Department of Vascular Surgery, Singapore General Hospital, Singapore.
Health Services Research Center, SingHealth, Singapore.
Phlebology. 2020 Sep;35(8):605-613. doi: 10.1177/0268355520922783. Epub 2020 May 6.
The VenaSeal™ Closure System is a non-thermal, non-tumescent venous closure device that employs a cyanoacrylate adhesive to occlude incompetent veins for superficial truncal reflux. The aim was to examine patient, Duplex-defined venous characteristics and treatment-related factors that may predict variances in remnant stump length at the sapheno-femoral and sapheno-popliteal junctions in the peri-procedural period.
A total of 73 patients (87 legs; 85 great saphenous veins; 11 small saphenous veins) of median age 63 years (range 26-86 years) underwent VenaSeal™ Closure System ablation. 44/85 (52%) great saphenous veins were treated with a modified instructions-for-use technique of using double-dose injection of glue (0.3 cc) at initial deposition for great saphenous veins diameters >6 mm. Median great saphenous veins and small saphenous veins lengths ablated were 48.0 cm (range 13-69 cm) and 32.0 cm (range 19-40 cm), respectively. A total of 62/87 (71.3%) legs had CEAP classification 4-6. A completion Duplex scan was performed immediately and 1 week post-procedure to measure remnant stump lengths at the sapheno-femoral and sapheno-popliteal junctions. Multivariate regression modelling was used to look for predictors of remnant stump length.
Mean sapheno-femoral and sapheno-popliteal junctions stump lengths immediately post procedure were 33.0 mm (range 0-58 mm) and 27 mm (range 5-33 mm), -17.0 mm and -23.0 mm less than the expected 50-mm baseline length, respectively. At 1 week post-procedure, mean sapheno-femoral and sapheno-popliteal junctions stump lengths were 25.0 mm and 25.0 mm, respectively, the former found to be shorter compared to immediately post-procedure (25 mm vs 33 mm; < 0.05). Multivariate analysis found larger upper thigh great saphenous veins diameter at sapheno-femoral junction to be predictive of shorter remnant stump lengths immediately post-procedure (<30 mm stump distance). Larger sapheno-femoral junction diameters and pre-existing ischemic heart disease for the sapheno-femoral junction and larger small saphenous veins diameters and age for the sapheno-popliteal junction were predictive of interval shortening of the measured remnant lengths found at the completion of the procedure and 1 week later. Initial double-dosing application of glue was not found to be predictive of shorter stump lengths.
In patients undergoing VenaSeal™ Closure System ablation for superficial truncal reflux, larger upper thigh great saphenous veins diameters predicted shorter remnant sapheno-femoral junction stump lengths immediately post-procedure. Comparing stump lengths at one week to immediately after procedure, larger sapheno-femoral junctions and ischemic heart disease predicted shorter stump lengths at the sapheno-femoral junction, while larger small saphenous vein diameters predicted shorter stump lengths at the sapheno-popliteal junction.
VenaSeal™ 闭合系统是一种非热、非肿胀的静脉闭合装置，采用氰基丙烯酸酯粘合剂来闭塞功能不全的静脉，以治疗浅表主干反流。本研究旨在检查患者、双能超声定义的静脉特征和与治疗相关的因素，这些因素可能预测在围手术期股隐和隐腘交界处的残端长度的差异。
共有 73 名患者（87 条腿；85 条大隐静脉；11 条小隐静脉），平均年龄 63 岁（26-86 岁），接受了 VenaSeal™ 闭合系统消融术。85 条大隐静脉中，44 条（52%）采用改良的使用说明书技术，即对于直径 >6mm 的大隐静脉，初始沉积时使用双倍剂量的胶水（0.3cc）。大隐静脉和小隐静脉消融的中位长度分别为 48.0cm（范围 13-69cm）和 32.0cm（范围 19-40cm）。62/87（71.3%）条腿的 CEAP 分级为 4-6 级。术后立即和术后 1 周进行全容积超声检查，以测量股隐和隐腘交界处的残端长度。采用多变量回归模型寻找残端长度的预测因素。
术后即刻股隐和隐腘交界处残端长度分别为 33.0mm（范围 0-58mm）和 27mm（范围 5-33mm），比预期的 50mm 基线长度分别短 17.0mm 和 23.0mm。术后 1 周，股隐和隐腘交界处残端长度分别为 25.0mm 和 25.0mm，前者较术后即刻（25mm 比 33mm；<0.05）短。多变量分析发现股隐交界处的大腿上部大隐静脉直径较大与术后即刻较短的残端长度有关（<30mm 残端距离）。股隐交界处直径较大和存在缺血性心脏病，以及隐腘交界处小隐静脉直径较大和年龄较大，与术中测量的残端长度缩短和术后 1 周的测量结果有关。术中初始双倍剂量的胶水应用并未发现与较短的残端长度有关。
在接受 VenaSeal™ 闭合系统消融术治疗浅表主干反流的患者中，大腿上部大隐静脉直径较大预测术后即刻股隐交界处残端较短。与术后即刻相比，术后 1 周股隐交界处较大的直径和缺血性心脏病预测较短的残端长度，而隐腘交界处较大的小隐静脉直径预测较短的残端长度。
