Pihlaja Toni, Vanttila Laura-Maria, Ohtonen Pasi, Pokela Matti
Department of Vascular Surgery, Oulu University Hospital, Oulu, Finland; Medical Research Center Oulu, University of Oulu, Oulu, Finland.
Medical Research Center Oulu, University of Oulu, Oulu, Finland.
J Vasc Surg Venous Lymphat Disord. 2022 Nov;10(6):1238-1244. doi: 10.1016/j.jvsv.2022.07.008. Epub 2022 Aug 9.
This retrospective trial analyzed the effect of predetermined variables on venous ulcer healing after endovenous ablation of insufficient veins.
A total of 259 patients presenting 273 venous leg ulcers (VLUs) at Oulu University Hospital vascular outpatient clinic between January 2010 and December 2020 were included in the study. In addition to compression therapy, all patients received endovenous ablation (endothermal ablation and/or foam sclerotherapy) to promote venous healing. The hazard ratio (HR) for an ulcer to heal was analyzed in univariate analysis of predetermined factors, including age, sex, recurrent venous ulcer, presence of great saphenous vein or small saphenous vein reflux, persistent superficial vein reflux after ablation, recanalization in treated segments, ulcer age, body mass index >35 kg/m, history of deep vein thrombosis, history of erysipelas, ability to move, smoking, hypertension, atrial fibrillation, coronary artery disease, diabetes mellitus, and cardiac insufficiency. Logistic regression was used in a multivariate analysis to identify independent risk factors for ulcer healing.
In the univariate analysis, healing was negatively associated with persistent superficial vein reflux after ablation (HR, 0.117; 95% confidence interval [CI], 0.088-0.354), recanalization in treated segments (HR, 0.161; 95% CI, 0.060-0.433), nonambulatory patient (HR, 0.322; 95% CI, 0.130-0.800), history of deep vein thrombosis (HR, 0.518; 95% CI, 0.294-0.910), and presence of small saphenous vein reflux (HR, 0.565; 95% CI, 0.384-0.830). Independent risk factors included persistent superficial vein reflux after ablation (HR, 0.123; 95% CI, 0.0051-0.295). All the patients in the persistent superficial vein reflux group had their VLUs eventually healed after further endovenous treatment.
When treating patients with VLUs, persistent superficial vein reflux after ablation was negatively associated with ulcer healing. After additional endovenous ablative treatment, ulcers with persistent reflux eventually healed.
本回顾性试验分析了预定变量对静脉功能不全静脉腔内消融术后静脉溃疡愈合的影响。
纳入2010年1月至2020年12月期间在奥卢大学医院血管门诊就诊的259例患者，共273处下肢静脉溃疡（VLU）。除压迫治疗外，所有患者均接受腔内消融（内热消融和/或泡沫硬化疗法）以促进静脉愈合。在对预定因素进行单因素分析时，分析溃疡愈合的风险比（HR），这些因素包括年龄、性别、复发性静脉溃疡、大隐静脉或小隐静脉反流的存在、消融后持续的浅静脉反流、治疗节段的再通、溃疡病程、体重指数>35kg/m²、深静脉血栓形成病史、丹毒病史、活动能力、吸烟、高血压、心房颤动、冠状动脉疾病、糖尿病和心功能不全。多因素分析采用逻辑回归以确定溃疡愈合的独立危险因素。
在单因素分析中，愈合与消融后持续的浅静脉反流（HR，0.117；95%置信区间[CI]，0.088 - 0.354）、治疗节段的再通（HR，0.161；95%CI，0.
