Prasad Bp Krishna, Joy Binu, Toms Ajith, Sleeba Teena
Department of Radiology, Rajagiri Hospital, Aluva, Kerala.
Phlebology. 2018 May;33(4):242-250. doi: 10.1177/0268355517696612. Epub 2017 Mar 16.
Recurrent lower limb venous insufficiency is often a challenge in clinical practice and is most commonly due to incompetent perforators. Many of these patients do not have adequate symptom relief with compression and require some form of treatment for incompetent perforator interruption. Various treatment methods have been tried with different efficiencies. Objective To evaluate the feasibility, efficiency and safety of an outpatient combined cyanoacrylate adhesion-sodium tetradecyl sulphate sclerotherapy for treatment of patients with symptoms of persistent or recurrent lower limb venous insufficiency secondary to incompetent perforators. Methods Eighty-three limbs of 69 patients with symptoms of persistent or recurrent lower limb venous insufficiency secondary to incompetent perforators were treated with cyanoacrylate embolization of incompetent perforators and sclerotherapy of dilated collateral veins (surface branch varicose veins). Technical success, procedural pain, perforator occlusion, venous occlusion, clinical improvement and ulcer healing were assessed. Follow-up was done three- and six-month post-procedure. Results Procedure could be successfully performed in all patients. One hundred and ninety-one perforators were treated in total. Perforator and varicose veins occlusion rate was 100%. Deep venous extension of cyanoacrylate occurred in four (4.8%) patients, with no adverse clinical outcome. Venous clinical severity score improved from a baseline of 8.18 ± 3.60 to 4.30 ± 2.48 on three-month follow-up and 2.42 ± 1.52 on six-month follow-up (p < 0.0001). All ulcers showed complete healing within three months. Significant prolonged thrombophlebitis occurred in 38.5% of limbs. Conclusion Combined cyanoacrylate adhesion and setrol sclerotherapy is technically easy, has a lot of advantages including being an outpatient procedure and highly efficacious but with a guarded safety profile.
复发性下肢静脉功能不全在临床实践中常常是一项挑战，最常见的原因是交通静脉功能不全。这些患者中的许多人通过压迫治疗无法获得足够的症状缓解，需要某种形式的治疗来中断功能不全的交通静脉。已经尝试了各种治疗方法，效率各不相同。目的评估门诊联合氰基丙烯酸酯黏附-十四烷基硫酸钠硬化疗法治疗继发于交通静脉功能不全的持续性或复发性下肢静脉功能不全症状患者的可行性、有效性和安全性。方法对69例继发于交通静脉功能不全的持续性或复发性下肢静脉功能不全症状患者的83条肢体，采用氰基丙烯酸酯栓塞功能不全的交通静脉和硬化治疗扩张的侧支静脉（浅表分支静脉曲张）。评估技术成功率、操作疼痛、交通静脉闭塞、静脉闭塞、临床改善和溃疡愈合情况。在术后3个月和6个月进行随访。结果所有患者的手术均能成功进行。共治疗了191条交通静脉。交通静脉和静脉曲张的闭塞率为100%。4例（4.8%）患者出现氰基丙烯酸酯向深静脉延伸，无不良临床后果。静脉临床严重程度评分从基线的8.18±3.60在3个月随访时改善至4.30±2.48，在6个月随访时改善至2.42±1.52（p<0.0001）。所有溃疡在3个月内均完全愈合。38.5%的肢体出现明显延长的血栓性静脉炎。结论联合氰基丙烯酸酯黏附和硬化疗法技术操作简单，具有诸多优点，包括可在门诊进行且疗效高，但安全性有待谨慎评估。
