) in the VFS group during sclerotherapy (p = 0.097). At 6-month follow-up, complete occlusion was found in 23 limbs (45.1%) treated with UGFS + VFS and in 22 limbs (42.3%) treated with VFS. The difference between the two groups was not significant (p = 0.775). Reflux was absent in 30 limbs (58.8%) treated with UGFS + VFS and in 37 (71.2%) treated with VFS (p = 0.190). There was no inter-group difference in post-treatment VCSS (p = 0.223).ConclusionsThese results show that UGFS + VFS and VFS are equally effective for the treatment of GSV reflux, despite the lower volume of foam used for VFS alone.     

Endothermal heat-induced thrombosis after endovenous laser ablation: A single-center experience

Lower limb varicose veins are a common vascular disorder producing pain and disability when truncal vein reflux is present. Endovenous laser ablation (EVLA) of the great saphenous vein (GSV) is a safe and effective method for treating this condition. An unintended complication of this procedure is endothermal heat-induced thrombosis (EHIT) of common femoral vein. A retrospective outcomes analysis of patients who underwent EVLA of the GSV at King Khalid University Hospital from June 2006 to November 2018 was conducted to identify the risks factors and incidence of EHIT. Patients were assessed by clinical examination and duplex ultrasound imaging after the EVLA, and patient demographic characteristics and procedural factors predictive of EHIT were determined. Following EVLA, 11,070 duplex ultrasound examinations were performed for 1,230 limbs, and EHIT was detected in 65 (5.3%) limbs in 60 (6.8%) patients. Essentially all EHIT cases were detected in the first week (n = 63; 96.9%) and clot regression occurred over a period of 1–4 weeks. There were no significant differences in patient demographic characteristics or procedural factors between the EHIT and non-EHIT groups, except for the percentage of women (86% v 73%; P = .02), maximum GSV diameter (6.7 ± 2.7 mm v 6.0 ± 2.1 mm; P = .04), and percentage of patients with a competent saphenofemoral junction (41% v 37%; P < .001). EVLA is a safe treatment for great saphenous vein reflux, but EHIT can occur and was associated with female sex, large maximum GSV diameter, and competent saphenofemoral junction. Venous duplex imaging after EVLA is recommended because EHIT is asymptomatic in most patients.     

A 1470-nm laser combined with foam sclerotherapy in day surgery: a better choice for lower limb varicose veins

Day surgery is being more and more adopted by clinicians. Higher wavelength lasers give patients better experience than lower wavelength lasers, which makes it more suitable for day surgery. This study compares the short- and mid-term efficacy, postoperative morbidity, and patient satisfaction of “1470-nm endovenous laser ablation (EVLA) combining foam sclerotherapy in day surgery” with “810-nm EVLA with high ligation combining foam sclerotherapy in hospital surgery” on great saphenous vein (GSV) insufficiency postoperatively. A single-institution historical cohort study of 194 patients was performed in Shanghai Ninth People’s Hospital, China. Ninety-seven patients received 1470-nm EVLA combining foam sclerotherapy in day surgery (“1470-nm group”), and 97 patients received 810-nm EVLA with high ligation combining foam sclerotherapy in hospital surgery recommended by guidelines (“810-nm group”). No significant difference was found between the 1470-nm group and the 810-nm group in terms of GSV occlusion rate (both 100%), complication rate, and recurrence rate (8.2 vs. 11.3%) during the period of 1–12 months after surgery. Serious complications in the 1470-nm group and 810-nm group were 0 and 1.0%. Minor complications in the 1470-nm group and 810-nm group were ecchymosis at 20.6 and 18.6%, edema at 69.1 and 63.9%, and paresthesia around ankle at 0 and 3.1%, respectively. Advantage of the 1470-nm group over the 810-nm group was statistically significant considering the patient perioperative comfort and economic cost. Treatment of 1470-nm EVLA combining foam sclerotherapy in day surgery has similar efficacy as the 810-nm EVLA with high ligation combining foam sclerotherapy in hospital surgery in GSV insufficiency and is more comfortable with less incision, hospitalization procedure, and medical costs. It may be a new option for patients who are afraid or unable to be hospitalized.     

射频消融治疗大隐静脉曲张的近期有效性及安全性

目的观察射频消融(RFA)治疗大隐静脉曲张的近期有效性及安全性。方法回顾性分析接受超声引导下RFA治疗的17例大隐静脉曲张患者(26条患肢)术前1周、术后即刻及术后1、3、6个月临床资料。结果 26条患肢中,术后即刻及术后1、3、6个月大隐静脉闭塞率均为100%(26/26)。术后3、6个月患肢活动能力较术前1周好转(P均0.05),术后6个月疼痛程度较术前1周缓解(P0.05)。术后1、3、6个月患肢临床-病因-解剖-病理生理(CEAP)临床分级及修订版静脉临床严重程度评分(rVCSS)与术前1周比较分级均降低(P均0.01)。术后6个月内7条患肢发生皮下条索僵硬静脉,1条隐股点不适,3条皮下出血。结论 RFA治疗大隐静脉曲张近期疗效好,且并发症少。     

Endovenous Laser Ablation (EVLA) of the Anterior Accessory Great Saphenous Vein (AAGSV): Abolition of Sapheno-Femoral Reflux with Preservation of the Great Saphenous Vein

