Bush Ronald G, Shamma H Nicholas, Hammond Karin
Midwest Vein and Laser Center, 8101 Miller Farm Lane, Dayton, Ohio 45459, USA.
Lasers Surg Med. 2008 Dec;40(10):676-9. doi: 10.1002/lsm.20722.
Endovenous laser ablation of the saphenous vein was studied from a histologic analysis to establish changes that occur from time of injury to 4 months when the vein is difficult to visualize by ultrasound.
Twenty-four patients were examined after treatment with either a 1319 nm diode laser (Sciton, Palo Alto, CA) or a 940 nm diode (Dornier, Kennasaw, GA) 12 patients were randomly assigned to the 940 nm group and 12 patients to the 1319 nm group. Histologic evaluations were only done once per patient. All patients had symptomatic saphenous insufficiency with varicosities. All were in CEAP class 3 or 4. Sections of treated veins were submitted for evaluation after staining with hematoxylin-eosin. The evaluations were done acutely, at 1 and 4 months. Ultrasound findings were also evaluated and compared at the same intervals.
Acutely, all examined veins revealed loss of intima. In the 1319 nm group numerous vacuoles were present in the subintimal layer. On gross exam at 1 month, both groups showed vein wall thickening, intraluminal thrombus and inflammatory changes. Histologic evaluation showed thrombus was present with many fibroblasts and inflammatory cells. At 4 months, collagen was the predominant histologic finding. However, the changes were less in regards to the injury response with the 1,319 nm group as manifested by less collagen deposition at 4 months.
This study demonstrates the cellular sequence that occurs after endovenous ablation. Fibroblast infiltration is a result of the injury response which leads to negative modeling of the thrombus and eventual collagen deposition. Replacement of the thrombus with collagen is necessary for eventual long-term success.
通过组织学分析研究大隐静脉腔内激光消融术后从损伤时到4个月（此时静脉难以通过超声显影）所发生的变化。
24例患者接受了1319纳米二极管激光（Sciton公司，加利福尼亚州帕洛阿尔托）或940纳米二极管激光（多尼尔公司，佐治亚州肯尼索）治疗。12例患者随机分配至940纳米组，12例患者分配至1319纳米组。每位患者仅进行一次组织学评估。所有患者均有症状性大隐静脉功能不全伴静脉曲张。均为CEAP分级3级或4级。经苏木精-伊红染色后，将治疗后的静脉切片送检评估。评估分别在术后即刻、1个月和4个月进行。同时，在相同时间间隔评估并比较超声检查结果。
术后即刻，所有检查的静脉均显示内膜缺失。在1319纳米组，内膜下层有大量空泡。在1个月时大体检查发现，两组均显示静脉壁增厚、管腔内血栓形成及炎症改变。组织学评估显示血栓伴有许多成纤维细胞和炎症细胞。在4个月时，胶原是主要的组织学表现。然而，1319纳米组在损伤反应方面的变化较小，表现为4个月时胶原沉积较少。
本研究展示了腔内消融术后发生的细胞序列。成纤维细胞浸润是损伤反应的结果，导致血栓的负向重塑并最终形成胶原沉积。用胶原替代血栓是最终长期成功的必要条件。
