Rustempasic Nedzad, Cvorak Alemko, Agincic Alija
Clinic for Vascular Surgery, Clinical Center of University of Sarajevo, Sarajevo, Bosnia and Herzegovina.
Clinic for Plastic and Reconstructive Surgery, Clinical Center of University of Sarajevo, Sarajevo, Bosnia and Herzegovna.
Acta Inform Med. 2014 Oct;22(5):329-32. doi: 10.5455/aim.2014.22.329-332. Epub 2014 Oct 29.
In Bosnia and Herzegovina according to available data, treatment of incompetent superficial lower extremity varicose veins by endovenous laser ablation (EVLA) has been introduced two years ago and so far no paper has been published regarding results of EVLA treatment of patients from our country. We wanted to present our results with EVLA treatment.
to evaluate and compare primary posttreatment outcomes of endovenous laser ablation (EVLA) with classical surgical method of varicose vein treatment.
The study was clinical and prospective. It was carried out at Clinic for vascular surgery in Sarajevo where fifty-eight (58) patients received surgical treatment for varicose veins and in Aesthetic Surgery Center "Nasa mala klinika" in Sarajevo were sixty-one (61) patients with varicose veins were treated by endovenous laser ablation. Total 119 patients (limbs) with pathologic reflux only in great saphenous vein were evaluated between 1st of January 2013 and 31st of April 2014. Following primary outcome endpoints were evaluated smean day of return to normal everyday activities, patient subjective quantification of pain during first seven days after intervention, incidence of deep venous thrombosis (DVT), incidence of wound bleeding requiring surgical intervention, incidence of peri-saphenous vein hematoma and infection rate.
Mean of return to normal activities (expressed in days after intervention); EVLA vs. stripping (surgery) =1.21vs12.24, T test 13,619; p=0, 000, p<0,05. T test was used for comparing Mean value of visual pain analog scale for the first 7 days between groups, for all seven days pain was significantly higher in surgical group of patients as compared to EVLA group; p<0,05. Incidence of hematoma greater than 1% of total body surface area was significantly higher in patients receiving surgical treatment; Pearson Chi Square=23,830, p<0,05; odds ratio:10,453. Incidences of infection, deep venous thrombosis and posttreatment bleeding were not statistically different between analyzed groups; EVLA vs Surgery (Pearson Chi Square =3,237; p>0,05; Pearson Chi Square=2,139, p>0,05, Pearson Chi Square=2,139, p>0,05, respectively.).
EVLA offers better patient recovery in terms of significantly lower post treatment pain, faster return to everyday activities and lower incidence of bruising (hematomas).
根据现有数据，在波斯尼亚和黑塞哥维那，两年前开始采用静脉腔内激光消融术（EVLA）治疗下肢浅静脉曲张功能不全，迄今为止，尚未有关于我国患者接受EVLA治疗结果的论文发表。我们希望展示我们采用EVLA治疗的结果。
评估并比较静脉腔内激光消融术（EVLA）与传统静脉曲张手术治疗的术后初期疗效。
本研究为临床前瞻性研究。在萨拉热窝的血管外科诊所，58例患者接受了静脉曲张手术治疗；在萨拉热窝的“我们的小诊所”美容外科中心，61例静脉曲张患者接受了静脉腔内激光消融术治疗。对2013年1月1日至2014年4月31日期间仅大隐静脉存在病理性反流的119例患者（肢体）进行了评估。评估了以下主要结局指标：恢复正常日常活动的平均天数、干预后前七天患者疼痛的主观量化、深静脉血栓形成（DVT）的发生率、需要手术干预的伤口出血发生率、隐静脉周围血肿的发生率以及感染率。
恢复正常活动的平均天数（以干预后的天数表示）；EVLA组与剥脱术（手术）组分别为1.21天和12.24天，T检验值为13,619；p = 0.000，p < 0.05。采用T检验比较两组前七天视觉模拟疼痛量表的平均值，在所有七天里，手术组患者的疼痛明显高于EVLA组；p < 0.05。接受手术治疗的患者中，血肿发生率大于体表面积1%的情况显著更高；Pearson卡方检验值为23,830，p < 0.05；优势比为10,453。分析组之间感染、深静脉血栓形成和治疗后出血的发生率无统计学差异；EVLA组与手术组相比（Pearson卡方检验值分别为3,237；p > 0.05；Pearson卡方检验值为2,139，p > 0.05，Pearson卡方检验值为2,139，p > 0.05）。
就治疗后疼痛显著减轻、更快恢复日常活动以及更低的瘀伤（血肿）发生率而言，EVLA能使患者恢复得更好。
