Theivacumar N S, Darwood R J, Dellagrammaticas D, Mavor A I D, Gough M J
Leeds Vascular Institute, The General Infirmary at Leeds, Great George Street, Leeds LS1 3EX, UK.
Phlebology. 2009 Feb;24(1):17-20. doi: 10.1258/phleb.2008.008004.
The standard technique for endovenous laser ablation (EVLA) for varicose veins due to great saphenous vein (GSV) reflux involves obliteration of the above-knee (AK) GSV. This study assesses the significance of persistent below-knee (BK) GSV reflux following such therapy.
Sixty-nine limbs (64 patients) with varicosities and GSV reflux underwent AK-EVLA. Post treatment, GSV reflux (ultrasound: six, 12 weeks) and Aberdeen varicose vein severity scores (AVVSS, 12 weeks) were assessed, and residual varicosities treated with foam sclerotherapy (six weeks).
The untreated BK-GSV remained patent in all limbs. Ultrasound showed normal antegrade flow in 34/69 (49%, Group A), flash reflux<1 s in 7/69 (10%, Group B) and >1 s reflux in 28/69 (41%, Group C). Although AVVSS improved in all groups (P<0.001): A: 14.6 (8.4-19.3) versus 2.8 (0.5-4.4), B: 13.9 (7.5-20.1) versus 3.7 (2.1-6.8), C: 15.1 (8.9-22.5) versus 8.1 (5.3-12.6) the improvement was less in Group C (P<0.001 versus A and B) and was associated with a greater requirement (A: 4/34 [12%]; B: 1/7 [14%]; C: 25/28 [89%]) for sclerotherapy (persisting varicosities) (P<0.001).
Although AK-GSV EVLA improves symptoms regardless of persisting BK reflux, the latter appears responsible for residual symptoms and a greater need for sclerotherapy for residual varicosities.
大隐静脉（GSV）反流所致静脉曲张的腔内激光消融术（EVLA）标准技术包括闭塞膝上（AK）段大隐静脉。本研究评估该治疗后持续存在的膝下（BK）大隐静脉反流的意义。
69条肢体（64例患者）患有静脉曲张且存在大隐静脉反流，接受了膝上腔内激光消融术。治疗后，评估大隐静脉反流情况（超声检查：术后6周、12周）以及阿伯丁静脉曲张严重程度评分（AVVSS，术后12周），并用泡沫硬化疗法治疗残留静脉曲张（术后6周）。
所有肢体中未治疗的膝下段大隐静脉均保持通畅。超声检查显示，34/69（49%，A组）的静脉呈正常顺行血流，7/69（10%，B组）的静脉出现<1秒的快速反流，28/69（41%，C组）的静脉出现>1秒的反流。尽管所有组的阿伯丁静脉曲张严重程度评分均有所改善（P<0.001）：A组从14.6（8.4 - 19.3）降至2.8（0.5 - 4.4），B组从13.9（7.5 - 20.1）降至3.7（2.1 - 6.8），C组从15.1（8.9 - 22.5）降至8.1（5.3 - 12.6），但C组的改善较小（与A组和B组相比，P<0.001），且与更高的硬化疗法需求相关（A组：4/34 [12%]；B组：1/7 [14%]；C组：25/28 [89%]）（残留静脉曲张）（P<0.001）。
尽管膝上大隐静脉腔内激光消融术可改善症状，无论膝下反流是否持续存在，但后者似乎是导致残留症状以及对残留静脉曲张更需要硬化疗法的原因。
