Bezerra de Souza Fonseca Flávia Lins, Lins Esdras Marques, Albuquerque Godoi Emmanuelle Tenório, Guedes Henrique Jorge, Xavier de Mendoza Ana Júlia, Serrano de Oliveira Camila Beatriz
Postgraduate Program in Surgery, CCM, Universidade Federal de Pernambuco, Recife, Brazil.
Postgraduate Program in Surgery, CCM, Universidade Federal de Pernambuco, Recife, Brazil.
J Vasc Surg Venous Lymphat Disord. 2025 Jan;13(1):101986. doi: 10.1016/j.jvsv.2024.101986. Epub 2024 Oct 10.
This study evaluates hemodynamic and anatomic changes in great saphenous vein (GSV) tributaries after endovenous laser ablation (EVLA).
This case series analyzed 112 areas in 28 lower limbs of 25 patients who underwent EVLA from April 2022 to June 2023 at the Hospital das Clínicas de Pernambuco/UFPE. All patients were evaluated by Doppler ultrasound preoperatively and 3 months after the surgical treatment. The parameters studied were GSV diameter and patency, GSV tributary diameter, patency and flow direction, and the Venous Clinical Severity Score after EVLA. The GSV characteristics were evaluated in four regions: saphenous-femoral junction, medium thigh, knee, and medium leg. The tributary veins were grouped in four areas: anterior thigh, posterior thigh, anterior leg, and posterior leg.
The results included 28 lower limbs from 23 patients; 18 patients (67.9%) were women, and the average age was 49 years; 2 patients were lost to follow-up. Ninety days after EVLA, all treated GSVs were occluded. The average diameter of GSV decreased in all four regions studied: saphenous-femoral junction, medium thigh, knee, and medium leg (P ≤ .001). We analyzed 101 GSV tributaries. In the analysis of GSV tributaries by area, we identified a mean diameter decrease in all groups of tributaries (P < .001). Considering the tributaries with reflux, we also identified a reduction in the number of tributaries with reflux in all four groups (P ≤ .001). All tributaries were patent preoperatively; at 3 months after the surgical treatment, GSV tributaries occlusion was infrequent, except for the anterior thigh group. There was a decrease from 9 to 5 points in Venous Clinical Severity Score after EVLA (P < .001).
This study demonstrated that, after GSV laser ablation, there was a statistically significant decrease in the diameters of all tributary groups, and the number of tributaries with decreased reflux; however, the occlusion of tributaries was not a frequent finding.
本研究评估大隐静脉（GSV）属支在腔内激光消融术（EVLA）后的血流动力学和解剖学变化。
本病例系列分析了2022年4月至2023年6月在伯南布哥临床医院/伯南布哥联邦大学接受EVLA治疗的25例患者28条下肢的112个区域。所有患者在术前及手术治疗后3个月接受多普勒超声评估。研究的参数包括GSV直径和通畅情况、GSV属支直径、通畅情况和血流方向，以及EVLA后的静脉临床严重程度评分。GSV特征在四个区域进行评估：隐股交界处、大腿中部、膝关节和小腿中部。属支静脉分为四个区域：大腿前部、大腿后部、小腿前部和小腿后部。
结果纳入23例患者的28条下肢；18例患者（67.9%）为女性，平均年龄49岁；2例患者失访。EVLA术后90天，所有接受治疗的GSV均闭塞。在研究的所有四个区域（隐股交界处、大腿中部、膝关节和小腿中部），GSV的平均直径均减小（P≤0.001）。我们分析了101条GSV属支。在按区域分析GSV属支时，我们发现所有属支组的平均直径均减小（P<0.001）。考虑有反流的属支，我们还发现所有四组中有反流的属支数量均减少（P≤0.001）。所有属支在术前均通畅；手术治疗后3个月，除大腿前部组外，GSV属支闭塞情况不常见。EVLA后静脉临床严重程度评分从9分降至5分（P<0.001）。
本研究表明，GSV激光消融术后，所有属支组的直径以及反流减少的属支数量均有统计学意义的下降；然而，属支闭塞并不常见。
