Patel Premal A, Barnacle Alex M, Stuart Sam, Amaral Joao G, John Philip R
Image Guided Therapy, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
Interventional Radiology, Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK.
Pediatr Radiol. 2017 Sep;47(10):1353-1363. doi: 10.1007/s00247-017-3863-4. Epub 2017 May 18.
Endovenous laser ablation is well recognized as the first-line treatment for superficial venous reflux with varicose veins in adults. It is not widely reported and is not an established practice in pediatric patients.
To illustrate a variety of pediatric venous conditions in which endovenous laser ablation can be utilized and to demonstrate its feasibility and safety in children.
We conducted a retrospective review of endovenous laser ablation procedures performed between January 2007 and July 2014 at two large pediatric institutions.
We included 35 patients (17 males) who underwent endovenous laser ablation to 43 veins. Median age at first treatment was 14 years (range: 3-18 years). Median weight was 56 kg (range: 19-97 kg). Underlying diagnoses were common venous malformation (15), Klippel-Trenaunay syndrome (8), superficial venous reflux with varicose veins (5), verrucous hemangioma-related phlebectasia (4), venous varix (2) and arteriovenous fistula (1). The most common aim of treatment was to facilitate sclerotherapy. Thirty-four patients had treatment in the lower limbs and one patient in an upper limb. Ten of the veins treated with endovenous laser ablation had an additional procedure performed to close the vein. Complications attributable to endovenous laser ablation occurred in two patients (6%). One patient experienced post-procedural pain and one patient developed a temporary sensory nerve injury. Median clinical follow-up was 13 months (range: 28 days-5.7 years). The aim of the treatment was achieved in 29 of the 35 (83%) patients.
Endovenous laser ablation is technically feasible and safe in children. It can be used in the management of a range of pediatric venous diseases with good outcomes.
静脉腔内激光消融术是公认的治疗成人浅表静脉反流伴静脉曲张的一线治疗方法。但在儿科患者中，其报道并不广泛，也未成为既定的治疗方法。
阐述多种可应用静脉腔内激光消融术的儿科静脉疾病，并证明其在儿童中的可行性和安全性。
我们对2007年1月至2014年7月在两家大型儿科机构进行的静脉腔内激光消融手术进行了回顾性研究。
我们纳入了35例患者（17例男性），对43条静脉进行了静脉腔内激光消融术。首次治疗时的中位年龄为14岁（范围：3 - 18岁）。中位体重为56千克（范围：19 - 97千克）。潜在诊断包括常见静脉畸形（15例）、克-特综合征（8例）、浅表静脉反流伴静脉曲张（5例）、疣状血管瘤相关静脉扩张（4例）、静脉瘤（2例）和动静脉瘘（1例）。最常见的治疗目的是辅助硬化治疗。34例患者在下肢接受治疗，1例患者在上肢接受治疗。接受静脉腔内激光消融术治疗的静脉中有10条进行了额外的手术以闭合静脉。静脉腔内激光消融术引起的并发症发生在2例患者（6%）中。1例患者术后出现疼痛，1例患者发生了暂时性感觉神经损伤。中位临床随访时间为13个月（范围：28天 - 5.7年）。35例患者中有29例（83%）达到了治疗目的。
静脉腔内激光消融术在儿童中技术上可行且安全。它可用于治疗一系列儿科静脉疾病，效果良好。
