Division of Vascular Surgery, Department of Surgery, Stony Brook University, Stony Brook, NY.
Division of Vascular Surgery, Department of Surgery, Stony Brook University, Stony Brook, NY.
J Vasc Surg Venous Lymphat Disord. 2019 May;7(3):344-348. doi: 10.1016/j.jvsv.2018.08.011. Epub 2018 Nov 12.
No clear data exist on the treatment patterns in patients with chronic venous disease. This study was designed to determine how such patients were treated in our center.
Consecutive patients presenting for a vein consultation at our center were collected during a 9-month period, allotting for at least 6 months of follow-up. All patients had a detailed history and physical examination by experienced vascular surgeons and a complete venous ultrasound evaluation by registered vascular technologists having experience in venous imaging. Charts were reviewed for patient factors including body mass index, age, clinical class (Clinical, Etiology, Anatomy, and Pathophysiology [CEAP] classification), and treatment. Deidentified data from the chart review were entered into a local database. Queries were designed to identify trends in the data. The results of the queries were exported to a spreadsheet program for analysis per patient and per limb.
There were 506 patients evaluated for venous disease during a period of 9 months. We identified 200 patients with chronic venous disease who required superficial vein treatment. There were 136 (68%) women. Ablation was required in 156 patients (78%), whereas 44 (22%) required only adjunctive therapy (microphlebectomy or sclerotherapy). The average number of ablations in patients with venous disease was 1.3 (259 ablations in 200 patients). In patients who needed at least one ablation, the average was 1.7 ablations per patient (259 ablations in 156 patients). Unilateral ablation was done in 94 patients (60%), and 62 patients (40%) had bilateral treatment. Of those who underwent unilateral ablations, 61% required adjunctive treatment of the contralateral limb. In patients who required only adjunctive therapy (no ablation), 73% underwent bilateral treatment. There were 182 limbs (45.5%) that did not require ablation as no reflux was found in the saphenous systems. Of the 156 patients who underwent ablation, 218 limbs had at least one ablation; 52% of limbs had C2 disease and on average underwent 1.1 ablations/limb. Only 7 of 113 (6%) limbs required more than one ablation. Average ablations per limb increased with clinical class, C3 having 1.2 ablations/limb, C4 having 1.4 ablations/limb, and C5 and C6 having 1.56 ablations/limb.
Patients with venous disease required on average 1.3 ablations/patient. Most (78%) require at least one ablation for an average of 1.7 ablations/patient. There were 182 limbs (45.5%) with no saphenous reflux that did not require an ablation. The average number of ablations/limb increased with CEAP class.
目前尚缺乏慢性静脉疾病患者治疗模式的明确数据。本研究旨在明确本中心此类患者的治疗方法。
连续收集本中心静脉疾病患者，在 9 个月期间进行静脉咨询，至少随访 6 个月。所有患者均由经验丰富的血管外科医生进行详细的病史和体格检查，并由具有静脉成像经验的注册血管技术人员进行完整的静脉超声评估。对图表进行回顾，分析患者的体重指数、年龄、临床分类（临床、病因、解剖和病理生理学[CEAP]分类）和治疗。从图表回顾中提取出的患者数据被输入到本地数据库中。设计查询以识别数据中的趋势。将查询结果导出到电子表格程序中，以每位患者和每条肢体进行分析。
在 9 个月期间，共有 506 例患者接受了静脉疾病评估。我们确定了 200 例需要治疗浅静脉的慢性静脉疾病患者。其中女性 136 例（68%）。需要消融治疗的患者有 156 例（78%），而仅需要辅助治疗（微静脉切除术或硬化治疗）的患者有 44 例（22%）。静脉疾病患者的平均消融次数为 1.3 次（200 例患者共 259 次消融）。需要至少一次消融的患者中，平均每人消融 1.7 次（156 例患者共 259 次消融）。94 例患者（60%）行单侧消融，62 例患者（40%）行双侧治疗。行单侧消融的患者中，61%需要对侧肢体的辅助治疗。仅行辅助治疗（无消融）的患者中，73%行双侧治疗。182 条肢体（45.5%）未发现隐静脉系统反流，无需消融。在 156 例行消融治疗的患者中，218 条肢体至少行一次消融；52%的肢体存在 C2 疾病，平均每条肢体消融 1.1 次。仅 113 条肢体中的 7 条（6%）需要不止一次消融。每条肢体的平均消融次数随临床分类而增加，C3 平均每条肢体消融 1.2 次，C4 平均每条肢体消融 1.4 次，C5 和 C6 平均每条肢体消融 1.56 次。
静脉疾病患者平均每人需要消融治疗 1.3 次。大多数（78%）患者至少需要一次消融，平均每人 1.7 次。182 条肢体（45.5%）无隐静脉反流，无需消融。CEAP 分级越高，每条肢体的平均消融次数越多。
