Department of Vascular Surgery, University of Helsinki, Helsinki University Hospital, PL 340, 00029 HUS, Helsinki, Finland.
Br J Surg. 2018 May;105(6):686-691. doi: 10.1002/bjs.10757.
New treatment methods have challenged open surgery as a treatment for great saphenous vein (GSV) insufficiency, the most common being ultrasound-guided foam sclerotherapy (UGFS) and endovenous laser ablation (EVLA). This study evaluated the long-term results of surgery, EVLA and UGFS in the treatment of GSV reflux.
Patients with symptomatic GSV reflux were randomized to undergo either open surgery, EVLA or UGFS. The main outcome measure was the occlusion rate of the GSV at 5 years after operation.
The study included 196 patients treated during 2008-2010; of these, 166 (84·7 per cent) participated in the 5-year follow-up. At 5 years, the GSV occlusion rate was 96 (95 per cent c.i. 91 to 100) per cent in the open surgery group, 89 (82 to 98) per cent after EVLA and 51 (38 to 64) per cent after UGFS (P < 0·001). For patients who had received no additional treatment during follow-up, the occlusion rates were 96 per cent (46 of 48), 89 per cent (51 of 57) and 41 per cent (16 of 39) respectively. UGFS without further GSV treatment was successful in only 16 of 59 patients (27 per cent) at 5 years.
UGFS has significantly inferior occlusion rates compared with open surgery or EVLA, and results in additional treatments.
新的治疗方法对大隐静脉（GSV）功能不全的开放性手术提出了挑战，其中最常见的是超声引导下泡沫硬化疗法（UGFS）和静脉内激光消融术（EVLA）。本研究评估了手术、EVLA 和 UGFS 治疗 GSV 反流的长期疗效。
患有症状性 GSV 反流的患者被随机分为接受开放性手术、EVLA 或 UGFS 治疗。主要观察指标是手术后 5 年 GSV 闭塞率。
本研究纳入了 2008 年至 2010 年期间治疗的 196 例患者；其中，166 例（84.7%）参与了 5 年随访。5 年后，开放性手术组 GSV 闭塞率为 96%（95%可信区间 91%至 100%），EVLA 组为 89%（82%至 98%），UGFS 组为 51%（38%至 64%）（P<0.001）。对于随访期间未接受其他治疗的患者，闭塞率分别为 96%（46/48）、89%（51/57）和 41%（16/39）。UGFS 组 59 例患者中，5 年后仅 16 例（27%）闭塞成功。
与开放性手术或 EVLA 相比，UGFS 的闭塞率明显较低，且需要进一步治疗。
