Yamaki T, Nozaki M, Sakurai H, Takeuchi M, Soejima K, Kono T
Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666 Japan.
Eur J Vasc Endovasc Surg. 2009 Mar;37(3):343-8. doi: 10.1016/j.ejvs.2008.08.021. Epub 2008 Oct 14.
To compare the proportion of foam sclerosant that enters deep veins between multiple injections of <0.5 ml foam per injection and a few injections of >0.5 ml foam per injection.
DESIGN & METHODS: One hundred and seven patients with superficial venous incompetence were randomised to receive either multiple injections of <0.5 ml 1% polidocanol (POL) -foam (multiple injections) or a few injections of >0.5 ml 1% POL-foam per injection (few injections) for the treatment of varicose tributaries. All patients then received ultrasound-guided foam sclerotherapy for refluxing great saphenous vein (GSV) using 3% POL-foam. Only a single session was allowed per patient in order to standardise treatment. Qualitative ultrasonographic inspection of the foam was carried out during a 5-min period before compression was applied. Post-sclerotherapy surveillance was done at day 3, 2 weeks, 1 month, 3 months, and 6 months.
Fifty-six limbs in 53 patients were treated with multiple injections and the remaining 56 limbs in 54 patients were treated with a few injections. There were no significant differences in age or male:female ratio between the groups. The mean volume of 1% POL-foam was 2.2 S.D. 0.6 ml (range: 0.7-4.0 ml) in the multiple injections group and 2.5 S.D. 0.6 ml (range: 1.0-4.0 ml) in the few injections group (p=0.003). The mean volume of 3% POL was 1.5 ml (range: 0.7-3.0 ml) and 1.4 ml (range: 0.7-3.0 ml), respectively (p=0.137). Ultrasonographic inspection immediately after sclerotherapy demonstrated that foam was distributed significantly more commonly in the deep veins of patients treated with a few injections (p=0.0003). Two (4%) of the patients treated with a few injections developed migraine during the procedure, but recovered quickly with no further complications. There was no significant difference in the success rate between the groups at 6 months (p=0.257).
These findings suggest that multiple small-dose injections can reduce the amount of foam sclerosant and the risk of foam sclerosant entering the deep veins in patients with superficial venous insufficiency.
比较每次注射<0.5 ml泡沫硬化剂多次注射与每次注射>0.5 ml泡沫硬化剂少量注射时进入深静脉的泡沫硬化剂比例。
107例浅静脉功能不全患者被随机分为两组，一组接受每次注射<0.5 ml 1%聚多卡醇（POL）泡沫（多次注射组），另一组接受每次注射>0.5 ml 1% POL泡沫少量注射（少量注射组），用于治疗曲张属支。所有患者随后均接受超声引导下使用3% POL泡沫对大隐静脉（GSV）反流进行硬化治疗。每位患者仅允许接受一次治疗以标准化治疗。在施加压迫前5分钟内对泡沫进行定性超声检查。硬化治疗后在第3天、2周、1个月、3个月和6个月进行随访。
53例患者的56条肢体接受了多次注射治疗，54例患者的其余56条肢体接受了少量注射治疗。两组患者的年龄或男女比例无显著差异。多次注射组1% POL泡沫的平均体积为2.2±0.6 ml（范围：0.7 - 4.0 ml），少量注射组为2.5±0.6 ml（范围：1.0 - 4.0 ml）（p = 0.003）。3% POL的平均体积分别为1.5 ml（范围：0.7 - 3.0 ml）和1.4 ml（范围：0.7 - 3.0 ml）（p = 0.137）。硬化治疗后立即进行的超声检查显示，少量注射组患者的泡沫在深静脉中的分布明显更常见（p = 0.0003）。少量注射组有2例（4%）患者在治疗过程中出现偏头痛，但恢复迅速，无进一步并发症。两组在6个月时的成功率无显著差异（p = 0.257）。
这些发现表明，多次小剂量注射可减少浅静脉功能不全患者的泡沫硬化剂用量及泡沫硬化剂进入深静脉的风险。
