Darke S G, Baker S J A
Vascular Surgery Department, Royal Bournemouth Hospital, Castle Lane East, Bournemouth BH7 7DW, UK.
Br J Surg. 2006 Aug;93(8):969-74. doi: 10.1002/bjs.5423.
The aim was to assess the early efficacy and complications of ultrasound-guided foam sclerotherapy (UGFS) in a cohort of patients with varicose veins.
Of 192 consecutive patients referred with varicose veins over 15 months, only 11 chose surgery; the rest underwent UGFS treatment. Polidocanol was foamed 1 : 3 with air. Under ultrasound control via butterfly or Seldinger cannulation, 1 per cent foam was injected into superficial veins and 3 per cent foam into saphenous trunks, up to a total volume of 14 ml. Outcome was defined as complete when occlusion of the saphenous trunk and/or over 85 per cent of the varicosities was achieved, and partial closure when less.
In 163 legs, complete occlusion occurred after one intervention, a further 32 after a second, and one after a third (overall 91 per cent). Of the remainder, all other legs achieved partial occlusion after up to three interventions, apart from two legs with great saphenous vein (GSV) incompetence, which failed. All 23 legs with small saphenous veins had complete occlusion after one intervention compared with 64 of 97 legs with GSV incompetence (P < 0.010). Occlusion rates were also higher when the GSV was cannulated directly: 56 of 70 versus 8 of 27 (P < 0.001).
UGFS achieved early complete occlusion safely in over 90 per cent of legs with varicose veins.
目的是评估超声引导下泡沫硬化疗法（UGFS）对一组静脉曲张患者的早期疗效及并发症。
在15个月内连续转诊的192例静脉曲张患者中，仅11例选择手术治疗；其余患者接受UGFS治疗。聚多卡醇与空气按1:3制成泡沫。通过蝶形针或Seldinger插管在超声引导下，将1%的泡沫注入浅静脉，3%的泡沫注入隐静脉主干，总量达14毫升。当隐静脉主干和/或85%以上的静脉曲张闭塞时定义为完全闭塞，否则为部分闭塞。
163条腿在一次治疗后完全闭塞，32条腿在第二次治疗后完全闭塞，1条腿在第三次治疗后完全闭塞（总体为91%）。其余患者中，除两条大隐静脉功能不全的腿治疗失败外，其他所有腿在最多三次治疗后均实现部分闭塞。23条小隐静脉的腿在一次治疗后均完全闭塞，而97条大隐静脉功能不全的腿中有64条完全闭塞（P<0.010）。直接插管至大隐静脉时闭塞率也更高：70条腿中有56条，27条腿中有8条（P<0.001）。
UGFS能使超过90%的静脉曲张腿安全地实现早期完全闭塞。
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