Department of Imaging, Division of Vascular Imaging and Intervention, Massachusetts General Hospital-Harvard Medical School, 55 Fruit Street, GRB-290, Boston, MA 02114-2696, USA.
Cardiovasc Intervent Radiol. 2010 Aug;33(4):766-71. doi: 10.1007/s00270-010-9806-1. Epub 2010 Jan 20.
To assess outcomes after endovenous laser ablation (EVLA) of the small saphenous vein (SSV). Retrospective review was performed of all consecutive EVLA procedures performed over a 39-month period at three neighboring vein practices for symptomatic, duplex ultrasound-proven incompetence of the SSV. EVLA was performed under ultrasound guidance with an 810- or 980-nm diode laser in continuous mode using the pullback method while sparing the deep, most cephalad segment of the SSV near the saphenopopliteal junction. Follow-up after EVLA included patient symptoms, physical examination, and duplex ultrasound. Pretreatment variables were similar across all three practices. EVLA was performed to treat 67 incompetent SSVs in 63 patients (86% women; mean age and 95% confidence interval, 50 +/- 3 years; range, 20-82 years). Average energy delivered was 92 J/cm. Immediate technical success and occlusion of the treated vein at 1-2 weeks was 100%. Imaging follow-up length was 243 +/- 65 days (range, 3-893 days). Clinical follow-up (243 +/- 66 days) showed symptomatic improvement in 66 (99%) of 67 patients; one patient had recanalization with recurrent reflux by ultrasound (2%). Complications included one case of paresthesias lasting beyond 1 month of follow-up (2%) and three cases of superficial phlebitis (4%), but no deep vein thrombosis, skin burns, or other complications. Although ablation involved only the superficial portion of the SSV and spared its deep segment in the popliteal fossa, SSV occlusion typically extended up to the saphenopopliteal junction or to a gastrocnemial collateral, without popliteal vein involvement. EVLA of the SSV is safe and effective when the saphenopopliteal junction and popliteal fossa are avoided. This approach may help reduce the risk of paresthesias or other complications while maintaining low recanalization rates.
评估静脉内激光消融（EVLA）治疗小隐静脉（SSV）后的结果。对三个相邻静脉诊所 39 个月期间进行的所有连续 EVLA 手术进行回顾性审查，这些手术均针对 SSV 症状性、超声双功能检查证实的功能不全。EVLA 在超声引导下进行，使用 810nm 或 980nm 二极管激光，以连续模式使用后退法，同时保留 SSV 近隐股静脉交界处的深部、最头侧段。EVLA 后的随访包括患者症状、体格检查和超声双功能检查。所有三个诊所的预处理变量相似。进行 EVLA 是为了治疗 63 名患者的 67 条功能不全的 SSV（86%为女性；平均年龄和 95%置信区间为 50 +/- 3 岁；范围为 20-82 岁）。平均输送能量为 92J/cm。即时技术成功率和治疗后静脉 1-2 周闭塞率为 100%。影像学随访时间为 243 +/- 65 天（范围为 3-893 天）。临床随访（243 +/- 66 天）显示 67 例患者中有 66 例（99%）症状改善；1 例患者在超声检查中出现再通和再反流（2%）。并发症包括 1 例随访超过 1 个月的感觉异常（2%）和 3 例浅静脉炎（4%），但无深静脉血栓形成、皮肤烧伤或其他并发症。尽管消融仅涉及 SSV 的浅层部分，并在腘窝中保留其深层部分，但 SSV 闭塞通常延伸至隐股静脉交界处或小腿肌侧支，而不涉及隐静脉。当避免隐股静脉交界处和腘窝时，SSV 的 EVLA 是安全有效的。这种方法可以在保持较低再通率的同时，有助于降低感觉异常或其他并发症的风险。
