Sybrandy Johannes E M, Wittens Cees H A
Department of Vascular Surgery, Sint Franciscus Hospital, Kleiweg 500, 3045 PM Rotterdam, The Netherlands.
J Vasc Surg. 2002 Dec;36(6):1207-12. doi: 10.1067/mva.2002.128936.
The most common site of venous reflux is the long saphenous vein (LSV). The preferred treatment for reflux in the LSV is surgical stripping of the LSV. However, the complications of surgical stripping are well documented and undesirable. The constant search for treatment options with less morbidity, which are also cosmetically more acceptable, has resulted in the endovenous treatment for primary varicose veins, developed by VNUS Medical Technologies, Inc (Sunnyvale, Calif). We hereby present our first treatment experiences and propose refinements to the procedure.
Two types of heat-generating endovenous catheters were used to treat incompetence of the LSV with a diameter of up to 12 mm. The procedure was performed on a blood-empty limb.
Twenty-six limbs, in 26 patients, were treated, and the follow-up period was 1 year. The mean preoperative CEAP score was 4, and the postoperative score was 1.26, which was statistically significantly less (P <.0001, with Wilcoxon nonparametric matched pair test). Five patients had postoperative paresthesia of the saphenous nerve, and one patient had a burn from the procedure. The overall complication rate was 23%. All complications occurred in the first half of the studied population (P =.015, with Fisher exact test), indicating the learning curve effect. In one patient (3.8%), was total recanalization of the treated segment occurred, one patient (3.8%) could not be treated at all (technical failure), and one patient (3.8%) had partial recanalization of the LSV. Eight patients (30.8%) had closure of the entire LSV but with persisting reflux in the saphenofemoral junction (SFJ). Two patients had a competent SFJ with occlusion of the LSV. In 13 patients (50%), closure of both the LSV and the SFJ was seen. The LSV was successfully occluded in 88% of the patients.
The endovenous catheter should not be used more than 5 to 10 cm below the knee to prevent saphenous nerve damage. Performance of the procedure with bloodlessness is preferable. A result of 88% of successfully treated LSV segments indicates a promising alternative for surgical stripping of the LSV.
静脉反流最常见的部位是大隐静脉（LSV）。大隐静脉反流的首选治疗方法是手术剥脱大隐静脉。然而，手术剥脱的并发症已得到充分记录且令人不满意。不断寻求发病率更低且在美容方面更易接受的治疗选择，促使了由VNUS医疗技术公司（加利福尼亚州桑尼维尔）研发的原发性静脉曲张的腔内治疗方法的出现。在此，我们展示我们的首次治疗经验并对该手术提出改进建议。
使用两种产热的腔内导管治疗直径达12毫米的大隐静脉功能不全。该手术在肢体排空血液的状态下进行。
对26例患者的26条肢体进行了治疗，随访期为1年。术前平均CEAP评分为4分，术后评分为1.26分，差异具有统计学意义（P <.0001，采用Wilcoxon非参数配对检验）。5例患者术后出现隐神经感觉异常，1例患者手术过程中出现烧伤。总体并发症发生率为23%。所有并发症均发生在研究人群的前半部分（P =.015，采用Fisher精确检验），表明存在学习曲线效应。1例患者（3.8%）治疗段完全再通，1例患者（3.8%）根本无法治疗（技术失败），1例患者（3.8%）大隐静脉部分再通。8例患者（30.8%）大隐静脉完全闭合，但隐股交界区（SFJ）仍存在反流。2例患者隐股交界区功能正常但大隐静脉闭塞。13例患者（50%）大隐静脉和隐股交界区均闭合。88%的患者大隐静脉成功闭塞。
腔内导管不应在膝关节以下超过5至10厘米处使用，以防止隐神经损伤。在肢体无血状态下进行该手术更佳。88%的大隐静脉段成功治疗的结果表明，这是大隐静脉手术剥脱的一种有前景的替代方法。
