Department for Dermatology, Ruhr-University Bochum, Bochum, Germany.
Praxis für Venen- und Hauterkrankungen, Jena, Germany.
J Vasc Surg Venous Lymphat Disord. 2021 Jan;9(1):137-145. doi: 10.1016/j.jvsv.2020.04.021. Epub 2020 May 1.
Although many studies have demonstrated that endovenous therapies have comparable efficacy to crossectomy and stripping, few studies have been published regarding the classification and recurrence patterns of varicose veins after endovenous therapy. This study attempted to provide an objective scheme for the definition and classification of recurrence. Moreover, it describes the types and rates of recurrence after endovenous thermal ablation, as well as factors associated with recurrence.
This prospective cohort study comprised a cohort of 449 patients with saphenofemoral junction (SFJ) insufficiency who underwent endoluminal varicose vein treatment for the first time in the limb between October 2013 and January 2015. The treatments were performed by a team of three experienced phlebologists. For endovenous laser ablation, Biolitec ELVeS was used with bare, radial or radial slim fibers. Radiofrequency ablation was performed with VNUS ClosureFAST (Medtronic, Deggendorf, Germany). The patients were consecutively scheduled for 3-year follow-up examinations. Detailed ultrasound findings were collected by two experienced phlebologists who classified the observed duplex ultrasound recurrence into different recurrence types.
Clinically relevant recurrence was found in only 5.1% of cases. Examining only the recanalizations requiring reintervention resulted in a recurrence rate of 2.6%. However, if every new varicose vein that occurred postoperatively was considered a recurrence, the resultant recurrence rate was almost 54%. Preliminarily, we defined a recurrence as newly developed varicose veins within the region of the SFJ or along the course of the former treated vein distal to the SFJ. According to this definition, we obtained a clinically relevant recurrence rate of 5.3%, thus indicating that neovascular vessels were the largest recurrence type (57.7% within the region of the SFJ and 9.9% distal to the SFJ), followed by recanalization (8.9% within the region of the SFJ and 9.4% distal to the SFJ) and a refluxing anterior accessory saphenous vein (7.5%). We also developed a modified classification of progression to better understand recurrence after treatment of chronic venous insufficiency; the scheme included method failure (recanalization), neovascularizations, and disease progression (refluxing untreated vessels and new varicose veins occurring outside the treated region). The diameter of the treated vein (P = .001) and the clinical class according to CEAP classification (P = .008) were significant predictors of recurrence.
Endoluminal therapies are efficient methods for the treatment of varicose veins, which result in low recurrence rates after 3 years. Several factors influence the development of recurrence. This study provides a practice-oriented classification and description of recurrence with clinical relevance, through making distinctions among technical error, progression of the underlying disease and actual recurrence.
虽然许多研究已经证明静脉内治疗与交叉切除术和剥脱术具有相当的疗效，但很少有研究报道静脉内治疗后静脉曲张的分类和复发模式。本研究试图为定义和分类复发提供一个客观的方案。此外，它描述了静脉内热消融后的复发类型和复发率，以及与复发相关的因素。
这是一项前瞻性队列研究，纳入了 2013 年 10 月至 2015 年 1 月期间首次在肢体中接受隐股交界处（SFJ）缺陷的腔内静脉治疗的 449 例大隐静脉曲张患者。治疗由三名经验丰富的静脉病专家团队进行。对于静脉内激光消融，使用 Biolitec ELVeS 进行治疗，使用裸光纤、放射状光纤或放射状纤细光纤。射频消融采用 VNUS ClosureFAST（美敦力，德国 Deggendorf）。患者连续安排 3 年随访检查。两名经验丰富的静脉病专家收集详细的超声检查结果，并将观察到的双功能超声复发分为不同的复发类型。
仅发现 5.1%的病例存在临床相关的复发。仅检查需要再次干预的再通，复发率为 2.6%。然而，如果将术后出现的每一条新静脉曲张都视为复发，那么复发率几乎为 54%。初步定义，复发为 SFJ 区域内或 SFJ 远端原治疗静脉沿线新出现的静脉曲张。根据这一定义，我们获得了 5.3%的临床相关复发率，表明新生血管是最大的复发类型（SFJ 区域内 57.7%，SFJ 远端 9.9%），其次是再通（SFJ 区域内 8.9%，SFJ 远端 9.4%）和反流性前辅助隐静脉（7.5%）。我们还开发了一种改良的进展分类，以更好地理解慢性静脉功能不全治疗后的复发；该方案包括方法失败（再通）、新生血管形成和疾病进展（未经治疗的血管反流和治疗区域外出现新的静脉曲张）。治疗后静脉直径（P=.001）和 CEAP 分类的临床分级（P=.008）是复发的显著预测因素。
腔内治疗是治疗静脉曲张的有效方法，3 年后复发率较低。有几个因素影响复发的发展。本研究通过区分技术错误、潜在疾病进展和实际复发，为具有临床相关性的复发提供了一种实用的分类和描述。
