Weinmann Eran E, Poluksht Natan, Chayen David, Bass Arie
Department of Vascular Surgery, Assaf Harofeh Medical Center, Zerifin, Israel.
Vasc Endovascular Surg. 2003 Mar-Apr;37(2):111-5. doi: 10.1177/153857440303700205.
Chronic venous insufficiency, which traditionally has been attributed to failure of the deep venous system, may result from reflux in the superficial venous system. Chronic venous insufficiency is common in elderly patients, but surgical treatment is seldom offered to this patient population. We evaluated the results of superficial venous surgery for the treatment of severe chronic venous insufficiency in a cohort of elderly patients. The authors assessed patients aged 70 years or more with chronic venous insufficiency that had failed conventional conservative treatment. The superficial and deep venous systems were thoroughly investigated by duplex ultrasonography. Associated medical conditions were reevaluated and their treatment optimized. Twenty-eight patients (11 men, 17 women), aged between 70 and 89 years (mean 79), underwent superficial venous surgery. Open ulcers, active dermatitis and recurrent erysipelas were evident in 12, 9 and 7 patients, respectively. Limb swelling and severe pain were present in 25 (89%). The operations were performed under general or regional anesthesia with overnight hospitalization. Surgical treatment consisted of ligation of the points of reflux at the junctions of the superficial and deep systems, as defined by the duplex examination (21 saphenofemoral junctions, 5 saphenopopliteal junctions, 10 perforator veins), and stripping of the long saphenous vein to knee level (15 patients). Postoperative ambulatory treatment was continued until the wounds were completely closed. All ulcers healed completely within 8 weeks. No cardiac, respiratory, or renal complications were encountered. Wound infection at the groin occurred in 1 patient. Cellulitis of the calf area developed in 4 patients. Two ulcers recurred during follow-up of 1 to 5 years (mean 2.5). Surgery of the superficial venous system for treatment of severe chronic venous insufficiency is effective and can be achieved with minimal morbidity in selected elderly patients. The risk/benefit ratio for this procedure has been reduced sufficiently to ensure a major improvement in the quality of life of such patients.
传统上一直被认为是深静脉系统功能衰竭所致的慢性静脉功能不全，可能是由浅静脉系统反流引起的。慢性静脉功能不全在老年患者中很常见，但很少对这一患者群体进行手术治疗。我们评估了浅静脉手术治疗老年患者严重慢性静脉功能不全的效果。作者评估了年龄在70岁及以上、经传统保守治疗无效的慢性静脉功能不全患者。通过双功超声对浅静脉和深静脉系统进行了全面检查。对相关内科疾病进行了重新评估，并优化了治疗方案。28例患者（11例男性，17例女性），年龄在70至89岁之间（平均79岁），接受了浅静脉手术。分别有12例、9例和7例患者存在开放性溃疡、活动性皮炎和复发性丹毒。25例（89%）患者存在肢体肿胀和严重疼痛。手术在全身麻醉或区域麻醉下进行，患者需住院过夜。手术治疗包括根据双功检查确定的浅静脉和深静脉系统交界处反流点的结扎（21个大隐静脉股静脉交界处、5个小隐静脉腘静脉交界处、10个穿支静脉），以及将大隐静脉剥脱至膝关节水平（15例患者）。术后持续门诊治疗直至伤口完全愈合。所有溃疡在8周内完全愈合。未出现心脏、呼吸或肾脏并发症。1例患者腹股沟出现伤口感染。4例患者小腿区域发生蜂窝织炎。在1至5年（平均2.5年）的随访中有2例溃疡复发。浅静脉系统手术治疗严重慢性静脉功能不全是有效的，并且在选定的老年患者中可以实现最低的发病率。该手术的风险/收益比已充分降低，足以确保此类患者的生活质量得到显著改善。
