Welch Harold J
Department of Vascular Surgery, Lahey Clinic and Tufts University School of Medicine, MA, USA.
J Vasc Surg. 2006 Sep;44(3):601-5. doi: 10.1016/j.jvs.2006.06.003.
Endovenous ablation of the great saphenous vein (GSV) may be performed simultaneously with stab phlebectomy of branch varicose veins or as a stand-alone procedure. A clinical approach of performing radiofrequency ablation (RFA) alone as initial treatment for varicose veins was reviewed.
Patients with duplex ultrasound-documented reflux in the GSV and CEAP clinical stage 2 to 6 were selected for RFA. Patients were examined within a week preoperatively with duplex ultrasound imaging. Patients were seen within a week postoperatively and again at 2 to 3 months to ascertain if further treatment was required. A retrospective review of the initial 184 procedures in a series from June 2002 through February 2005 was performed, allowing for a 9-month follow-up period.
Three procedures were performed under general anesthesia and 181 with intravenous sedation and tumescent anesthesia. Postoperative duplex scans showed total occlusion or partial patency of <10 cm in 155 limbs. Seven (4.5%) had concomitant stab phlebectomy, seven subsequently had sclerotherapy, and 39 (25.2%) underwent subsequent stab phlebectomy of persistent symptomatic varicosities. In 101 limbs (65.1%), symptoms resolved and had no further therapy, and 24 limbs had a GSV that was patent for >10 cm on postoperative duplex imaging. Nine limbs had no further therapy (37.5%), eight (33.3%) had subsequent stab phlebectomy, and three had stripping of the GSV and stab phlebectomy. Four limbs had a redo RFA, four limbs had an aborted RFA procedure, and one limb was lost to follow-up. Failure of total GSV occlusion was more often associated with use of a 6F catheter. Complications were generally mild, and there was no postoperative deep vein thrombosis.
Endovenous ablation of the GSV can be performed safely and effectively as the initial treatment for lower extremity varicose veins. Because most patients show clinical improvement after RFA, an algorithm of reassessment of the limb and branch varicose veins several months post-RFA allows most patients to defer stab phlebectomy.
大隐静脉（GSV）腔内消融可与分支静脉曲张的点状静脉切除术同时进行，也可作为独立手术。本文回顾了一种仅采用射频消融（RFA）作为静脉曲张初始治疗方法的临床路径。
选择经双功超声检查证实GSV存在反流且临床CEAP分级为2至6级的患者进行RFA。术前一周内对患者进行双功超声成像检查。术后一周内对患者进行检查，并在2至3个月后再次检查，以确定是否需要进一步治疗。对2002年6月至2005年2月期间一系列的最初184例手术进行回顾性分析，随访期为9个月。
3例手术在全身麻醉下进行，181例采用静脉镇静和肿胀麻醉。术后双功扫描显示155条肢体的GSV完全闭塞或部分通畅长度<10 cm。7例（4.5%）同时进行了点状静脉切除术，7例随后接受了硬化治疗，39例（25.2%）因持续性有症状的静脉曲张而接受了后续点状静脉切除术。101条肢体（65.1%）症状缓解且无需进一步治疗，24条肢体的GSV在术后双功成像中通畅长度>10 cm。9条肢体无需进一步治疗（37.5%），8条（33.3%）随后接受了点状静脉切除术，3条进行了GSV剥脱术和点状静脉切除术。4条肢体进行了再次RFA，4条肢体的RFA手术中止，1条肢体失访。GSV完全闭塞失败更常与使用6F导管有关。并发症一般较轻，且未发生术后深静脉血栓形成。
GSV腔内消融作为下肢静脉曲张的初始治疗方法可安全有效地进行。由于大多数患者在RFA后临床症状改善，因此在RFA后数月对肢体和分支静脉曲张进行重新评估的流程可使大多数患者推迟点状静脉切除术。
