Marston William A, Brabham V Wells, Mendes Robert, Berndt Daniel, Weiner Meredith, Keagy Blair
Division of Vascular Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
J Vasc Surg. 2008 Aug;48(2):400-5; discussion 405-6. doi: 10.1016/j.jvs.2008.03.039.
Twenty to thirty percent of patients with symptomatic chronic venous insufficiency (CVI) are found to have combined superficial and deep venous reflux on duplex testing. It is currently unclear whether endovenous ablation (EVA) of the saphenous vein will result in correction of CVI without addressing the deep venous reflux. In this study, we examined deep venous reflux velocities to determine whether these would predict outcome after endovenous ablation.
Patients with symptomatic CVI and both saphenous and deep venous reflux were identified using duplex ultrasonography. Reflux times and maximal reflux velocity (MRV) in each examined vein segment were determined. In each limb, the venous filling index (VFI) and the venous clinical severity score (VCSS) were obtained both before and after laser ablation of the great and/or small saphenous veins. Preoperative venous reflux velocities were correlated with improvement in VFI and VCSS after ablation.
75 limbs with both deep and superficial venous reflux were identified. Seventy-five percent of limbs were CEAP clinical class 3 or 4 and the other 25% were class 5 or 6. Forty limbs demonstrated deep venous reflux in the femoral and/or popliteal vein. After EVA, significant improvements in VFI and VCSS were seen, but this depended on MRV in the deep vein. When MRV in the popliteal or femoral vein was <10 cm/sec, limbs had significantly better outcomes than limbs with MRV >10 cm/sec as measured by both VFI (P = .01) and VCSS (P = .03). In 35 limbs, deep venous reflux was identified only in the CFV. In this group, the average pre-procedure VFI (6.54 +/- 3.9 cc/sec) decreased significantly to 2.2 +/- 1.9 cc/sec (P < .001) and the VCSS improved markedly from 7.0 +/- 2.8 to 1.3 +/- 1.4 (P < .001).
EVA of the saphenous veins can be performed in patients with concomitant deep venous insufficiency with hemodynamic and clinical improvement in most cases. Patients with popliteal or femoral reflux velocities lower than 10 cm/sec usually experience marked improvement in both the VFI and the VCSS. Patients with femoral or popliteal reflux velocities greater than 10 cm/sec have a high incidence of persistent symptoms after EVA.
在有症状的慢性静脉功能不全（CVI）患者中，20%至30%经双功超声检查发现同时存在浅静脉和深静脉反流。目前尚不清楚大隐静脉腔内消融（EVA）在未解决深静脉反流的情况下是否能纠正CVI。在本研究中，我们检测了深静脉反流速度，以确定其是否能预测腔内消融后的结果。
使用双功超声检查确定有症状的CVI且同时存在大隐静脉和深静脉反流的患者。测定每个检查静脉段的反流时间和最大反流速度（MRV）。在每个肢体上，在大隐静脉和/或小隐静脉激光消融前后均获取静脉充盈指数（VFI）和静脉临床严重程度评分（VCSS）。术前静脉反流速度与消融后VFI和VCSS的改善情况相关。
共识别出75条同时存在深静脉和浅静脉反流的肢体。75%的肢体为CEAP临床分级3级或4级，另外25%为5级或6级。40条肢体在股静脉和/或腘静脉存在深静脉反流。EVA后，VFI和VCSS有显著改善，但这取决于深静脉的MRV。当腘静脉或股静脉的MRV<10 cm/秒时，与MRV>10 cm/秒的肢体相比，通过VFI（P = 0.01）和VCSS（P = <0.03）测量，这些肢体的结局明显更好。在35条肢体中，仅在股总静脉（CFV）发现深静脉反流。在该组中，术前平均VFI（6.54±3.9 cc/秒）显著降至2.2±1.9 cc/秒（P < 0.001），VCSS从7.0±2.8明显改善至1.3±1.4（P < 0.001）。
对于同时存在深静脉功能不全的患者，大隐静脉EVA在大多数情况下可改善血流动力学和临床症状。腘静脉或股静脉反流速度低于10 cm/秒的患者，VFI和VCSS通常会有显著改善。股静脉或腘静脉反流速度大于10 cm/秒的患者在EVA后持续存在症状的发生率较高。
