对于小隐静脉的热消融而言，小腿中部水平作为穿刺部位不够安全。
Mid-calf level as a puncture site is not safe enough for thermal ablation of the small saphenous vein.
作者信息
Sanioglu Soner, Yerebakan Halit, Ozgen Ali, Ozdemir Huseyin O, Sancar Nurcan K, Farsak Mustafa B
机构信息
Department of Cardiovascular Surgery, Yeditepe University Hospital, Istanbul, Turkey.
Department of Radiology, Yeditepe University Hospital, Istanbul, Turkey.
出版信息
SAGE Open Med. 2017 Sep 12;5:2050312117731474. doi: 10.1177/2050312117731474. eCollection 2017.
BACKGROUND
Endovenous thermal ablation of the small saphenous vein carries a risk for sural nerve injury. Ablation above mid-calf level is recommended to avoid it. However, this strategy could not eradicate this complication. We present our results of consecutive 30 small saphenous vein thermal ablations which are performed after ultrasonographic identification of the sural nerve.
METHODS
We studied 26 consecutive subjects with a total of 30 limbs. Ablation was performed proximal to the risk point by a 1470-nm diode laser. Patients were asked to attend follow-up outpatient controls at 7 days, 30 days, and 180 days postoperatively. Rate of identification of the sural nerve by ultrasonography, safety of the mid-calf level as a puncture site and postoperative sural nerve damage were assessed.
RESULTS
The sural nerve identification was achieved by ultrasonography in all patients except for one. Mid-calf level as a puncture site was not safe in three (10%) extremities. None of the patients showed any evidence suggesting postoperative sural nerve damage.
CONCLUSION
Choosing the puncture site according to the risk point may be more reasonable than general mid-calf level which is being used.
背景
小隐静脉腔内热消融存在腓肠神经损伤风险。建议在小腿中部以上进行消融以避免该风险。然而，这种策略并不能根除这一并发症。我们展示了在超声识别腓肠神经后连续进行的30例小隐静脉热消融的结果。
方法
我们研究了26例连续的受试者，共30条肢体。通过1470纳米二极管激光在风险点近端进行消融。要求患者在术后7天、30天和1８0天进行门诊随访。评估超声识别腓肠神经的比率、小腿中部水平作为穿刺部位的安全性以及术后腓肠神经损伤情况。
结果
除1例患者外，所有患者均通过超声识别出腓肠神经。在3条（10%）肢体中，小腿中部水平作为穿刺部位不安全。没有患者显示出任何术后腓肠神经损伤的证据。
结论
根据风险点选择穿刺部位可能比使用常规的小腿中部水平更合理。
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