Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Md.
Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Md; Department of Surgery, Baltimore Veterans Affairs Medical Center, Baltimore, Md.
J Vasc Surg Venous Lymphat Disord. 2017 Jul;5(4):507-513. doi: 10.1016/j.jvsv.2017.03.014.
The objective of this study was to characterize the technique and to report the results of double prepuncture used during complex radiofrequency ablation (RFA) in cases of treating multiple incompetent veins or encountering focal obstruction to catheter advancement.
A double prepuncture technique was applied in patients requiring endovascular ablation of multiple veins and patients with great saphenous vein cannulation failure. We treated 13 limbs in 12 patients during a 24-month period with RFA in which the double prepuncture technique was used. Clinical history, operative reports, outcomes, and follow-up were reviewed.
RFA was performed with the double puncture technique on, collectively, 10 great saphenous veins, 5 small saphenous veins, and 5 anterior accessory saphenous veins. Mean preoperative Clinical, Etiology, Anatomy, and Pathophysiology score was 4.38 ± 1.6. Three limbs required prepuncture because of difficulty in advancing the catheter cephalad through tortuosity and focal obstruction after failure with techniques such as a guidewire, a guide catheter, and manual compression with ultrasound guidance. Ten limbs received planned double prepuncture for multiple adjacent incompetent veins, for which venipuncture and cannulation of the second target vein would be difficult after tumescent application to the first vein. Postoperative ultrasound demonstrated successful closure of all target veins in which the double prepuncture technique was used. One patient had a deep venous thrombosis (7.7%) that resolved without complications.
Double prepuncture is a useful technical adjunct both for simultaneous endovenous ablation of multiple adjacent incompetent veins and when catheter passage is impeded. This technique aids in efficient and successful application of endovenous ablation to complex venous anatomy.
本研究旨在描述该技术，并报告在治疗多条功能不全静脉或遇到导管推进时的局部梗阻时使用双预穿刺的复杂射频消融（RFA）的结果。
在需要血管内消融多条静脉和大隐静脉穿刺失败的患者中应用双预穿刺技术。我们在 24 个月的时间内对 12 例患者的 13 条肢体进行了 RFA，其中使用了双预穿刺技术。回顾了临床病史、手术报告、结果和随访情况。
使用双穿刺技术共对 10 条大隐静脉、5 条小隐静脉和 5 条前副隐静脉进行了 RFA。术前临床、病因、解剖和病理生理学评分的平均值为 4.38±1.6。3 条肢体因在导丝、导引导管和超声引导下手动压迫等技术失败后，导管向头侧推进时出现迂曲和局部梗阻而需要预穿刺。10 条肢体因计划对多个相邻功能不全静脉进行双预穿刺，在第一条静脉肿胀后，第二条目标静脉的穿刺和插管会很困难。术后超声显示所有使用双预穿刺技术的目标静脉均成功闭合。1 例患者（7.7%）发生深静脉血栓形成，无并发症。
双预穿刺是一种有用的技术辅助手段，可同时用于消融多条相邻的功能不全静脉，也可用于导管通过受阻时。该技术有助于将静脉内消融技术有效地应用于复杂的静脉解剖结构。
