de Araujo Walter Junior Boim, Timi Jorge Rufino Ribas, Nejm Carlos Seme, Erzinger Fabiano Luiz, Caron Filipe Carlos
Universidade Federal do Paraná - UFPR, Departamento de Cirurgia, Curitiba, PR, Brazil.
J Vasc Bras. 2016 Apr-Jun;15(2):113-119. doi: 10.1590/1677-5449.001516.
In endovenous laser ablation (EVLA), the great saphenous vein (GSV) is usually ablated from the knee to the groin, with no treatment of the below-knee segment regardless of its reflux status. However, persistent below-knee GSV reflux appears to be responsible for residual varicosities and symptoms of venous disease.
To evaluate clinical and duplex ultrasound (DUS) outcomes of the below-knee segment of the GSV after above-knee EVLA associated with conventional surgical treatment of varicosities and incompetent perforating veins.
Thirty-six patients (59 GSVs) were distributed into 2 groups, a control group (26 GSVs with normal below-knee flow on DUS) and a test group (33 GSVs with below-knee reflux). Above-knee EVLA was performed with a 1470-nm bare-fiber diode laser and supplemented with phlebectomies of varicose tributaries and insufficient perforating-communicating veins through mini-incisions. Follow-up DUS, clinical evaluation using the venous clinical severity score (VCSS), and evaluation of complications were performed at 3-5 days after the procedure and at 1, 6, and 12 months.
Mean patient age was 45 years, and 31 patients were women (86.12%). VCSS improved in both groups. Most patients in the test group exhibited normalization of reflux, with normal flow at the beginning of follow-up (88.33% of GSVs at 3-5 days and 70% at 1 month). However, in many of these patients reflux eventually returned (56.67% of GSVs at 6 months and 70% at 1 year).
These data suggest that reflux in the below-knee segment of the GSV was not influenced by the treatment performed.
在腔内激光消融术（EVLA）中，大隐静脉（GSV）通常从膝盖至腹股沟进行消融，无论其膝下段有无反流，均不对该段进行治疗。然而，持续存在的膝下段GSV反流似乎是导致残留静脉曲张和静脉疾病症状的原因。
评估在膝上EVLA联合传统手术治疗静脉曲张和功能不全的交通静脉后，GSV膝下段的临床及双功超声（DUS）结果。
36例患者（59条GSV）被分为2组，对照组（26条DUS显示膝下段血流正常的GSV）和试验组（33条存在膝下段反流的GSV）。使用1470nm裸光纤二极管激光进行膝上EVLA，并通过小切口对曲张属支静脉和功能不全的交通静脉进行静脉切除术。在术后3 - 5天、1个月、6个月和12个月进行随访DUS、使用静脉临床严重程度评分（VCSS）进行临床评估以及并发症评估。
患者平均年龄为45岁，31例为女性（86.12%）。两组的VCSS均有所改善。试验组的大多数患者反流恢复正常，随访开始时血流正常（3 - 5天时88.33%的GSV，1个月时70%）。然而，这些患者中有许多最终反流又复发（6个月时56.67%的GSV，1年时70%）。
这些数据表明，GSV膝下段反流不受所进行治疗的影响。
