Leeds Vascular Institute, The General Infirmary at Leeds, Leeds LS1 3EX, United Kingdom.
Eur J Vasc Endovasc Surg. 2011 May;41(5):691-6. doi: 10.1016/j.ejvs.2011.01.018. Epub 2011 Feb 26.
This cohort study assesses the effectiveness and safety of endovenous laser ablation (EVLA) in the management of recurrent varicose veins (RVVS).
104 limbs (95 patients) undergoing EVLA for RVVS were grouped according to pattern of reflux. For patients with recurrent SFJ/great saphenous vein (GSV) (Group GR) and SPJ/small saphenous vein (SSV) (Group SR) varicosities ablation rates and QoL (Aberdeen Varicose Vein Severity Scores (AVVSS)) were compared with those for age/sex matched patients undergoing EVLA for primary GSV/SSV dependent varicose veins (Groups GP and SP).
In patients with RVVS the axial vein was ablated in 102/104 (98%) limbs whilst 2 GSVs (group GR) partially recanalised by 3 months (GSV ablated in 49/51 (96%) limbs versus 50/51 (98%) limbs in GP [p = 0.2]). Improvements in AVVSS at 3 months (median GR: 14.2 (inter-quartile range (IQR) 10.2-18.9) to 3.2(1.2-6.4), p < 0.001; GP: median 15.9(IQR 11.4-22.7) to 3.8(1.1-5.6), p < 0.001, Mann-Whitney u-test) were similar (78% versus 76%, p = 0.23). The SSV was ablated in 24/24 limbs in groups SR and SP and the % improvement in AVVSS was 83% (median 14.4 (IQR 8.2-19.4) to 2.4 (1.9-4.6), p < 0.001, Mann-Whitney u-test) and 84% (median 13.8 (IQR 6.3-17.5) to 2.2 (1.2-5.1), p < 0.001) respectively (p = 0.33). These improvements persisted at 1 year follow-up. A further 29 limbs with isolated anterior accessory great saphenous vein (AAGSV) or segmental GSV/SSV reflux were successfully ablated. Complication rates for primary and RVVS were similar.
EVLA is a safe and effective option for the treatment of RVVS and could be a preferred option for suitable patients.
本队列研究评估静脉内激光消融术（EVLA）治疗复发性静脉曲张（RVVS）的有效性和安全性。
104 条肢体（95 例患者）因 RVVS 行 EVLA，根据反流模式分组。对于复发的隐股静脉交界处/大隐静脉（GSV）（GR 组）和隐胫前静脉/小隐静脉（SPJ/SSV）（SR 组）静脉曲张患者，消融率和生活质量（Aberdeen 静脉曲张严重程度评分（AVVSS））与年龄/性别匹配的因原发性 GSV/SSV 相关性静脉曲张行 EVLA 的患者（GP 和 SP 组）进行比较。
在 RVVS 患者中，104 条肢体中的 102 条（98%）行轴向静脉消融，而 2 条 GSV（GR 组）在 3 个月时部分再通（49/51 条肢体消融 GSV[96%]与 GP 组 50/51 条肢体[98%]相比[P=0.2]）。3 个月时 AVVSS 改善（GR 中位数：14.2（四分位距（IQR）10.2-18.9）至 3.2（1.2-6.4），P＜0.001；GP 中位数：15.9（IQR 11.4-22.7）至 3.8（1.1-5.6），P＜0.001，Mann-Whitney u 检验）相似（78%比 76%，P=0.23）。SR 和 SP 组的 24 条肢体均消融 SSV，AVVSS 改善率为 83%（中位数 14.4（IQR 8.2-19.4）至 2.4（1.9-4.6），P＜0.001，Mann-Whitney u 检验）和 84%（中位数 13.8（IQR 6.3-17.5）至 2.2（1.2-5.1），P＜0.001），差异无统计学意义（P=0.33）。这些改善在 1 年随访时仍然存在。另外 29 条肢体存在孤立的前副隐股静脉（AAGSV）或节段性 GSV/SSV 反流，均成功消融。原发性和 RVVS 的并发症发生率相似。
EVLA 是治疗 RVVS 的一种安全有效的方法，可能是适合患者的首选方法。
