Teaching and Health Care Unit of Vascular and Endovascular Surgery's Medical Staff, Pedro Ernesto University Hospital (HUPE), Rio de Janeiro State University (UERJ), Rio De Janeiro, Brazil.
Medical Sciences College (FCM), Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil.
Vasc Health Risk Manag. 2021 Jul 2;17:379-387. doi: 10.2147/VHRM.S313282. eCollection 2021.
This study assessed the outcomes and impact on the quality of life following one-step outpatient radiofrequency ablation (RFA) and ultrasound guided foam sclerotherapy (USGFS) for large reflux with varicosities in the great saphenous vein (GSV).
Prospective, single-centre, analytical cohort.
Thirty symptomatic patients having reflux in the GSV and varicosities (CEAP C3 to C6) were treated with RFA and USGFS simultaneously, in a single-step procedure, from March 2016 to December 2016. They were followed up at 1 week, 6 months, 1 and 3 years. Clinical outcomes, changes in the Quality of Life (QOL) questionnaires SF-36™, VCSS and AVVQ, evolutive vein occlusion rates were assessed by duplex ultrasound, and ulcer closure was checked.
The sample was divided into two groups: (Group 1) GSV diameter ≥13.0 mm (median 19.0 [14-24]), 17 subjects, and (Group 2) GSV diameter ≤12.9 mm (median 10.3 [10-12]), 16 subjects. No major adverse event was observed, and the postoperative minor adverse event rates were similar between the two groups. A significant improvement was observed in VCSS and AVVQ from the preoperative levels to the sixth month and the third-year follow-up. Twelve of 13 ulcers had healed at 1 year and remained closed until 3 years. The entire sample had a significant increase in all short form 36 domains, except for mental health in the Group 2 (GSV ≥ 13.0 mm). Overall first week occlusion rate for the whole sample was 90.9% and 69.7% at the 3-year follow-up. No difference in occlusion rate was observed between the two groups at any time.
Exclusively outpatient combined techniques were safe and feasible in this study with no major adverse events, despite the large diameters of the GSV or ulcer presence. Within 3 years, both diameter groups showed equivalent improvement in all QOL parameters, satisfactory axial occlusion, and maintained ulcer closure.
本研究评估了一步法门诊射频消融（RFA）联合超声引导下泡沫硬化疗法（USGFS）治疗大隐静脉曲张伴反流和静脉曲张（CEAP C3 至 C6）的结局和对生活质量的影响。
前瞻性、单中心、分析队列。
2016 年 3 月至 2016 年 12 月，30 例大隐静脉曲张伴反流和静脉曲张（CEAP C3 至 C6）的症状性患者接受了 RFA 和 USGFS 的联合治疗，采用一步法。患者在第 1 周、第 6 个月、第 1 年和第 3 年进行随访。采用超声双功能检查评估临床结局、SF-36™、VCSS 和 AVVQ 生活质量问卷的变化、静脉闭塞率的演变，以及溃疡的闭合情况。
样本分为两组：（组 1）大隐静脉直径≥13.0mm（中位数 19.0[14-24]），17 例；（组 2）大隐静脉直径≤12.9mm（中位数 10.3[10-12]），16 例。两组均未发生重大不良事件，且术后小的不良事件发生率相似。VCSS 和 AVVQ 评分自术前至第 6 个月和第 3 年随访均显著改善。13 例溃疡中有 12 例在 1 年内愈合，3 年内均保持闭合。除了组 2（大隐静脉直径≥13.0mm）的心理健康外，所有患者的所有 SF-36 短式问卷维度在整体上均显著增加。所有患者在术后第 1 周的闭塞率为 90.9%，第 3 年随访时为 69.7%。两组在任何时间的闭塞率均无差异。
尽管大隐静脉直径较大或存在溃疡，但在本研究中，仅门诊联合技术是安全可行的，且无重大不良事件发生。在 3 年内，两组在所有生活质量参数方面均显示出等效的改善，轴向闭塞满意，溃疡保持闭合。
