Department of Surgery, Yale University School of Medicine, New Haven, Conn.
Division of Vascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn.
J Vasc Surg Venous Lymphat Disord. 2019 Sep;7(5):685-692. doi: 10.1016/j.jvsv.2019.05.006.
Venous ablation (VA) is the recommended treatment of superficial venous insufficiency affecting the lower extremities. The safety and efficacy of the procedure in octogenarians have not been well studied. We postulate that VA in octogenarians is as safe and effective as in younger age groups.
A retrospective single-center review of consecutive patients undergoing VA using radiofrequency in an outpatient office was performed. Patients, imaging, and procedural characteristics were reviewed from the medical records. A telephone survey inquiring about intensity of symptoms on a numeric rating scale of 0 to 10 before and after treatment was conducted. Patients were divided into three groups based on age: <65 years, 65 to 79 years, and ≥80 years. Clinical success was defined by patients' reporting improvement or resolution of symptoms and was reported per leg. Technical success was defined by vein closure on duplex ultrasound and was reported per vein. Patients and outcomes were compared between the three groups using χ or analysis of variance test in SAS software (SAS Institute, Cary, NC).
There were 362 patients who underwent 627 VAs in 512 legs. Octogenarians constituted 9.4% of the patient population and were more likely to have cardiovascular comorbidities. Octogenarians were significantly more likely to have advanced venous disease as determined by the Clinical, Etiology, Anatomy, and Pathophysiology classification compared with younger patients (P = .005). On ultrasound, younger patients had significantly larger vein diameters (P = .04) and longer reflux times (P < .001). There was no significant difference in the types of veins (P = .08) or the mean number of veins (P = .37) treated in the three groups; however, there was a trend toward younger patients' requiring more adjunctive procedures (P = .1). The clinical success (P = .86), technical success (P = .19), and complications (P = .36) were not different between octogenarians and younger patients. The survey results demonstrated similar findings with no difference in pain improvement (P = .27) or recurrence (P = .36).
Octogenarians treated with VA present at a more advanced clinical stage compared with younger patients but have less severe ultrasound findings. VA is safe and effective in all age groups. Age should not be used to deny patients VA.
静脉消融（VA）是治疗下肢浅静脉功能不全的推荐方法。80 岁以上人群中该手术的安全性和疗效尚未得到很好的研究。我们推测，80 岁以上人群中 VA 的安全性和有效性与年轻人群相同。
对在门诊使用射频进行 VA 的连续患者进行回顾性单中心回顾。从病历中回顾患者、影像学和手术特征。通过电话调查，询问治疗前后数字评分量表（0 到 10 分）的症状强度。根据年龄将患者分为三组：<65 岁、65 至 79 岁和≥80 岁。临床成功定义为患者报告症状改善或缓解，按腿报告。技术成功定义为双功能超声检查显示静脉闭合，按静脉报告。使用 SAS 软件（SAS Institute，Cary，NC）中的 χ 或方差分析检验比较三组患者和结局。
共有 362 例患者在 512 条腿中接受了 627 次 VA。80 岁以上人群占患者人群的 9.4%，更有可能患有心血管合并症。与年轻患者相比，80 岁以上人群的静脉疾病严重程度更高，根据临床、病因、解剖和病理生理学分类确定（P=0.005）。在超声检查中，年轻患者的静脉直径明显更大（P=0.04），反流时间明显更长（P<0.001）。三组患者静脉类型（P=0.08）或治疗静脉平均数量（P=0.37）无显著差异；然而，年轻患者更倾向于需要更多辅助治疗（P=0.1）。80 岁以上人群与年轻患者的临床成功率（P=0.86）、技术成功率（P=0.19）和并发症（P=0.36）无差异。调查结果表明，疼痛改善（P=0.27）或复发（P=0.36）无差异。
与年轻患者相比，接受 VA 治疗的 80 岁以上人群处于更晚期的临床阶段，但超声检查结果较轻。VA 在所有年龄段均安全有效。年龄不应成为拒绝患者接受 VA 的原因。
