Joh Jin Hyun, Kim Woo-Shik, Jung In Mok, Park Ki-Hyuk, Lee Taeseung, Kang Jin Mo
Department of Surgery, Kyung Hee University Hospital at Gangdong, Seoul.
Department of Cardiothoracic Surgery, National Medical Center, Seoul.
Vasc Specialist Int. 2014 Dec;30(4):105-12. doi: 10.5758/vsi.2014.30.4.105. Epub 2014 Dec 31.
The objective of this paper is to introduce the schematic protocol of radiofrequency (RF) ablation for the treatment of varicose veins.
anatomic or pathophysiologic indication includes venous diameter within 2-20 mm, reflux time ≥0.5 seconds and distance from the skin ≥5 mm or subfascial location. Access: it is recommended to access at or above the knee joint for great saphenous vein and above the mid-calf for small saphenous vein. Catheter placement: the catheter tip should be placed 2.0 cm inferior to the saphenofemoral or saphenopopliteal junction. Endovenous heat-induced thrombosis ≥class III should be treated with low-molecular weight heparin. Tumescent solution: the composition of solution can be variable (e.g., 2% lidocaine 20 mL+500 mL normal saline+bicarbonate 2.5 mL with/without epinephrine). Infiltration can be done from each direction. Ablation: two cycles' ablation for the first proximal segment of saphenous vein and the segment with the incompetent perforators is recommended. The other segments should be ablated one time. During RF energy delivery, it is recommended to apply external compression. Concomitant procedure: It is recommended to do simultaneously ambulatory phlebectomy. For sclerotherapy, it is recommended to defer at least 2 weeks. Post-procedural management: post-procedural ambulation is encouraged to reduce the thrombotic complications. Compression stocking should be applied for at least 7 days. Minor daily activity is not limited, but strenuous activities should be avoided for 2 weeks. It is suggested to take showers after 24 hours and tub baths, swimming, or soaking in water after 2 weeks.
本文的目的是介绍用于治疗静脉曲张的射频消融示意图方案。
解剖学或病理生理学适应症包括静脉直径在2 - 20毫米之间、反流时间≥0.5秒以及距皮肤≥5毫米或位于筋膜下位置。入路：对于大隐静脉，建议在膝关节或其上方入路；对于小隐静脉，建议在小腿中部上方入路。导管放置：导管尖端应放置在隐股或隐腘交界处下方2.0厘米处。静脉内热诱导血栓形成≥III级应使用低分子肝素治疗。肿胀液：溶液的成分可以变化（例如，2%利多卡因20毫升 + 500毫升生理盐水 + 2.5毫升碳酸氢盐，可加或不加肾上腺素）。可从各个方向进行浸润。消融：建议对大隐静脉的第一段近端和有功能不全穿支静脉的节段进行两个周期的消融。其他节段应进行一次消融。在输送射频能量期间，建议施加外部压迫。同期手术：建议同时进行门诊静脉切除术。对于硬化疗法，建议至少推迟2周。术后管理：鼓励术后活动以减少血栓形成并发症。应至少穿戴弹力袜7天。日常轻微活动不受限制，但应避免剧烈活动2周。建议24小时后淋浴，2周后盆浴、游泳或浸泡在水中。
