Puggioni Alessandra, Lurie Fedor, Kistner Robert L, Eklof Bo
Deparment of Research, Straub Foundation Honolulu, Hawaii 96814-1617, USA.
J Vasc Surg. 2003 Sep;38(3):517-21. doi: 10.1016/s0741-5214(03)00413-0.
Deep venous reflux resolution after great saphenous vein surgery has been reported, but the studies evaluated mainly patients with deep segmental reflux. We prospectively analyzed the effects of greater saphenous vein ablation on coexisting primary deep axial venous reflux compared with segmental venous reflux. Patients and methods Between February 1997 and June 2001, patients with primary deep venous reflux scheduled for greater saphenous vein surgery were included in the study. Limbs of patients with a history of deep venous thrombosis, thrombophlebitis, trauma, and orthopedic or venous surgery were excluded. After surgery, duplex scanning was repeated and patients were examined for persistent deep venous reflux.
Thirty-three patients (38 limbs) were followed up with duplex scanning. Follow-up ranged from 2 weeks to 38 months. Preoperative axial deep reflux was present in 17 extremities, and segmental reflux was present in 21. The total number of incompetent segments was 59. Overall reflux abolishment rate was similar in extremities with axial and segmental reflux (30% vs 36%; P >.05). When segments were analyzed individually, abolishment of superficial femoral vein reflux was observed more often in extremities with segmental reflux than those with axial reflux (odds ratio, 4). In the extremities where deep reflux was not abolished with greater saphenous vein ablation, degree of reflux did not change significantly (P >.1). Duplex scanning was performed more than once during follow-up in 9 patients. In 3 of these patients reflux resolved by the second follow-up evaluation, and in 2 reflux was decreased at the second and third follow-up evaluations.
In patients with concomitant deep and superficial venous reflux, saphenous vein ablation results in resolution of deep reflux in about a third of patients. Superficial femoral vein reflux is seldom corrected in limbs with axial reflux compared with those limbs with segmental reflux. To appreciate the effects of greater saphenous vein ablation, longer follow-up may be needed.
已有报道称大隐静脉手术后深静脉反流得到缓解，但这些研究主要评估的是存在深段反流的患者。我们前瞻性地分析了大隐静脉消融术对并存的原发性深轴性静脉反流与节段性静脉反流的影响。
1997年2月至2001年6月期间，计划接受大隐静脉手术的原发性深静脉反流患者被纳入本研究。有深静脉血栓形成、血栓性静脉炎、创伤以及骨科或静脉手术史的患者肢体被排除。术后，重复进行双功超声扫描，并检查患者是否存在持续性深静脉反流。
33例患者（38条肢体）接受了双功超声扫描随访。随访时间为2周至38个月。术前17条肢体存在轴性深反流，21条肢体存在节段性反流。功能不全节段总数为59个。轴性反流和节段性反流肢体的总体反流消除率相似（30%对36%；P>.05）。单独分析节段时，节段性反流肢体比轴性反流肢体更常观察到股浅静脉反流消除（优势比，4）。在大隐静脉消融术后深反流未消除的肢体中，反流程度无显著变化（P>.1）。9例患者在随访期间进行了不止一次双功超声扫描。其中3例患者在第二次随访评估时反流消失，2例患者在第二次和第三次随访评估时反流减少。
在伴有深静脉和浅静脉反流的患者中，大隐静脉消融术可使约三分之一的患者深反流得到缓解。与节段性反流肢体相比，轴性反流肢体的股浅静脉反流很少得到纠正。为了解大隐静脉消融术的效果，可能需要更长时间的随访。
