大隐静脉至股隐静脉交界处静脉腔内激光消融术的可行性和安全性。
Feasibility and safety of flush endovenous laser ablation of the great saphenous vein up to the saphenofemoral junction.
机构信息
Department of Angiology, Ospedale Regionale di Locarno, Locarno, Switzerland.
Department of Angiology, Ospedale Regionale di Locarno, Locarno, Switzerland.
出版信息
J Vasc Surg Venous Lymphat Disord. 2020 Nov;8(6):1006-1013. doi: 10.1016/j.jvsv.2020.01.017. Epub 2020 Apr 10.
OBJECTIVE
The optimal ablation distance from the catheter tip to the common femoral vein during endovenous laser ablation (EVLA) of the great saphenous vein (GSV) is a matter of debate. In this study, we evaluated the feasibility and safety of flush ablation (fEVLA) of the GSV.
METHODS
This single-center, retrospective analysis of prospectively collected data included all consecutive fEVLA interventions of the GSV between September 2017 and October 2018. Interventions were performed with a 1470-nm radially emitting fiber. Primary end points were technical feasibility of fEVLA and endovenous heat-induced thrombosis (EHIT) class 2 to class 4. Secondary end points were procedure-related complications; anatomic success at week 6; and flush occlusion at day 1, day 10, and week 6.
RESULTS
A total of 135 consecutive intended fEVLA procedures were performed in 113 patients (86 female, 27 male). The average body mass index was 24.9 ± 4.3 kg/m. The Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) clinical class for these patients was C2 in 78 (57.8%), C3 in 48 (35.6%), C4 in 8 (5.9%), and C5 in 1 (0.7%). The GSV diameter at the saphenofemoral junction was 9.4 ± 2.7 mm with a maximum of 16 mm. In 126 cases (93.3%), concomitant treatment of tributaries with phlebectomy or foam sclerotherapy was performed. In 127 cases (94.1%), fEVLA was technically feasible; in 8 cases (5.9%), appropriate catheter tip placement was not possible. In these cases, "standard" GSV ablation 10 to 20 mm distal to the saphenofemoral junction was performed. In the remaining 127 cases, one (0.8%) EHIT class 2 and one (0.8%) EHIT class 3 developed at day 10. After a 2- to 3-week course of anticoagulation with rivaroxaban, these EHIT cases resolved without sequelae. Furthermore, one (0.8%) superficial vein thrombosis and one (0.8%) calf vein thrombosis at the site of phlebectomy were observed. No local groin complication occurred. Flush occlusion was observed in 94.5%, 95.3%, and 88.2% of the cases at day 1, day 10, and week 6, respectively. Multivariate regression analysis revealed no significant association between flush ablation at day 1 and age, body mass index, CEAP class, fiber type, maximum vein diameter, or applied joules per centimeter.
CONCLUSIONS
The results of this study suggest that fEVLA of the GSV using a radial emitting laser is feasible and seems to be safe.
目的
在大隐静脉（GSV）的静脉内激光消融（EVLA）中，导管尖端到股总静脉的最佳消融距离是一个有争议的问题。本研究旨在评估 flush 消融（fEVLA）GSV 的可行性和安全性。
方法
本研究为单中心、前瞻性数据回顾性分析，纳入 2017 年 9 月至 2018 年 10 月期间连续行 fEVLA 治疗的 GSV。干预措施采用 1470nm 径向发射光纤进行。主要终点是 fEVLA 的技术可行性和静脉内热诱导血栓形成（EHIT）2 至 4 级。次要终点为与手术相关的并发症；第 6 周解剖学成功；以及第 1、10 和 6 天 flush 闭塞。
结果
共对 113 例患者（86 例女性，27 例男性）的 135 例连续的 fEVLA 手术进行了评估。平均体重指数为 24.9±4.3kg/m。这些患者的临床、病因、解剖和病理生理学（CEAP）临床分类为 C2 期 78 例（57.8%）、C3 期 48 例（35.6%）、C4 期 8 例（5.9%）和 C5 期 1 例（0.7%）。股隐静脉交界处的 GSV 直径为 9.4±2.7mm，最大直径为 16mm。在 126 例（93.3%）患者中，同时行隐静脉属支的抽剥术或泡沫硬化剂治疗。在 127 例（94.1%）患者中，fEVLA 技术上是可行的；在 8 例（5.9%）患者中，导管尖端的适当放置是不可能的。在这些情况下，在股隐静脉交界处远端 10 至 20mm 处进行“标准”GSV 消融。在其余的 127 例患者中，有 1 例（0.8%）在第 10 天发生 EHIT 2 级，1 例（0.8%）发生 EHIT 3 级。在接受利伐沙班抗凝治疗 2-3 周后，EHIT 病例无需后续治疗即可缓解。此外，在 phlebectomy 部位观察到 1 例（0.8%）浅静脉血栓形成和 1 例（0.8%）小腿静脉血栓形成。未发生局部腹股沟并发症。在第 1、10 和第 6 天，分别有 94.5%、95.3%和 88.2%的病例出现 flush 闭塞。多变量回归分析显示，第 1 天的 flush 消融与年龄、体重指数、CEAP 分类、光纤类型、最大静脉直径或应用焦耳每厘米之间无显著相关性。
结论
本研究结果表明，使用径向发射激光进行 fEVLA 的 GSV 是可行的，似乎是安全的。
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