Vascular Surgery Service, Humanitas Gavazzeni, Bergamo, Italy.
Tirrenia Hospital, Belvedere Marittimo, Italy.
Vasc Endovascular Surg. 2024 Jan;58(1):60-64. doi: 10.1177/15385744231188804. Epub 2023 Jul 10.
endovenous laser ablation (EVLA) represents the gold standard in treating both great and small saphenous veins (GSV and SSV) incompetence. To achieve a "no-scalpel" procedure in patients with chronic venous insufficiency (CVI, CEAP C3-C6), concomitant phlebectomies could be replaced by ultrasound-guided foam sclerotherapy (UGFS) into varicose tributaries. The aim of this study is to present a single-centre experience on EVLA + UGFS for patients with CVI secondary to varicose veins and saphenous trunk incompetence, analysing ling-term outcomes.
all consecutive patients with CVI and treated by EVLA + UGFS from 2010 to 2022 were included in the analysis. EVLA was performed using a 1470-nm diode laser (LASEmaR® 1500, Eufoton, Trieste, Italy), adapting the linear endovenous energy density (LEED) depending on saphenous trunk diameter. Tessari method was used for UGFS. Patients were evaluated clinically and by duplex scanning at 1, 3 and 6 months, and annually up to 4 years, to assess treatment efficacy and adverse reactions.
5500 procedures in 4895 patients (3818 women, 1077 men) with a mean age of 51.4 years were analysed during the study period. A total of 3950 GSVs and 1550 SSVs were treated with EVLA + UGFS (C3 59%, C4 23%, C5 17% and C6 1%). Neither deep vein thrombosis nor pulmonary embolism were detected during follow-up, as well as superficial burns. Ecchymoses (7%), transitory paraesthesia (2%), palpable vein induration/superficial vein thrombosis (15%) and transient dyschromia (1%) were registered. Saphenous and tributaries closure rate at 30 days, 1 and 4 years were 99.1%, 98.3% and 97.9%, respectively.
EVLA + UGFS for an extremely minimally invasive procedure appears to be a safe technique, with only minor effects and acceptable long-term outcomes, in patients with CVI. Further prospective randomized studies are needed to confirm the role of this combined therapy in such patients.
静脉内激光消融术 (EVLA) 是治疗大隐静脉和小隐静脉 (GSV 和 SSV) 功能不全的金标准。为了在慢性静脉功能不全 (CVI，CEAP C3-C6) 患者中实现“无刀”手术，可以用超声引导下泡沫硬化疗法 (UGFS) 代替静脉内激光消融术 (EVLA) 治疗静脉曲张属支。本研究旨在介绍静脉内激光消融术联合超声引导下泡沫硬化疗法治疗大隐静脉和隐静脉主干功能不全引起的 CVI 的单中心经验，并分析其长期疗效。
回顾性分析 2010 年至 2022 年期间接受 EVLA 联合 UGFS 治疗的 CVI 患者的临床资料。EVLA 采用 1470nm 二极管激光 (LASEmaR® 1500，Eufoton，的里雅斯特，意大利) 进行，根据隐静脉主干直径调整线性静脉内能量密度 (LEED)。UGFS 采用 Tessari 法。患者在治疗后 1、3 和 6 个月以及每年进行临床和双功能超声检查，直至 4 年，以评估治疗效果和不良反应。
研究期间共对 4895 例患者 (3818 例女性，1077 例男性) 的 5500 例次手术进行了分析，患者平均年龄为 51.4 岁。共治疗 3950 条大隐静脉和 1550 条小隐静脉，采用 EVLA 联合 UGFS 治疗 (C3 占 59%，C4 占 23%，C5 占 17%，C6 占 1%)。随访期间未发现深静脉血栓形成或肺栓塞，也未发现浅表烧伤。术后出现瘀斑 (7%)、短暂感觉异常 (2%)、可触及静脉硬结/浅表静脉血栓形成 (15%)和短暂色素沉着异常 (1%)。术后 30 天、1 年和 4 年的隐静脉和属支闭塞率分别为 99.1%、98.3%和 97.9%。
对于慢性静脉功能不全患者，EVLA 联合 UGFS 是一种微创、安全性高的技术，术后仅出现轻微影响，长期疗效良好。需要进一步开展前瞻性随机研究来确定这种联合治疗在这类患者中的作用。
