改良导管法联合经皮注射硬化治疗下肢静脉曲张

目的探讨改良导管法联合经皮注射硬化治疗大隐静脉曲张的临床疗效。方法收集我科泡沫硬化治疗下肢静脉曲张患者110例,CEAP分级2~6级。在普通导管法硬化治疗下肢静脉曲张的基础上加以改良,采用球囊导管替代普通导管行下肢静脉曲张硬化治疗,即经健侧股静脉穿刺,引入球囊导管翻山至患侧大隐静脉主干中下段,充盈球囊阻断大隐静脉回流后,采用聚桂醇泡沫硬化剂行大隐静脉主干及属支治疗;联合经皮注射巩固治疗。术后第2天观察患肢大隐静脉曲张症状、体征改善程度及并发症,第3天彩超复查曲张静脉闭合率。术后第2周、3个月、6个月及1年门诊随访复查,重点观察疗效、相关并发症及复发率。症状、体征改善,曲张静脉闭合为治疗有效或成功。结果 110例患者均1次治疗成功,每条患肢平均应用泡沫硬化剂32.4 ml(相当于聚桂醇原液8.2 ml)。全部患者术后当天患肢酸胀、乏力及浅静脉突起明显改善;术后第3天彩超复查示大隐静脉主干及曲张属支血流信号消失,闭合率100%。其中8例伴小腿皮肤湿疹者术后2周缓解,3例伴顽固性溃疡者半年后愈合。不良反应:术后1周内出现浅静脉炎11例,皮肤硬结、色素沉着9例。随访1年,无患者出现深静脉血栓、肺动脉栓塞等并发症;无患者静脉曲张复发。结论改良导管法联合经皮注射硬化治疗下肢静脉曲张,大隐静脉主干及分支闭合率较高,症状及体征改善明显,并发症少。该治疗方法微创、安全,疗效明确,值得临床推广。

Efficacy of balloon catheter-assisted sclerotherapy with direct injection into the great saphenous varicosity

Objective To assess the efficacy of balloon catheter-assisted sclerotherapy with direct injection into the great saphenous varicosity.Methods 110 patients with lower limb varicosity were treated with direct injection of foam sclerosant into the great saphenous varicose veins through a balloon catheter to prevent backflow of the foam sclerosant.The contralateral femoral vein was punctured and a balloon catheter was introduced to the great saphenous vein of the affected side.After blocking the blood flow by inflating the balloon,the foam sclerosant was injected to the great saphenous vein guided by digital subtraction angiography.The symptoms,signs and complication were recorded on the 2nd day followed by color Doppler US on the 3rd day.The patients were followed up clinically at 2 weeks,3 months,6 months,and 1 year.Results The average volume of foam sclerosant injected in each limb was 32.4 mL equivalent to 8.2 mL of polidocanol liquid.The symptoms including lower limb pain,fatigue,and varicosity after prolonged standing were alleviated on the day after the treatment.Follow-up color Doppler US showed occlusion of the trunk and branches of the great saphenous varicose veins without blood flow in all patients.Eczema in the lower limbs of 8 patients resolved after 2 weeks.Three patients with intractable ulcers were healed after 6 months.Complications included phlebitis (11),subcutaneous sclerosis and pigmentation (9).No deep vein thrombosis or pulmonary embolism was observed.There was no recurrence of varicose at 1 year follow-up.Conclusion The new approach using direct injection of foam sclerosant into the great saphenous varicosity through a balloon catheter has higher occlusion rate of the great saphenous vein trunk and branches with marked symptom relief and few adverse reactions.