Proebstle Thomas M, Krummenauer Frank, Gül Doendue, Knop Juergen
Department of Dermatology, University of Mainz, Mainz, Germany.
Dermatol Surg. 2004 Feb;30(2 Pt 1):174-8. doi: 10.1111/j.1524-4725.2004.30051.x.
Parameters influencing failure and recanalization rates of endovenous laser treatment (ELT) of the great saphenous vein (GSV) are still to be determined.
To evaluate treatment-related parameters of ELT with respect to early failure of occlusion or recanalization of GSVs.
A series of 77 consecutive patients received ELT of 106 GSVs with continuous pullback of the laser fiber. Duplex examination was performed at 1 day, 4 weeks, and 3 months after the procedure. Clinical patient and vessel characteristics as well as technical parameters of the ELT procedure were evaluated via multiple logistic regression analysis.
A median vein length of 60 cm (range of 18 to 90) was treated with a median pullback velocity of 0.6 cm/sec (range of 0.4 to 1.3), resulting in a median energy delivery of 23.4 J/cm (range of 11.8 to 35.5) and a median laser fluence of 11.8 J/cm2 (range of 2.8 to 37.3). At day 1 after ELT, 6 GSVs (6%) were not occluded. At 1 and 3 months after ELT, 9 GSVs (9%) and 11 GSVs (10%), respectively, were found open by color duplex examination. Risk factors for nonocclusion 3 months after ELT, by univariate analysis, were laser fluence, laser energy per centimeter of vein length, diameter of the vein before treatment, and distance of the thrombus to the sapheno-femoral junction at day 1 after treatment. Finally, multiple regression analysis selected laser fluence (p=0.004, odds ratio=0.40 J/cm2) as the relevant risk factor for ELT failure or recanalization.
ELT failure seems to be related to the administration of low laser fluences.
影响大隐静脉腔内激光治疗（ELT）失败率和再通率的参数仍有待确定。
评估大隐静脉腔内激光治疗中与早期闭塞失败或再通相关的治疗参数。
连续77例患者接受了106条大隐静脉的腔内激光治疗，激光光纤持续回撤。术后1天、4周和3个月进行双功超声检查。通过多元逻辑回归分析评估临床患者和血管特征以及腔内激光治疗的技术参数。
治疗的大隐静脉中位长度为60cm（范围18至90cm），中位回撤速度为0.6cm/秒（范围0.4至1.3cm/秒），中位能量输送为23.4J/cm（范围11.8至35.5J/cm），中位激光能量密度为11.8J/cm²（范围2.8至37.3J/cm²）。腔内激光治疗后1天，6条大隐静脉（6%）未闭塞。腔内激光治疗后1个月和3个月，分别有9条大隐静脉（9%）和11条大隐静脉（10%）经彩色双功超声检查发现通畅。单因素分析显示，腔内激光治疗后3个月未闭塞的危险因素包括激光能量密度、每厘米静脉长度的激光能量、治疗前静脉直径以及治疗后1天血栓与隐股交界处的距离。最终，多元回归分析选择激光能量密度（p=0.004，比值比=0.40J/cm²）作为腔内激光治疗失败或再通的相关危险因素。
腔内激光治疗失败似乎与低激光能量密度的应用有关。
