Department of Cardiovascular Surgery, Health Science University, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.
Department of Cardiovascular Surgery, Health Science University, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.
J Vasc Surg Venous Lymphat Disord. 2022 Jul;10(4):865-871. doi: 10.1016/j.jvsv.2021.10.009. Epub 2021 Oct 22.
In the present retrospective, single-center study, we evaluated the long-term effectiveness and reliability of endovenous laser ablation (EVLA), endovenous n-butyl cyanoacrylate (NBCA) application, and radiofrequency ablation (RFA) in the management of chronic venous insufficiency (CVI).
The medical records of patients who had undergone EVLA, NBCA, or RFA for CVI from January 1, 2014 to January 1, 2017 were reviewed. The medical records included data on sex, age, body mass index, American Society of Anesthesiologists score, and symptoms at admission. The great saphenous vein diameter, CEAP (Clinical, Etiology, Anatomy, and Pathophysiology) classification, and venous clinical severity score were also recorded. All the patients were followed up with physical examinations and color Doppler ultrasound scan at the first week and 6 and 12 months after treatment. After 12 months, the follow-up examinations were performed annually.
A total of 232 patients who had undergone lower limb CVI surgical treatment (EVLA, n = 77; NBCA, n = 73; RFA, n = 82). The mean follow-up time was 67.5 ± 4.7 months. The procedure duration was significantly shorter for the NBCA group (13.5 minutes) vs that for the EVLA (31.7 minutes) and RFA (27.9 minutes) groups (P = .001). The pain score was highest in the EVLA group (P = .001). The EVLA group had also experienced a significantly greater incidence of complications and a longer time to return to daily activities (P = .001). The post hoc analysis revealed comparable occlusion success among the three groups on the first postoperative day and at 6, 12, and 24 months postoperatively. However, significantly better occlusion rates were found for RFA vs EVLA at 3 and 5 years of follow-up (P = .024 and P = .011, respectively). The success of NBCA and RFA was similar at 3 and 5 years of follow-up (P = .123 and P = .330, respectively).
The outcomes showed similar early postoperative occlusion success among all three CVI treatment techniques. However, RFA resulted in a significantly higher success rate compared with EVLA at 3 and 5 years of follow-up. Additionally, the NBCA and RFA procedures achieved comparable long-term success. However, EVLA was associated with significantly greater complication rates and pain scores and a longer time to return to daily activities. The NBCA procedure had a significantly shorter operation time compared with the other procedures.
在本回顾性、单中心研究中，我们评估了静脉内激光消融（EVLA）、静脉内丁基氰基丙烯酸酯（NBCA）应用和射频消融（RFA）在治疗慢性静脉功能不全（CVI）中的长期效果和可靠性。
回顾了 2014 年 1 月 1 日至 2017 年 1 月 1 日期间因 CVI 接受 EVLA、NBCA 或 RFA 治疗的患者的病历。病历包括性别、年龄、体重指数、美国麻醉医师协会评分和入院时的症状。还记录了大隐静脉直径、CEAP（临床、病因、解剖和病理生理学）分类和静脉临床严重程度评分。所有患者均在治疗后第 1 周、第 6 个月和第 12 个月进行体格检查和彩色多普勒超声扫描随访。12 个月后，每年进行随访检查。
共 232 例接受下肢 CVI 手术治疗的患者（EVLA 组 n=77；NBCA 组 n=73；RFA 组 n=82）。平均随访时间为 67.5±4.7 个月。NBCA 组的手术时间明显短于 EVLA 组（13.5 分钟）和 RFA 组（27.9 分钟）（P=0.001）。EVLA 组的疼痛评分最高（P=0.001）。EVLA 组还经历了更高的并发症发生率和更长的日常活动恢复时间（P=0.001）。事后分析显示，三组在术后第 1 天和术后 6、12 和 24 个月的闭塞成功率相当。然而，在 3 年和 5 年随访时，RFA 与 EVLA 相比，闭塞率显著更高（P=0.024 和 P=0.011）。NBCA 和 RFA 的成功率在 3 年和 5 年随访时相似（P=0.123 和 P=0.330）。
结果显示，三种 CVI 治疗技术的早期术后闭塞成功率相似。然而，与 EVLA 相比，RFA 在 3 年和 5 年随访时的成功率显著更高。此外，NBCA 和 RFA 治疗的长期成功率相当。然而，EVLA 与更高的并发症发生率和疼痛评分以及更长的日常活动恢复时间相关。与其他手术相比，NBCA 手术的手术时间明显更短。
