Gao Rong-Ding, Qian Song-Yi, Wang Hai-Hong, Liu Yong-Sheng, Ren Shi-Yan
Department of Laser and Vascular Surgery, Aviation General Hospital, China Medical University, Beijing 100012, China.
Department of Cardiac Surgery, Zhongshan Hospital (Xiamen Brach), Fudan University, Xiamen 361015, Fujian Province, China.
World J Clin Cases. 2022 Jun 26;10(18):5946-5956. doi: 10.12998/wjcc.v10.i18.5946.
Patients with varicose veins can be treated with conservative or surgical approaches based on the clinical conditions and patient preferences. In the recent decade, the recommendations for managing symptomatic varicose veins have changed dramatically due to the rise of minimally invasive endovascular techniques. The literature was systematically searched on Medline without language restrictions. All papers on the treatment of varicose veins and venous insufficiency with different procedures were included and reviewed. Endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) both are same safe and effective in terms of occlusion rate, and time to return to normal activity. In comparison with RFA or EVLT, Cure conservatrice et Hemodynamique de l'Insufficience Veineuse en Ambulatoire (CHIVA) may cause more bruising and make little or no difference to rates of limb infection, superficial vein thrombosis, nerve injury, or hematoma. In terms of recurrence of varicose veins, there is little or no difference between CHIVA and stripping, RFA, or EVLT. Great saphenous vein recanalization is highest in the ultrasound-guided foam sclerotherapy (FS) group (51%) during 1 year of follow-up. The 2013 National Institute for Health and Care Excellence clinical guidelines recommend surgery as a third-line therapeutic option after EVLA or RFA and sclerotherapy. Although the mechanochemical endovenous ablation (MOCA) is a non-thermal, non-tumescent option and appears to be of similar efficacy to stab avulsion with no potential risk of nerve damage, the overall success rate of MOCA is lower than those of other procedures such as EVLA, RFA, or high ligation and stripping. EVLA is the most cost-effective therapeutic option, with RFA being a close second for the treatment of patients with varicose veins. Endovenous thermal ablation (EVLA or RFA) is recommended as a first-line treatment for varicose veins and has substituted the high ligation of saphenofemoral junctional reflux and stripping of varicose veins. Ultrasound-guided FS is associated with a high recurrence rate and can be used in conjunction with other procedures. MOCA and cyanoacrylate embolization appear promising, but evidence of their effectiveness is required.
静脉曲张患者可根据临床情况和患者偏好采用保守或手术方法进行治疗。在最近十年中，由于微创血管内技术的兴起，治疗有症状静脉曲张的建议发生了巨大变化。对Medline进行了无语言限制的系统检索。纳入并审查了所有关于用不同方法治疗静脉曲张和静脉功能不全的论文。就闭塞率和恢复正常活动的时间而言，腔内激光消融术（EVLA）和射频消融术（RFA）同样安全有效。与RFA或EVLT相比，门诊静脉功能不全的保守和血流动力学治疗（CHIVA）可能会导致更多瘀伤，并且对肢体感染、浅静脉血栓形成、神经损伤或血肿的发生率几乎没有影响或没有差异。就静脉曲张复发而言，CHIVA与剥脱术、RFA或EVLT之间几乎没有差异。在1年的随访中，超声引导下泡沫硬化疗法（FS）组的大隐静脉再通率最高（51%）。2013年英国国家卫生与临床优化研究所临床指南推荐手术作为EVLA或RFA及硬化疗法后的三线治疗选择。尽管机械化学腔内消融术（MOCA）是一种非热、非肿胀的选择，并且似乎与穿刺剥脱术具有相似的疗效，且没有神经损伤的潜在风险，但MOCA的总体成功率低于其他手术，如EVLA、RFA或高位结扎剥脱术。EVLA是最具成本效益的治疗选择，RFA在治疗静脉曲张患者方面紧随其后。腔内热消融术（EVLA或RFA）被推荐为静脉曲张的一线治疗方法，并且已经取代了大隐静脉股静脉交界反流的高位结扎和静脉曲张剥脱术。超声引导下FS的复发率较高，可以与其他手术联合使用。MOCA和氰基丙烯酸酯栓塞术似乎很有前景，但需要其有效性的证据。
