Division of Vascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn.
Division of Vascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn.
J Vasc Surg Venous Lymphat Disord. 2021 Jul;9(4):932-937. doi: 10.1016/j.jvsv.2020.11.013. Epub 2020 Nov 27.
Varicose veins are commonly caused by valvular reflux in the saphenous vein. Most insurance companies will approve venous ablation (VA) for the treatment of junctional reflux only and will deny coverage for symptomatic patients with significant nonjunctional reflux of the saphenous vein at the deep system. The present study compared the outcomes of VA for patients with junctional reflux and patients with nonjunctional reflux.
A retrospective, single-center review of consecutive patients who had undergone VA using radiofrequency in an outpatient office was performed from 2012 to 2016. The patients' electronic medical records were reviewed for the characteristics, imaging findings, and outcomes. A telephone survey inquiring about the intensity of symptoms using a numeric rating scale of 0 to 10 before and after treatment was also conducted, with higher number correlating with increasing symptom severity. Patients were grouped according to the location of reflux, either at the saphenofemoral-saphenopopliteal junction or below the junction (nonjunctional). The patient characteristics and outcomes were compared between the two groups. Clinical success was defined by symptom improvement or resolution. Technical success was defined by vein closure on duplex ultrasonography.
A total of 265 patients (224 with junctional reflux [84.5%] and 41 with nonjunctional reflux [15.5%]) had undergone VA of 343 veins. The mean patient age was 58.8 ± 15 years. No differences in age, sex, or race were present between the two groups. Patients with junctional reflux were significantly more likely to have undergone bilateral treatment (33.3% vs 12.2%; P = .006). No difference was found in CEAP (clinical, etiologic, anatomic, pathophysiologic) class, laterality, or type of vein treated. On ultrasonography, the veins with junctional reflux had significantly larger diameters (5.8 ± 2.1 mm vs 4.8 ± 1.8 mm; P = .004). However, the veins with nonjunctional reflux had a longer reflux time (5.5 ± 0.6 seconds vs 4 ± 1.7 seconds; P < .0001). The clinical success rates, technical success rates, and incidence of complications were not different between patients with junctional reflux and those with nonjunctional reflux. The telephone survey was completed by 217 patients after a mean follow-up of 24.9 ± 11.3 months. The survey results demonstrated no differences in improvement in pain or swelling or recurrence of pain or swelling after 2 years.
Junctional reflux in the saphenous vein is more likely to be bilateral compared with nonjunctional reflux. The location of reflux did not affect patient presentation or outcomes after VA.
静脉曲张通常是由于大隐静脉的瓣膜反流引起的。大多数保险公司将批准静脉消融术（VA）治疗交通支反流，但对于大隐静脉深部系统存在明显非交通支反流的有症状患者，将拒绝承保。本研究比较了 VA 治疗交通支反流和非交通支反流患者的疗效。
回顾性分析了 2012 年至 2016 年在门诊行射频静脉消融术的连续患者的病历资料。对患者的病历资料进行了特征、影像学表现和结果的回顾。还进行了电话调查，询问治疗前后疼痛程度的数字评分（0 到 10 分），评分越高表示症状越严重。根据反流部位，患者被分为交通支（大隐静脉-股隐静脉交界处或以下）或非交通支（大隐静脉-腘静脉交界处以上）反流。比较两组患者的特征和疗效。临床疗效定义为症状改善或缓解。技术疗效定义为双功能超声检查显示静脉闭合。
共 265 例患者（224 例交通支反流[84.5%]，41 例非交通支反流[15.5%]）接受了 343 条静脉的 VA 治疗。患者平均年龄为 58.8±15 岁。两组患者的年龄、性别或种族无差异。交通支反流患者双侧治疗的比例明显更高（33.3% vs 12.2%；P=0.006）。CEAP（临床、病因、解剖、病理生理）分级、侧别或治疗静脉类型无差异。超声检查显示，交通支反流的静脉直径明显较大（5.8±2.1mm vs 4.8±1.8mm；P=0.004）。然而，非交通支反流的静脉反流时间明显较长（5.5±0.6 秒 vs 4±1.7 秒；P<0.0001）。交通支反流与非交通支反流患者的临床有效率、技术有效率和并发症发生率无差异。平均随访 24.9±11.3 个月后，217 例患者完成了电话调查。调查结果显示，2 年后疼痛或肿胀的改善、疼痛或肿胀的复发无差异。
与非交通支反流相比，大隐静脉交通支反流更可能为双侧。反流部位不影响 VA 治疗后的患者表现或疗效。
