Department of Dermatology, Erasmus MC, Erasmus University Rotterdam, Rotterdam, the Netherlands.
Department of Dermatology, Erasmus MC, Erasmus University Rotterdam, Rotterdam, the Netherlands.
Eur J Vasc Endovasc Surg. 2019 Aug;58(2):244-248. doi: 10.1016/j.ejvs.2018.12.007. Epub 2019 May 29.
The aim was to evaluate the safety and effectiveness of endovenous thermal ablation (EVTA) with or without adding high ligation (HL) for the treatment of incompetent saphenous veins with an aneurysm (>20 mm for the great saphenous vein, >15 mm for the small saphenous vein) close to the junction.
This was a prospective observational cohort study in a single centre. All patients presenting with saphenous aneurysms close to the junction were included. Those with a venous aneurysm more distally, at >2 cm from the junction, or with associated deep venous aneurysms were excluded. Patients were treated with EVTA alone or combined with HL in cases of an aneurysm with a diameter >30 mm. Phlebectomies were performed during the same treatment session. Patients were followed up one and six weeks, and one year after treatment. Duplex ultrasound (DUS) was performed to evaluate occlusion of the vein and aneurysm as well as possible complications such as endovenous heat induced thrombosis (EHIT) or deep vein thrombosis (DVT). Venous clinical severity scores (VCSS) were registered before and one year after treatment.
Thirteen patients (15 limbs) were included between February 2012 and January 2015. Eleven limbs were treated with EVTA alone, the remaining four limbs with EVTA and HL. No severe adverse events occurred (no EHIT, no DVT). After one year none of the aneurysms was still visible on DUS and the truncal obliteration rate was 80% (two partial, one segmental recanalisation). Both treatment strategies showed significant improvement of the VCSS at the one year follow up, from a median score of 6 (interquartile range [IQR] 5-7) to 2 (IQR 1-3) (p = .001).
EVTA with or without HL appeared to be a safe and effective treatment for patients presenting with incompetent saphenous veins with an aneurysm close to the junction.
评估静脉内热消融（EVTA）联合或不联合高位结扎（HL）治疗靠近交通支的大隐静脉＞20mm、小隐静脉＞15mm 静脉瘤样扩张（动脉瘤＞20mm）的安全性和有效性。
这是一项单中心前瞻性观察队列研究。所有存在靠近交通支的隐静脉动脉瘤的患者均纳入研究。那些静脉瘤位于交通支＞2cm 处或合并深静脉动脉瘤的患者被排除在外。对于直径＞30mm 的动脉瘤，采用 EVTA 联合或不联合 HL 治疗。在同一治疗过程中进行静脉切除术。患者在治疗后 1 周、6 周和 1 年进行随访。采用双功能超声（DUS）评估静脉闭塞和动脉瘤情况以及可能的并发症，如静脉内热诱导血栓形成（EHIT）或深静脉血栓形成（DVT）。在治疗前和治疗后 1 年记录静脉临床严重程度评分（VCSS）。
2012 年 2 月至 2015 年 1 月期间，共纳入 13 例患者（15 条肢体）。11 条肢体采用 EVTA 单独治疗，4 条肢体采用 EVTA 联合 HL 治疗。无严重不良事件发生（无 EHIT，无 DVT）。1 年后，DUS 检查均未见动脉瘤，主干闭塞率为 80%（2 例部分再通，1 例节段性再通）。两种治疗策略在 1 年随访时均显著改善了 VCSS，从中位数 6 分（四分位距 [IQR] 5-7）降至 2 分（IQR 1-3）（p=0.001）。
EVTA 联合或不联合 HL 治疗靠近交通支的隐静脉动脉瘤样扩张患者是一种安全有效的治疗方法。
