Tepelenis Kostas, Papathanakos Georgios, Barbouti Alexandra, Paraskevas Georgios, Kitsouli Aikaterini, Alexandra Kefala Maria, Tepelenis Nikolaos, Kanavaros Panagiotis, Kitsoulis Panagiotis
Department of Surgery, General Hospital of Filiates, Thesprotia, Greece.
Intensive Care Unit, University Hospital of Ioannina, Ioannina, Greece.
Vasa. 2020 Aug;49(5):349-358. doi: 10.1024/0301-1526/a000868. Epub 2020 Apr 23.
Phlebosclerosis is a venous wall degenerative disease which has gained little popularity in the literature due to its uncertain clinical significance. The objective of this review is to evaluate the epidemiology, etiology and clinical significance of phlebosclerosis in lower extremities veins, particularly the effect of preexisting phlebosclerosis of the great saphenous vein on vein graft patency. Medline was searched from inception until November 1, 2019. Reference lists of included studies were scanned. Only articles published after 1949 were included. Two reviewers independently screened titles/abstracts and full-text papers for any study design in relation to phlebosclerosis in lower extremities veins and abstracted data. A total of 16 Cohort studies and one case-control study (3708 participants, mean age 61.8 years, 59.3 % men, and 40.7 % women) were included after screening 317 titles and abstracts, and 80 full-text articles. The incidence of phlebosclerosis ranged from 1.5-9.7 % depending on the radiological features. On the contrary, the incidence of the phlebosclerotic great saphenous vein prior to its use as a vein graft was 26.9-91 % on histological examination. The small saphenous vein was the most common location of phlebosclerosis followed by the great saphenous vein. There is a link between phlebosclerosis and age, venous insufficiency and haemodialysis. As for the vein graft patency seven studies demonstrated a correlation between preexisting phlebosclerosis and vein graft stenosis, whereas three studies failed to prove any association. In conclusion, the radiological incidence of phlebosclerosis depended on the ultrasound findings. Its presence in the great saphenous vein prior to its use as a vein graft is established on histological examination. The small saphenous vein is mainly affected. Risk factors included age, haemodialysis, and venous insufficiency. Preexisting wall thickness of the great saphenous vein graft seemed to affect negatively its patency in bypass surgery.
静脉硬化是一种静脉壁退行性疾病，由于其临床意义不明确，在文献中受到的关注较少。本综述的目的是评估下肢静脉静脉硬化的流行病学、病因及临床意义，尤其是大隐静脉预先存在的静脉硬化对静脉移植物通畅性的影响。检索了Medline数据库自建库至2019年11月1日的文献。对纳入研究的参考文献列表进行了筛查。仅纳入1949年以后发表的文章。两名研究者独立筛选标题/摘要和全文论文，以查找与下肢静脉静脉硬化相关的任何研究设计，并提取数据。在筛选了317篇标题和摘要以及80篇全文文章后，共纳入了16项队列研究和1项病例对照研究（3708名参与者，平均年龄61.8岁，男性占59.3%，女性占40.7%）。根据放射学特征，静脉硬化的发生率在1.5%至9.7%之间。相反，在组织学检查中，大隐静脉在用作静脉移植物之前发生静脉硬化的发生率为26.9%至91%。小隐静脉是静脉硬化最常见的部位，其次是大隐静脉。静脉硬化与年龄、静脉功能不全和血液透析之间存在关联。至于静脉移植物通畅性，7项研究表明预先存在的静脉硬化与静脉移植物狭窄之间存在相关性，而3项研究未能证明有任何关联。总之，静脉硬化的放射学发生率取决于超声检查结果。在组织学检查中确定其在大隐静脉用作静脉移植物之前的存在情况。小隐静脉主要受累。危险因素包括年龄、血液透析和静脉功能不全。大隐静脉移植物预先存在的管壁厚度似乎对其在旁路手术中的通畅性有负面影响。
