Yang G X, Luan J Y, Jia Z C
Department of Interventional Radiology and Vascular Surgery, Peking University Third Hospital, Beijing 100191, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2021 Mar 4;53(2):332-336. doi: 10.19723/j.issn.1671-167X.2021.02.017.
To explore the technical details and short-term effects of radiofrequency obliteration of varicose veins of lower extremities guided by combined venography and ultrasound.
Thirty-seven patients with varicose veins of lower extremities were treated with radiofrequency obliteration using Olympus Celon RFiTT under combined guidance of venography and ultrasound. The indications included varicose veins of lower extremities and reflux of the great saphenous vein confirmed by ultrasound. The contraindications included deep vein thrombosis, cardiac pacemaker, severe cardio- and cerebrovascular diseases or coagulation disorders. Under ultrasound guidance, the saphenous vein around knee level was punctured using a 21G needle, and a 7F sheath was introduced. Through the sheath a venography was made, and an Olympus Celon ProCurve radiofrequency catheter was inserted and advanced to the great saphenous vein under road map, and the catheter tip was positioned at the point 2 cm below the sapheno-femoral junction. The swelling anesthesia was made under ultrasound guidance. Then the radiofrequency obliteration was performed with pressing of the treatment section. The venography was repeated to ensure optimal outcomes. If necessary the radiofrequency obliteration could be repeated once to twice. After that the superficial varicose veins were stripping by small incisions under local anesthesia. After operation, medical decompression stocking was utilized immediately and sustained for three months. The clinical data, intraoperative radiation dose, exposure time and short-term effects were retrospectively analyzed.
After the operation, all the patients walked out of the operating room by themselves. The success rate of operation was 100%. The intraoperative radiation dose was 1.78-10.12 mGy (mean 6.56 mGy), and the exposure time was 61-448 s (mean 161 s). By 3 months follow-up, the symptoms were alleviated in all the 37 patients, and the occlusion rate was 100%. No complications such as skin burns, ecchymosis and deep venous thrombosis were found.
The short-term effects of radiofrequency obliteration using Olympus Celon RFiTT system in a manner of twice fixed point followed by once reciprocating radiofrequency were satisfactory. Radiofrequency obliteration of great saphenous veins guided by venography and ultrasound has not only the advantages of minimal trauma and rapid recovery, but also the advantages of accurate location, exact effect and avoidance of complications.
探讨静脉造影与超声联合引导下射频消融治疗下肢静脉曲张的技术细节及短期疗效。
37例下肢静脉曲张患者在静脉造影与超声联合引导下，使用奥林巴斯Celon RFiTT进行射频消融治疗。适应证为超声证实的下肢静脉曲张及大隐静脉反流。禁忌证包括深静脉血栓形成、心脏起搏器、严重的心脑血管疾病或凝血功能障碍。在超声引导下，用21G穿刺针穿刺膝部水平的大隐静脉，置入7F鞘管。通过鞘管进行静脉造影，在路径图引导下插入奥林巴斯Celon ProCurve射频导管并推进至大隐静脉，导管尖端置于隐股静脉交界处下方2 cm处。在超声引导下进行肿胀麻醉。然后在压迫治疗段的情况下进行射频消融。重复静脉造影以确保最佳效果。必要时可重复射频消融1～2次。之后在局部麻醉下通过小切口剥脱浅静脉曲张。术后立即使用医用减压弹力袜并持续3个月。回顾性分析临床资料、术中辐射剂量、曝光时间及短期疗效。
术后所有患者均自行走出手术室。手术成功率为100%。术中辐射剂量为1.78～10.12 mGy（平均6.56 mGy），曝光时间为61～448 s（平均161 s）。随访3个月时，37例患者症状均缓解，闭塞率为100%。未发现皮肤灼伤、瘀斑及深静脉血栓形成等并发症。
采用奥林巴斯Celon RFiTT系统以两次定点后一次往复式射频方式进行射频消融的短期疗效满意。静脉造影与超声联合引导下大隐静脉射频消融术不仅具有创伤小、恢复快的优点，还具有定位准确、效果确切、避免并发症等优点。
