Leopardi Marco, Salerno Alessia, Dante Angelica, Cofini Vincenza, Necozione Stefano, Ventura Marco
Vascular Surgery Unit, San Salvatore Hospital, University of L'Aquila, L'Aquila, Italy.
Vascular Surgery Unit, San Salvatore Hospital, University of L'Aquila, L'Aquila, Italy.
Ann Vasc Surg. 2019 Jul;58:302-308. doi: 10.1016/j.avsg.2018.11.029. Epub 2019 Feb 13.
The aim of this study is to compare 2 groups of patients treated for great saphenous vein (GSV) reflux with open surgical saphenofemoral ligation (SFL) and endovenous laser ablation (EVLA).
Consecutive patients with primary unilateral GSV reflux undergoing EVLA treatment since 2014 were enrolled, and another series of patients treated with SFL was considered. The patients were stratified according to treatment and the results were compared using the propensity score (1:1). The covariables were age, gender, body mass index, CEAP (Clinical class, Etiology, Anatomy and Pathophysiology) staging, and GSV and saphenofemoral junction diameters. Primary outcomes were GSV occlusion or recurrent groin varicose veins at 1 year after treatment. Secondary outcomes included vein thrombosis, hyperpigmentation, paresthesia, postoperative pain, analgesic requirement, and ecchymosis assessed at discharge and CEAP stage and quality of life (QoL) assessment 1 month after surgery.
A total of 123 patients were included in the study: 59 were treated with EVLA and 64 with SFL. At 12 months, we observed 10 recurrent groin varicose veins after SFL (15.6%) and 6 GSV recanalization after EVLA (10.2%, P = 0.369). Extra-saphenous recurrent varicose veins were observed in 36 patients (29.3%): 20 in the open group (31.2%) and 16 in EVLA group (27.1%, P = 0.615). After matching procedure 74 patients were analyzed (37 patients by group), logistic regression model showed that the risk of outcome was not associated with the surgical treatment (odds ratio 1.76, 95% confidence interval 0.52-6.01).
Both techniques to treat saphenous impairment have demonstrated to be safe, with good results in terms of efficacy and symptomatic improvement at follow-up. EVLA with 1,470 nm seems to have lower rates of recurrence and good perceived QoL. Tumescent anesthesia is a good option with good results and may be extended to open surgical ligation.
本研究旨在比较接受大隐静脉（GSV）反流开放手术隐股结扎术（SFL）和腔内激光消融术（EVLA）治疗的两组患者。
纳入自2014年以来接受EVLA治疗的连续性原发性单侧GSV反流患者，并纳入另一组接受SFL治疗的患者。根据治疗方式对患者进行分层，并使用倾向评分（1:1）比较结果。协变量包括年龄、性别、体重指数、CEAP（临床分级、病因、解剖和病理生理学）分期以及GSV和隐股交界处直径。主要结局为治疗后1年时GSV闭塞或腹股沟复发性静脉曲张。次要结局包括出院时评估的静脉血栓形成、色素沉着、感觉异常、术后疼痛、镇痛需求和瘀斑，以及术后1个月的CEAP分期和生活质量（QoL）评估。
本研究共纳入123例患者：59例接受EVLA治疗，64例接受SFL治疗。在12个月时，我们观察到SFL术后有10例腹股沟复发性静脉曲张（15.6%），EVLA术后有6例GSV再通（10.2%，P = 0.369）。36例患者（29.3%）观察到隐静脉外复发性静脉曲张：开放组20例（31.2%），EVLA组16例（27.1%，P = 0.615）。匹配程序后分析了74例患者（每组37例），逻辑回归模型显示结局风险与手术治疗无关（比值比1.76，95%置信区间0.52 - 6.01）。
两种治疗大隐静脉病变的技术均已证明是安全的，在随访时疗效和症状改善方面效果良好。1470nm的EVLA似乎复发率较低且QoL良好。肿胀麻醉效果良好，是一个不错的选择，且可扩展至开放手术结扎。
