Riviera Vein Institute, Nice, France.
J Vasc Surg. 2010 Jun;51(6):1442-50. doi: 10.1016/j.jvs.2009.12.065. Epub 2010 Mar 20.
Surgical treatment for varicose recurrence (STVR) involves removing all sources of reflux from the deep venous network to the superficial venous network. STVR is usually more complex and aggressive than first-line treatment by stripping, particularly for redo surgery at the groin (RSG). This retrospective study compared traditional STVR and a less aggressive surgical approach focusing on treatment of the varicose reservoir and avoiding RSG if possible.
Two successive periods of STVR after great saphenous vein stripping were compared: traditional STVR (T1) and STVR focusing on the varicose reservoir (T2). We reviewed postoperative complications and studied the hemodynamic and clinical results.
During T1 and T2, we operated 473 legs in 288 patients (236 women, 52 men) to treat varicose recurrence after great saphenous vein stripping. Mean age was 60.83 years (range, 28-88 years). We operated on 137 patients during T1 and 151 during T2. Patients had similar demographic data, CEAP classification, and Venous Disability Score. Inguinal reflux occurred in 73.9% of T1 patients and in 74.4% of T2 patients. We performed RSG in 66.0% of T1 patients and in 2.2% of T2 patients (P < .05). We did not use echo-guided sclerotherapy in addition to primary STVR. Tumescent local anesthesia was used in 96.2% of STVR in T2 vs 4.0% in T1 (P < .05), and 95.3% of T2 procedures were outpatient vs 13.7% of T1 (P < .05). Outcomes of limbs presenting an inguinal reflux treated with RSG during T1 (group 1) and without RSG during T2 (group 2) were compared. Postoperative complications occurred in 6.7% in group 1 vs 0.5% in group 2 (P < .05), with inguinal complications predominating. The mean cost of the procedure per limb was euro1,195.88 in group 1 vs euro863.08 in group 2 (P < .0001). After 3 years of follow-up, Kaplan-Meier life-table analysis showed group 1 and 2 patients had similar rates of freedom from inguinal reflux (90.8% vs 92.9% survival rate) and from varicose repeat-recurrence (90.8% vs 91.9% survival rate). Group 1 had better results for the Venous Disability Score (0.38 vs 0.58, P = .02) and cosmetic improvement (94.2% vs 84.2%; P = .00032).
STVR focusing on the varicose reservoir and avoiding RSG led to a minimally invasive procedure and a reduction in postoperative complications, with good medium-term clinical and hemodynamic results, particularly for symptoms improvement and cosmetic appearance, with a lower cost vs traditional STVR with RSG.
静脉曲张复发的手术治疗（STVR）包括从深静脉网络到浅静脉网络去除所有反流源。STVR 通常比剥脱术等一线治疗更为复杂和激进，尤其是在腹股沟处进行再次手术（RSG）时。本回顾性研究比较了传统的 STVR 和一种侵袭性较小的手术方法，该方法侧重于治疗静脉曲张储池，并尽可能避免 RSG。
对大隐静脉剥脱术后连续两个时期的 STVR 进行比较：传统 STVR（T1）和侧重于静脉曲张储池的 STVR（T2）。我们回顾了术后并发症，并研究了血流动力学和临床结果。
在 T1 和 T2 期间，我们对 288 例患者的 473 条肢体进行了手术，以治疗大隐静脉剥脱术后的静脉曲张复发。平均年龄为 60.83 岁（范围 28-88 岁）。我们在 T1 期间对 137 例患者进行了手术，在 T2 期间对 151 例患者进行了手术。患者的人口统计学数据、CEAP 分类和静脉残疾评分相似。T1 患者中有 73.9%存在腹股沟反流，T2 患者中有 74.4%存在腹股沟反流。我们在 T1 患者中进行了 66.0%的 RSG，在 T2 患者中进行了 2.2%的 RSG（P<.05）。我们没有在初次 STVR 之外使用回声引导硬化疗法。T2 中 96.2%的 STVR 使用肿胀局部麻醉，而 T1 中为 4.0%（P<.05），95.3%的 T2 手术为门诊手术，而 T1 中为 13.7%（P<.05）。比较了 T1 中接受 RSG 治疗（组 1）和 T2 中未接受 RSG 治疗（组 2）的存在腹股沟反流的肢体的术后并发症。组 1 中术后并发症发生率为 6.7%，组 2 中为 0.5%（P<.05），主要为腹股沟并发症。组 1 每例肢体的手术费用为 1195.88 欧元，组 2 为 863.08 欧元（P<.0001）。经过 3 年的随访，Kaplan-Meier 生存表分析显示组 1 和组 2 的患者腹股沟反流无复发率（90.8%与 92.9%的生存率）和静脉曲张复发无复发率（90.8%与 91.9%的生存率）相似。组 1 的静脉残疾评分（0.38 与 0.58，P=0.02）和美容改善（94.2%与 84.2%；P=0.00032）更好。
侧重于静脉曲张储池并避免 RSG 的 STVR 导致了一种微创程序，并减少了术后并发症，具有良好的中期临床和血流动力学结果，特别是在症状改善和美容外观方面，成本低于传统的 RSG 与 STVR。
