Dzieciuchowicz Łukasz, Krasiński Zbigniew, Kruszyna Łukasz, Espinosa Gaudencio
Department of Angiology and Vascular Surgery, Navarra University Hospital, Pamplona, Spain.
Ann Vasc Surg. 2013 Apr;27(3):322-8. doi: 10.1016/j.avsg.2012.04.021. Epub 2012 Oct 23.
To compare the level of difficulty of four techniques of endovenous thermal ablation (EVTA) of the great saphenous vein and the echogenicity of the tip of the working device in vivo.
Sixty patients qualified to the EVTA of the great saphenous vein were randomly assigned to treatment with an 810-nm axial diode laser [endovenous laser ablation (EVLA) 810] with two different delivery systems: 4-F introducer, 0.018" guidewire, 22-G needle (EVLA810-1) and 4-F introducer, 0.035" guidewire, 19-G needle (EVLA810-2); a 1470-nm radial diode laser (EVLA1470); or radiofrequency ablation (RFA; ClosureFAST). The level of difficulty of four stages of the procedure-cannulation of a vein, advancement of the working part to the saphenofemoral junction (SFJ), visualization of a tip of the working part at SFJ, and difficulty of performing the ablation and delivering the planned linear energy density-was subjectively assessed. An objective comparison of visibility of working parts in ultrasonography was performed with analysis of grayscale median.
The cannulation of a distal segment of the obliterated vein was the most difficult in EVLA810-1, P = 0.015. The delivery of a working part to the SFJ was the least problematic in RFA and EVLA1470, P = 0.024. The visualization of the working tip at the SFJ was the most difficult in RFA, P = 0.028. The application of desired amount of energy was the easiest in RFA, P = 0.038. The EVLA1470 presented the best echogenicity.
Although all the examined techniques have advantages and disadvantages, EVTA with the 1470-nm diode laser with radial optic fiber seems to be the easiest.
比较大隐静脉腔内热消融（EVTA）的四种技术的难度水平以及工作器械尖端在体内的回声性。
60例符合大隐静脉EVTA条件的患者被随机分配接受使用810纳米轴向二极管激光的治疗[810纳米腔内激光消融（EVLA）]，采用两种不同的输送系统：4F导管鞘、0.018英寸导丝、22G穿刺针（EVLA810 - 1）和4F导管鞘、0.035英寸导丝、19G穿刺针（EVLA810 - 2）；1470纳米径向二极管激光（EVLA1470）；或射频消融（RFA；ClosureFAST）。对操作的四个阶段——静脉置管、将工作部件推进至隐股交界处（SFJ）、在SFJ处观察工作部件尖端以及进行消融和输送计划的线能量密度的难度——进行主观评估。通过灰度中位数分析对超声检查中工作部件的可视性进行客观比较。
在EVLA810 - 1中，闭塞静脉远段的置管最为困难，P = 0.015。在RFA和EVLA1470中，将工作部件输送至SFJ的问题最少，P = 0.024。在RFA中，在SFJ处观察工作尖端最为困难，P = 0.028。在RFA中，施加所需能量最容易，P = 0.038。EVLA1470呈现出最佳的回声性。
尽管所有检查的技术都有优缺点，但使用带径向光纤的1470纳米二极管激光进行EVTA似乎是最容易的。
