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下肢浅表静脉有创治疗后的压迫治疗:美国静脉论坛、血管外科学会、美国静脉病理学会、血管医学学会和国际静脉联盟的临床实践指南。

Compression therapy after invasive treatment of superficial veins of the lower extremities: Clinical practice guidelines of the American Venous Forum, Society for Vascular Surgery, American College of Phlebology, Society for Vascular Medicine, and International Union of Phlebology.

机构信息

Jobst Vascular Institute of Promedica, Toledo, Ohio; University of Michigan, Ann Arbor, Mich.

University of Maryland School of Medicine and Baltimore VA Medical Center, Baltimore, Md.

出版信息

J Vasc Surg Venous Lymphat Disord. 2019 Jan;7(1):17-28. doi: 10.1016/j.jvsv.2018.10.002.

Abstract

Guideline 1.1: Compression after thermal ablation or stripping of the saphenous veins. When possible, we suggest compression (elastic stockings or wraps) should be used after surgical or thermal procedures to eliminate varicose veins. [GRADE - 2; LEVEL OF EVIDENCE - C] Guideline 1.2: Dose of compression after thermal ablation or stripping of the varicose veins. If compression dressings are to be used postprocedurally in patients undergoing ablation or surgical procedures on the saphenous veins, those providing pressures >20 mm Hg together with eccentric pads placed directly over the vein ablated or operated on provide the greatest reduction in postoperative pain.[GRADE - 2; LEVEL OF EVIDENCE - B] Guideline 2.1: Duration of compression therapy after thermal ablation or stripping of the saphenous veins. In the absence of convincing evidence, we recommend best clinical judgment to determine the duration of compression therapy after treatment. [BEST PRACTICE] Guideline 3.1: Compression therapy after sclerotherapy. We suggest compression therapy immediately after treatment of superficial veins with sclerotherapy to improve outcomes of sclerotherapy. [GRADE - 2; LEVEL OF EVIDENCE - C] Guideline 3.2: Duration of compression therapy after sclerotherapy. In the absence of convincing evidence, we recommend best clinical judgment to determine the duration of compression therapy after sclerotherapy. [BEST PRACTICE] Guideline 4.1: Compression after superficial vein treatment in patients with a venous leg ulcer. In a patient with a venous leg ulcer, we recommend compression therapy over no compression therapy to increase venous leg ulcer healing rate and to decrease the risk of ulcer recurrence. [GRADE - 1; LEVEL OF EVIDENCE - B] Guideline 4.2: Compression after superficial vein treatment in patients with a mixed arterial and venous leg ulcer. In a patient with a venous leg ulcer and underlying arterial disease, we suggest limiting the use of compression to patients with ankle-brachial index exceeding 0.5 or if absolute ankle pressure is >60 mm Hg. [GRADE - 2; LEVEL OF EVIDENCE - C].

摘要

指南 1.1:在静脉热消融或剥脱术后进行压缩治疗。我们建议在外科或热消融手术后使用压缩(弹性袜子或包裹物)来消除静脉曲张。[GRADE-2;证据级别-C]

指南 1.2:静脉热消融或剥脱术后的压缩治疗剂量。如果要在接受静脉消融或手术的患者术后使用压缩敷料,那些提供压力>20mmHg 的敷料,以及直接放置在消融或手术静脉上的偏心垫,可最大程度地减轻术后疼痛。[GRADE-2;证据级别-B]

指南 2.1:静脉热消融或剥脱术后压缩治疗的持续时间。在缺乏确凿证据的情况下,我们建议根据最佳临床判断确定治疗后的压缩治疗持续时间。[最佳实践]

指南 3.1:硬化治疗后压缩治疗。我们建议在硬化治疗治疗浅表静脉后立即进行压缩治疗,以改善硬化治疗的效果。[GRADE-2;证据级别-C]

指南 3.2:硬化治疗后压缩治疗的持续时间。在缺乏确凿证据的情况下,我们建议根据最佳临床判断确定硬化治疗后的压缩治疗持续时间。[最佳实践]

指南 4.1:静脉溃疡患者浅表静脉治疗后的压缩治疗。对于静脉性溃疡患者,我们建议采用压缩治疗而非不进行压缩治疗,以提高静脉性溃疡的愈合率并降低溃疡复发的风险。[GRADE-1;证据级别-B]

指南 4.2:混合性动静脉性溃疡患者浅表静脉治疗后的压缩治疗。对于静脉性溃疡和潜在动脉疾病的患者,我们建议将压缩治疗限于踝肱指数>0.5 或绝对踝压>60mmHg 的患者。[GRADE-2;证据级别-C]

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