Varcoe Ramon L, Thomas Shannon D, Bourke Victor, Rübesamen Nicole M K, Lennox Andrew F
1 Department of Vascular Surgery, Prince of Wales Hospital, Sydney, Australia.
2 Faculty of Medicine, University of New South Wales, Sydney, Australia.
J Endovasc Ther. 2017 Apr;24(2):290-296. doi: 10.1177/1526602816686734. Epub 2017 Jan 6.
To report the use of adjunctive venography for the treatment of superficial venous reflux.
Two hundred consecutive patients (mean age 60.9 years, range 33-86; 128 women) with chronic venous disease underwent saphenous or perforator vein ablation in 268 limbs (305 venous trunks) guided by adjunctive venography and fluoroscopy in addition to ultrasound between October 2010 and May 2016. Intraprocedural venograms were independently evaluated by 2 vascular specialists to identify the presence of venous anomalies and the need for fluoroscopy-guided maneuvers to successfully complete venous ablation. Intraprocedural venography results were compared with preoperative venous duplex scan reports to ascertain if the duplex study could be of value in identifying preoperatively any anatomical variants that may pose a technical challenge to the operator.
In this cohort, 542 venograms (2.0/limb) were performed with a mean duration of 4.9±9.1 minutes (range 1-48). Two thirds of patients (132, 66%) had anomalies or abnormalities within the target vein; more than a third (88, 44%) required an endovascular maneuver to successfully complete the ablation and 17% (34) of cases were impossible to complete without adjunctive fluoroscopic guidance. Per-patient comparison of intraprocedural venography with preoperative venous duplex reports identified 21 (11%) patients with abnormalities detected on ultrasound (23 anomalies) compared with 123 (64%) on venography (193 anomalies). This gave ultrasound a 17.1% sensitivity, 100% specificity and positive predictive value, and 40.7% negative predictive value.
Venography is a valuable addition to ultrasound to facilitate complete ablation of insufficient saphenous veins in selected patients with complex anatomy.
报告辅助静脉造影在浅表静脉反流治疗中的应用。
2010年10月至2016年5月期间，200例连续的慢性静脉疾病患者（平均年龄60.9岁，范围33 - 86岁；128例女性）在268条肢体（305条静脉主干）中接受了大隐静脉或穿支静脉消融术，除超声检查外，还在辅助静脉造影和荧光透视引导下进行。术中静脉造影由2名血管专科医生独立评估，以确定静脉异常的存在以及是否需要荧光透视引导的操作来成功完成静脉消融。将术中静脉造影结果与术前静脉双功扫描报告进行比较，以确定双功检查在术前识别可能给操作者带来技术挑战的任何解剖变异方面是否有价值。
在该队列中，共进行了542次静脉造影（平均每条肢体2.0次），平均持续时间为4.9±9.1分钟（范围1 - 48分钟）。三分之二的患者（132例，66%）在目标静脉内存在异常或病变；超过三分之一（88例，44%）需要进行血管内操作才能成功完成消融，17%（34例）的病例在没有辅助荧光透视引导的情况下无法完成。将术中静脉造影与术前静脉双功报告进行逐患者比较，发现超声检查出异常的患者有21例（11%）（23处异常），而静脉造影检查出异常的患者有123例（64%）（193处异常）。这使得超声的敏感性为17.1%，特异性和阳性预测值为100%，阴性预测值为40.7%。
对于解剖结构复杂的特定患者，静脉造影是超声检查的重要补充，有助于完全消融功能不全的大隐静脉。
