Theivacumar N S, Darwood R J, Gough M J
Leeds Vascular Institute, The General Infirmary at Leeds, Great George Street, Leeds LS1 3EX, UK.
Eur J Vasc Endovasc Surg. 2009 Apr;37(4):477-81. doi: 10.1016/j.ejvs.2008.11.035. Epub 2009 Feb 7.
During surgery for sapheno-femoral junction (SFJ) and anterior accessory great saphenous vein (AAGSV) reflux, many surgeons also strip the great saphenous vein (GSV). This study assesses the short-term efficacy (abolition of reflux on Duplex ultrasound) of endovenous laser ablation (EVLA) of the AAGSV with preservation of a competent GSV in the treatment of varicose veins occurring due to isolated AAGSV incompetence.
Thirty-three patients (21 women and 12 men) undergoing AAGSV EVLA alone (group A) and 33 age/sex-matched controls undergoing GSV EVLA (Group B) were studied. Comparisons included ultrasound assessment of SFJ competence, successful axial vein ablation, Aberdeen Varicose Vein Symptom Severity Scores (AVVSS) and a visual analogue patient-satisfaction scale.
At the 1-year follow-up, EVLA had successfully abolished the target vein reflux (AAGSV: median length 19 cm (inter-quartile range, IQR: 14-24 cm) vs. GSV: 32 cm (IQR 24-42 cm)) and had restored SFJ competence in all patients. Twenty of the 33 patients (61%) in group A and 14 of the 33 (42%) in group B (p=0.218) required post-ablation sclerotherapy at 6 weeks post-procedure for residual varicosities. The AVVSS at 12 months follow-up had improved from the pre-treatment scores in both the groups (group A: median score 4.1 (IQR 2.1-5.2) vs. 11.6 (IQR: 6.9-15.1) p<0.001; group B: median score 3.3 (IQR 1.1-4.5) vs. 14.5 (IQR 7.6-20.2), p<0.001), with no significant difference between the groups. Patient-satisfaction scores were similar (group A: 84% and group B: 90%). Previous intervention in group A included GSV EVLA (n=3) or stripping (n=9). Thus, the GSV was preserved in 21 patients. The AVVSS also improved in this subgroup (4.4 (2.0-5.4) vs. 11.4 (6.0-14.1), p<0.001) and SFJ/GSV competence was found to be restored at the 1-year follow-up.
AAGSV EVLA abolishes SFJ reflux, improves symptom scores and is, therefore, suitable for treating varicose veins associated with AAGSV reflux.
在隐股交界处（SFJ）和大隐静脉前副属支（AAGSV）反流的手术中，许多外科医生也会剥脱大隐静脉（GSV）。本研究评估保留功能正常的GSV的情况下，AAGSV腔内激光消融术（EVLA）治疗因孤立性AAGSV功能不全所致静脉曲张的短期疗效（双功超声检查显示反流消失）。
对33例仅接受AAGSV EVLA的患者（A组，21例女性和12例男性）和33例年龄/性别匹配的接受GSV EVLA的对照患者（B组）进行研究。比较内容包括SFJ功能的超声评估、轴向静脉消融成功情况、阿伯丁静脉曲张症状严重程度评分（AVVSS）以及视觉模拟患者满意度量表。
在1年随访时，EVLA成功消除了目标静脉反流（AAGSV：中位长度19 cm（四分位间距，IQR：14 - 24 cm），GSV：32 cm（IQR 24 - 42 cm）），并使所有患者的SFJ功能恢复正常。A组33例患者中有20例（61%），B组33例中有14例（42%）（p = 0.218）在术后6周因残留静脉曲张需要进行消融后硬化治疗。两组在12个月随访时的AVVSS均较治疗前评分有所改善（A组：中位评分4.1（IQR 2.1 - 5.2），术前为11.6（IQR：6.9 - 15.1），p < 0.001；B组：中位评分3.3（IQR 1.1 - 4.5），术前为14.5（IQR 7.6 - 20.2），p < 0.001），两组间无显著差异。患者满意度评分相似（A组：84%，B组：90%）。A组既往干预措施包括GSV EVLA（n = 3）或剥脱术（n = 9）。因此，21例患者的GSV得以保留。该亚组的AVVSS也有所改善（4.4（2.0 - 5.4），术前为11.4（6.0 - 14.1），p < 0.001），且在1年随访时发现SFJ/GSV功能恢复正常。
AAGSV EVLA可消除SFJ反流，改善症状评分，因此适用于治疗与AAGSV反流相关的静脉曲张。
