Yamaki T, Nozaki M, Sakurai H, Takeuchi M, Soejima K, Kono T
Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan.
Eur J Vasc Endovasc Surg. 2009 Jan;37(1):103-8. doi: 10.1016/j.ejvs.2008.10.004. Epub 2008 Nov 17.
To evaluate the efficacy and haemodynamic effects of great saphenous vein (GSV) sparing surgery--valvuloplasty combined with axial transposition of a competent tributary vein (A-VACT).
Eighty-five limbs in 74 patients with isolated GSV incompetence were selected for GSV sparing surgery. After angiographic valvuloplasty, the competent tributary vein was exposed and cut 1.5 cm distal to its insertion point on the GSV. The transected vein was anastomosed end-to-side to the GSV, which was ligated between the tributary insertion site and the anastomosis. Venous valve competence were screened by serial postoperative duplex examination, and venous haemodynamic changes were analyzed using venous filling index (VFI) measured by air plethysmograph pre- and postoperatively. The follow-up period was 5-years.
Sixty-seven patients were included in whom 76 limbs were treated. There was a statistically significant reduction in the vein diameter at the SFJ after 5-years (0.83 S.D. 0.29 cm to 0.46 S.D. 0.12 cm, p=0.0002, Wilcoxon). Similarly, significant reduction was found in the GSV at the 5-year follow-up point (0.63 S.D. 0.19 cm to 0.39 S.D. 0.11 cm, p<0.0001, Wilcoxon). On the other hand, there was significant increase in the diameter of the competent tributary vein postoperatively (0.22 S.D. 0.13 cm to 0.31 S.D. 0.12 cm, p<0.0001, Wilcoxon). Duplex scanning demonstrated reflux at the SFJ in 12 limbs (16%). Similarly, in the GSV, venous reflux was found in 13 limbs (17%). Reflux in the transposed tributary vein was found in 20 limbs (26%). But only 7 limbs (9%) had minor varicose veins' recurrence. VFI remained normal during the follow-up examination. The preoperative VFI confirmed the presence of venous reflux, but there were significant improvement in the VFI values at all postoperative examinations.
A-VACT procedure improves venous function, resolves varicose veins at 5-years follow-up as well as preserving the GSV for future grafting.
评估保留大隐静脉（GSV）手术——瓣膜成形术联合功能正常的属支静脉轴向转位术（A-VACT）的疗效及血流动力学效应。
选取74例单纯GSV功能不全患者的85条肢体行保留GSV手术。在血管造影引导下行瓣膜成形术后，显露功能正常的属支静脉，并在其于GSV上的汇入点远端1.5 cm处切断。将切断的静脉与GSV行端侧吻合，GSV在属支汇入点与吻合口之间予以结扎。术后通过系列双功超声检查筛查静脉瓣膜功能，采用空气容积描记法术前及术后测量静脉充盈指数（VFI）分析静脉血流动力学变化。随访期为5年。
纳入67例患者，共治疗76条肢体。5年后SFJ处静脉直径有统计学意义的减小（0.83标准差0.29 cm至0.46标准差0.12 cm，p = 0.0002，Wilcoxon检验）。同样，在5年随访时GSV也有显著减小（0.63标准差0.19 cm至0.39标准差0.11 cm，p < 0.0001，Wilcoxon检验）。另一方面，术后功能正常的属支静脉直径有显著增加（0.22标准差0.13 cm至0.31标准差0.12 cm，p < 0.0001，Wilcoxon检验）。双功扫描显示12条肢体（16%）的SFJ处有反流。同样，在GSV中，13条肢体（17%）发现静脉反流。转位属支静脉中有20条肢体（26%）发现反流。但只有7条肢体（9%）有轻度静脉曲张复发。随访检查期间VFI保持正常。术前VFI证实存在静脉反流，但术后所有检查时VFI值均有显著改善。
A-VACT手术可改善静脉功能，在5年随访时消除静脉曲张，同时保留GSV以备将来移植使用。