AimDuring surgery for sapheno-femoral junction (SFJ) and anterior accessory great saphenous vein (AAGSV) reflux, many surgeons also strip the great saphenous vein (GSV). This study assesses the short-term efficacy (abolition of reflux on Duplex ultrasound) of endovenous laser ablation (EVLA) of the AAGSV with preservation of a competent GSV in the treatment of varicose veins occurring due to isolated AAGSV incompetence.MethodThirty-three patients (21 women and 12 men) undergoing AAGSV EVLA alone (group A) and 33 age/sex-matched controls undergoing GSV EVLA (Group B) were studied. Comparisons included ultrasound assessment of SFJ competence, successful axial vein ablation, Aberdeen Varicose Vein Symptom Severity Scores (AVVSS) and a visual analogue patient-satisfaction scale.ResultsAt the 1-year follow-up, EVLA had successfully abolished the target vein reflux (AAGSV: median length 19 cm (inter-quartile range, IQR: 14–24 cm) vs. GSV: 32 cm (IQR 24–42 cm)) and had restored SFJ competence in all patients. Twenty of the 33 patients (61%) in group A and 14 of the 33 (42%) in group B (p = 0.218) required post-ablation sclerotherapy at 6 weeks post-procedure for residual varicosities. The AVVSS at 12 months follow-up had improved from the pre-treatment scores in both the groups (group A: median score 4.1 (IQR 2.1–5.2) vs. 11.6 (IQR: 6.9–15.1) p < 0.001; group B: median score 3.3 (IQR 1.1–4.5) vs. 14.5 (IQR 7.6–20.2), p < 0.001), with no significant difference between the groups. Patient-satisfaction scores were similar (group A: 84% and group B: 90%).Previous intervention in group A included GSV EVLA (n = 3) or stripping (n = 9). Thus, the GSV was preserved in 21 patients. The AVVSS also improved in this subgroup (4.4 (2.0–5.4) vs. 11.4 (6.0–14.1), p < 0.001) and SFJ/GSV competence was found to be restored at the 1-year follow-up.ConclusionsAAGSV EVLA abolishes SFJ reflux, improves symptom scores and is, therefore, suitable for treating varicose veins associated with AAGSV reflux.     

Efficacy and safety of ultrasound-guided foam sclerotherapy combined with endoluminal radiofrequency closure in patients with varicose veins of lower extremities

We aimed to explore the efficacy and safety of ultrasound-guided foam sclerotherapy combined with endoluminal radiofrequency closure in patients with varicose veins of lower extremities (VVLEs); furthermore, we aimed to provide a theoretical basis for the effective management of VVLE patients in clinical work. From January 1, 2020, to March 1, 2021, 88 patients with VVLE admitted to Third Hospital of Shandong Province were included in this retrospective study. Depending on the type of treatment, the patients were divided into study groups and control groups. The study group consisted of 44 patients who were given ultrasound-guided foam sclerotherapy combined with endoluminal radiofrequency closure. The control group consisted of 44 patients who were given high ligation and stripping of the great saphenous vein. Efficacy indicators included postoperative venous clinical severity score (VCSS) of affected limb and postoperative visual analogue scale (VAS) score. Safety indicators included length of operation, intraoperative blood loss, length of postoperative rest in bed, length of hospital stay, postoperative heart rate, preoperative blood saturation (SpO₂), preoperative mean arterial pressure (MAP), and complications. The VCSS score 6 months after operation in the study group was significantly lower than that in the control group (P < .05). The pain VAS score in the study group was significantly lower than that in the control group at 1 and 3 days after operation (both P < .05). Compared with the control group, the study group was significantly lower in length of operation, intraoperative blood loss, postoperative in-bed time, and hospital stays (all P < .05). Heart rate and SpO₂ were significantly higher, and MAP was significantly lower in the study group compared with that in the control group 12 hours after surgery (all P < .05). The overall postoperative complication rate in the study group was significantly lower than that in the control group (P < .05). In conclusion, compared with surgical treatment of high ligation and stripping of the great saphenous vein, ultrasound-guided foam sclerotherapy combined with endoluminal radiofrequency ablation for the treatment of VVLE disease has better efficacy and safety, which is worthy of clinical promotion.     

下肢静脉性溃疡的外科微创治疗

目的探讨下肢静脉性溃疡外科微创治疗的效果。方法对31例(33侧患肢)下肢静脉性溃疡通过静脉造影检查明确引起溃疡的原发病变,根据患肢血流动力学异常的种类和程度对10例(11侧患肢)行高位大隐静脉结扎联合静脉腔内激光治疗术;17例(18侧患肢)行高位大隐静脉结扎联合静脉腔内激光治疗、内镜深筋膜下交通静脉离断术;4例(4侧患肢)行高位大隐静脉结扎联合静脉腔内激光治疗、内镜深筋膜下交通静脉离断和股浅静脉瓣膜包窄术。溃疡一律行周缘环行缝扎。结果术后33侧患肢浅静脉曲张均消失,色素沉着、湿疹样病变均明显减轻;24侧小腿酸胀沉重感、疼痛、水肿12~16d消失;溃疡18~40d内愈合。随访1~36个月,平均14.8月,3侧(9.1%)肢体溃疡复发。结论纠正浅静脉、交通支静脉、深静脉功能不全和重视溃疡创面的处理是治疗下肢静脉性溃疡的有效疗法,静脉腔内激光治疗、内镜深筋膜下交通静脉离断术操作简便、微创、安全,联合股浅静脉瓣膜包窄术可以有效地减少下肢静脉性溃疡的复发。