Sinabulya H, Östmyren R, Blomgren L
Department of Vascular Surgery, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.
Venous Centre, Stockholm, Sweden.
Eur J Vasc Endovasc Surg. 2017 May;53(5):710-716. doi: 10.1016/j.ejvs.2017.02.028. Epub 2017 Apr 10.
The aim of this study was to assess the mid-term ulcer recurrence rate in patients with healed or active venous ulcers treated with endovenous laser ablation (EVLA) for incompetent superficial axial veins and to search for possible risk factors for non-healing and recurrence.
Consecutive patients treated with EVLA because of a healed or active venous ulcer between 2006 and 2013 were identified in the medical records and quality registry and invited to follow-up, including clinical history, study examination, Duplex ultrasound scanning, ankle brachial pressure, photoplethysmography, venous clinical severity score (VCSS), and health related quality of life (HRQoL) measured with EQ5D. Of 228 patients, 170 (195 legs) fulfilled the inclusion criteria. Twenty patients were interviewed by phone, 27 were unreachable and 11 were excluded. Univariate and multivariate regression analyses were performed to identify possible risk factors for recurrence.
The mean follow-up time was 41 months (range 14-89 months). The average age was 66.6 years (range 36-87 years). All 86 legs operated on for an active ulcer had this ulcer healed sometime between the operation and the study examination, but thereafter it recurred in 14 patients (16%). In 109 legs operated on for a healed ulcer, the ulcer recurred in 17 legs (16%). Complications such as permanent sensory loss were seen in 16 legs (8%) and deep venous thrombosis in two legs (1%). Thirty legs (15%) were re-treated for superficial venous incompetence (SVI). Reduced ankle mobility was a risk factor for recurrence in both univariate and multivariate analysis (p=.048).
These midterm results demonstrate that endovenous laser ablation of SVI in patients with healed or active venous ulcers achieves good healing and low ulcer recurrence rates, with a low rate of complications and an acceptable re-intervention rate.
本研究旨在评估接受腔内激光消融术（EVLA）治疗功能不全的浅表轴向静脉的愈合或活动性静脉溃疡患者的中期溃疡复发率，并寻找可能导致不愈合和复发的危险因素。
在病历和质量登记处中识别出2006年至2013年间因愈合或活动性静脉溃疡接受EVLA治疗的连续患者，并邀请他们进行随访，包括临床病史、研究检查、双功超声扫描、踝肱压力、光电容积描记法、静脉临床严重程度评分（VCSS）以及用EQ5D测量的健康相关生活质量（HRQoL）。228例患者中，170例（195条腿）符合纳入标准。通过电话采访了20例患者，27例无法联系到，11例被排除。进行单因素和多因素回归分析以确定可能的复发危险因素。
平均随访时间为41个月（范围14 - 89个月）。平均年龄为66.6岁（范围36 - 87岁）。所有86条因活动性溃疡接受手术的腿在手术至研究检查期间的某个时间溃疡均已愈合，但此后14例患者（16%）复发。在109条因愈合溃疡接受手术的腿中，17条腿（16%）复发。16条腿（8%）出现永久性感觉丧失等并发症，2条腿（1%）出现深静脉血栓形成。30条腿（15%）因浅表静脉功能不全（SVI）接受了再次治疗。在单因素和多因素分析中，踝关节活动度降低均是复发的危险因素（p = 0.048）。
这些中期结果表明，对愈合或活动性静脉溃疡患者进行腔内激光消融治疗SVI可实现良好的愈合和低溃疡复发率，并发症发生率低且再次干预率可接受。
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