Pichot Olivier, Kabnick Lowell S, Creton Denis, Merchant Robert F, Schuller-Petroviae Sanja, Chandler James G
Division of Vascular Medicine, Grenoble University Hospital, 38043 Grenoble Cedex 9, France.
J Vasc Surg. 2004 Jan;39(1):189-95. doi: 10.1016/j.jvs.2003.07.015.
To assess the clinical and duplex ultrasound scan findings in the groin and thigh 2 years after great saphenous vein (GSV) radiofrequency endovenous obliteration (RFO).
Sixty-three limbs in 56 patients with symptomatic varicose veins and GSV incompetence were treated with RFO, usually with adjunctive stab-avulsion phlebectomies, and examined at a median follow-up of 25 months, by using a color-coded, duplex sonography protocol that mandated views in at least two planes of the saphenofemoral junction (SFJ) and its tributaries and at three GSV levels in the thigh.
The commonest duplex finding in the groin was an open, competent, SFJ with a < or =5-cm patent terminal GSV segment conducting prograde tributary flow through the SFJ (82%). Despite the presence of a total of 104 patent junctional tributaries, SFJ reflux was uncommon, affecting only five limbs. GSV truncal occlusion was observed in 90% of treated GSVs. Limited segmental treatment was successful in three limbs with a midthigh reflux source well below competent terminal and subterminal valves. Six GSV trunks had partial or no occlusion, but only one refluxed. These were anatomical RFO failures (9.5%) but were clinically improved, including the refluxing limb. Neovascularity was not identified in any groin. Thigh varicosities were observed in 12 limbs, including telangiectasias and isolated small tributary branches. New varicosities, linked to refluxing thigh perforators (two), or patent SFJ tributaries (three), were present in five limbs.
RFO is the ideological opposite of high ligation without GSV stripping. It leaves physiologic tributary flow relatively undisturbed, does not incite groin neovascularity, eliminates the GSV as a refluxing conduit in >90% of limbs and has a 2-year, postadjunctive phlebectomy varicosity prevalence of 7.9%, with symptom score improvement in 95% of limbs with an initial score higher than zero.
评估大隐静脉（GSV）射频静脉腔内闭塞术（RFO）2年后腹股沟和大腿的临床及双功超声扫描结果。
对56例有症状性静脉曲张且GSV功能不全患者的63条肢体进行RFO治疗，通常辅助采用小切口剥脱式静脉切除术，并在中位随访25个月时进行检查，使用彩色编码双功超声检查方案，要求至少在两个平面观察大隐静脉股静脉交界处（SFJ）及其分支，并在大腿的三个GSV水平进行观察。
腹股沟最常见的双功超声表现是开放、功能正常的SFJ，其终末GSV段通畅且长度≤5 cm，有正向分支血流通过SFJ（82%）。尽管共有104条交界性分支通畅，但SFJ反流并不常见，仅累及5条肢体。90%接受治疗的GSV出现主干闭塞。在3条大腿中段反流源位于功能正常的终末和亚终末瓣膜下方的肢体中，有限节段治疗成功。6条GSV主干部分闭塞或未闭塞，但只有1条出现反流。这些是解剖学上的RFO失败病例（9.5%），但临床症状有所改善，包括出现反流的肢体。腹股沟未发现新生血管。12条肢体观察到大腿静脉曲张，包括毛细血管扩张和孤立的小分支。5条肢体出现与反流性大腿穿通支（2条）或通畅的SFJ分支（3条）相关的新静脉曲张。
RFO与不进行GSV剥脱的高位结扎在理念上相反。它使生理性分支血流相对不受干扰，不引发腹股沟新生血管，在90%以上的肢体中消除了GSV作为反流通道的作用，辅助静脉切除术后2年的静脉曲张患病率为7.9%，初始评分高于零的肢体中95%症状评分有所改善。
