Whiteley Mark S, Davies Charlotte E
The Whiteley Clinic, Guildford, Surrey, UK.
Faculty of Health and Biomedical Sciences, University of Surrey, Guildford, Surrey, UK.
SAGE Open Med Case Rep. 2021 Feb 12;9:2050313X21994993. doi: 10.1177/2050313X21994993. eCollection 2021.
Endovenous thermal ablation is a first-line treatment for symptomatic varicose veins due to truncal vein reflux. Ablation of an incompetent great saphenous vein is usually performed from distally, with the vein access at the lowest point of reflux, or just below the knee. Occasionally there are patients in whom the great saphenous vein is difficult to access distally for reasons such as small vein diameter, scar tissue, vasospasm, difficult anatomy or multiple attempts with haematoma formation. In such cases, we access the great saphenous vein in a retrograde fashion by percutaneous cannulation of the superficial inferior epigastric vein, passing the catheter into the great saphenous vein just distal to the saphenofemoral junction and then down the vein to the required distal position. Ablation can then be performed, stopping the ablation in the great saphenous vein just distal to the junction of superficial inferior epigastric vein and great saphenous vein. We present a patient to illustrate our technique.
腔内热消融是治疗因主干静脉反流引起的有症状静脉曲张的一线治疗方法。对于功能不全的大隐静脉，通常从远端进行消融，静脉穿刺点位于反流最低点或膝关节以下。偶尔会有患者因静脉直径小、瘢痕组织、血管痉挛、解剖结构复杂或多次穿刺形成血肿等原因，难以从远端进入大隐静脉。在这种情况下，我们通过经皮穿刺腹壁下浅静脉以逆行方式进入大隐静脉，将导管插入到股隐静脉交界处远端的大隐静脉内，然后沿静脉向下至所需的远端位置。然后进行消融，在腹壁下浅静脉与大隐静脉交界处远端的大隐静脉内停止消融。我们介绍一位患者以说明我们的技术。
