Obermayer Alfred, Aubry Jean-François, Barnat Nesrine
Institute for Functional Phlebosurgery, Karl Landsteiner Society, Melk, Austria.
Physics for Medicine Paris, INSERM, ESPCI Paris, CNRS, PSL Research University, Paris, France.
EJVES Vasc Forum. 2020 Dec 5;50:1-5. doi: 10.1016/j.ejvsvf.2020.11.005. eCollection 2021.
Endovenous techniques such as ultrasound guided foam sclerotherapy, thermal methods, or glues are generally recommended to occlude incompetent veins. However, these methods can be technically challenging and risky for patients with severe atrophic skin disorders like lipodermatosclerosis or atrophie blanche. High intensity focused ultrasound (HIFU), which has been shown to coagulate and occlude veins successfully, may offer an alternative method. This case report details ultrasound guided HIFU to occlude non-invasively a refluxing perforator vein causing active ulcers.
A 95 year old man presented to the Institute for Functional Phlebology (Melk, Austria) with painful recurrent ulcers in his left medial calf. His limb was scored C2,3,4a, b,6, Ep, Ap, Pr,18 according to the Clinical, Etiology, Anatomic, Pathophysiology (CEAP) classification. Lower limb ultrasound revealed a refluxing posterior tibial perforating vein, measuring 2.7 mm in diameter at the level of the fascia. Extracorporeal HIFU pulses were delivered to this vein with the Sonovein device (Theraclion, Malakoff, France). Sonication was applied for eight seconds at a mean acoustic power of 80 W. The patient was followed up for three months post-treatment and occlusion was evaluated by duplex ultrasound. There were no complications during treatment or follow up. Three months after the treatment, reflux was abolished and the two initially active ulcers had healed.
Although this is an early report, this study shows that HIFU can be successful in ablation of incompetent perforator veins in the treatment of venous leg ulcers.
诸如超声引导下泡沫硬化疗法、热消融方法或胶水注射等静脉内技术通常被推荐用于闭塞功能不全的静脉。然而，对于患有严重萎缩性皮肤病（如脂膜炎性硬化症或白色萎缩）的患者，这些方法在技术上可能具有挑战性且存在风险。高强度聚焦超声（HIFU）已被证明能够成功地凝固并闭塞静脉，可能提供一种替代方法。本病例报告详细介绍了超声引导下的HIFU无创闭塞导致活动性溃疡的反流性穿支静脉。
一名95岁男性因左小腿内侧疼痛性复发性溃疡就诊于功能性静脉病研究所（奥地利梅尔）。根据临床、病因、解剖、病理生理学（CEAP）分类，他的肢体评分为C2、3、4a、b、6、Ep、Ap、Pr、18。下肢超声显示一条反流的胫后穿支静脉，在筋膜水平直径为2.7毫米。使用Sonovein设备（法国马拉科夫Theraclion公司）向该静脉发射体外HIFU脉冲。以平均80瓦的声功率进行超声处理8秒。对患者进行治疗后三个月的随访，并通过双功超声评估闭塞情况。治疗期间及随访过程中均未出现并发症。治疗三个月后，反流消失，最初的两个活动性溃疡已愈合。
尽管这是一份早期报告，但本研究表明HIFU在治疗下肢静脉溃疡时成功消融功能不全的穿支静脉方面是可行的。
