Sotiris Davlouros, Pallotta Graziano, Nittari Giulio, Amenta Francesco
Dr. Sotiris is with the University of Pavia in Pavia, Italy and the University of Camerino in Camerino, Italy.
Drs. Pallotta, Amenta, and Nittari are with the Telemedicine and Telepharmacy Center at the University of Camerino in Camerino, Italy.
J Clin Aesthet Dermatol. 2020 Aug;13(8):E59-E64. Epub 2020 Aug 1.
The Triplex method is a three-step treatment approach to reducing the appearance of small and medium-sized varicose veins and phlebological imperfections of the lower limbs. This study evaluated the effectiveness, duration of results, adverse events, patient satisfaction, and improvements in quality of life in patients with small and medium-sized varicose veins who were treated with the Triplex method. We conducted a six-year follow-up study of 4,000 patients from the years 2012 to 2018. Patients with chronic venous insufficiency of the lower limbs were included. Patients with active or previous phlebitis or phlebostatic ulcers were excluded. An average of three sessions was performed on each patient in the Triplex group. Follow-up assessments were performed 1, 3, 6, and 12 months after the completion of the treatment, and they included a morphofunctional study, histological examination, and photographic documentation. The first step of the treatment approach utilized an injectable shrinkage solution consisting of sodium salicylate, physiological solution with 10% glycerol, and lidocaine, which was injected into the varices to trigger a reduction of the vessel lumen. For patients in whom the targeted vessels were not sufficienty narrowed by the shrinkage solution, the second step - ultrasound-guided foam sclerotherapy, or scleromousse - was utilized, which consisted of either lauromacrogol 1% or sodium tetradecyl sulfate 1%, with one group of patients (n=50) receiving the former and the other group of patients (n=50) receiving the latter. All patients were administered Step 3 of the treatment approach, which usually included varicose treatment with low concentrations of sodium tetradecyl sulfate (STS) 0.2 to 0.50% or lauromacrogol 0.25%, with compression additionally prescribed in some patients. Over a follow-up period of six years, in patients who underwent full Triplex treatment, we observed 1) a greater duration of the narrowing of the vessel's caliber, with disappearance of the varices; 2) reduced utilization of the foam solution at the reflux point due to the narrowing of the gauge; and 3) no relevant hemodynamic effects emerged in patients with recanalization. In patients who underwent Steps 1 and 2 of the treatment approach, reflux was not hemodynamically significant. No significant differences were observed in the lauromacrogol group of patients compared to the sodium tetradecyl sulfate group. Compared to patients in whom only scleromousse was performed at the reflux site, the narrowing of the varicose wall that is achieved using the Triplex method is associated with longer lasting results in the treatment of small and medium-sized varicose veins, with physiological recovery of superficial venous circulation.
三联疗法是一种分三步的治疗方法，用于减少中小静脉曲张的外观以及下肢静脉学方面的瑕疵。本研究评估了接受三联疗法治疗的中小静脉曲张患者的疗效、效果持续时间、不良事件、患者满意度以及生活质量的改善情况。我们对2012年至2018年期间的4000名患者进行了为期六年的随访研究。纳入了下肢慢性静脉功能不全的患者。排除了患有活动性或既往静脉炎或静脉淤积性溃疡的患者。三联疗法组的每位患者平均接受了三次治疗。在治疗完成后的1、3、6和12个月进行随访评估，评估内容包括形态功能研究、组织学检查和摄影记录。治疗方法的第一步使用了一种可注射的收缩溶液，该溶液由水杨酸钠、含10%甘油的生理溶液和利多卡因组成，将其注入静脉曲张以促使血管腔缩小。对于那些目标血管未被收缩溶液充分缩窄的患者，采用第二步——超声引导下泡沫硬化疗法，即硬化泡沫剂，其成分是1%的聚多卡醇或1%的十四烷基硫酸钠，一组患者（n = 50）接受前者，另一组患者（n = 50）接受后者。所有患者都接受了治疗方法的第三步，这通常包括用0.2%至0.50%的低浓度十四烷基硫酸钠（STS）或0.25%的聚多卡醇进行静脉曲张治疗，部分患者还额外开具了加压治疗。在六年的随访期内，在接受完整三联疗法治疗的患者中，我们观察到：1）血管口径缩窄的持续时间更长，静脉曲张消失；2）由于管径缩窄，回流点处泡沫溶液的使用减少；3）再通患者未出现相关血流动力学影响。在接受治疗方法第一步和第二步的患者中，回流在血流动力学上不显著。聚多卡醇组患者与十四烷基硫酸钠组患者相比未观察到显著差异。与仅在回流部位进行硬化泡沫剂治疗的患者相比，使用三联疗法实现的静脉曲张壁缩窄与中小静脉曲张治疗的更持久效果相关，且浅静脉循环可生理性恢复。
