Golovina Veronika, Panfilov Vladislav, Seliverstov Evgenii, Erechkanova Darina, Zolotukhin Igor
Department of Fundamental and Applied Research in Vascular Surgery, Pirogov Russian National Research Medical University, 119049 Moscow, Russia.
Pirogov City Clinical Hospital No. 1, 119049 Moscow, Russia.
J Clin Med. 2024 Dec 18;13(24):7747. doi: 10.3390/jcm13247747.
The great saphenous vein (GSV) has long been recognized as the best conduit for vascular bypass procedures. Concomitant varicose veins disease may be a reason for GSV unavailability either due to dilatation and tortuosity of the vein or due to its destruction during invasive venous treatment. -to assess the rate of varicose vein patients with concomitant lower extremity arterial disease (LEAD) who have previously lost their GSV due to venous ablation. A total of 285 patients (76 F, 209 M) with LEAD were consecutively enrolled. A total of 111 patients (222 limbs) underwent a detailed duplex ultrasound of the lower extremity veins for assessing suitability of the GSV as a conduit. We registered presence of varicose veins (VVs), type of previous invasive procedure and availability of saphenous veins as possible grafts. The mean age of screened patients was 70.5 ± 9.1.62 (21.75%) patients had varicose veins or were operated on before due to varicose veins. A total of 42 patients with varicose veins had C2 disease, 10 had C3, 9 had C4 and 1 had C6 according to CEAP classification. A total of 222 lower extremities were examined by duplex ultrasound of which 51 limbs had VVs. Despite the presence of varicose tributaries, the GSV was suitable for bypass in 9 of those lower extremities. The GSV was not available as a conduit in 34 (19.9%) ipsilateral lower extremities in the LEAD with no VVs group and in 42 (82.6%) ipsilateral lower extremities in the LEAD with VVs group ( = 0.0001). Varicose vein disease was associated with a higher frequency of the GSV unavailability (odds ratio 18.8, 95% confidence interval 8.35-42.35). On the 11 ipsilateral limbs (5% of LEAD patients and 21.6% of LEAD with VVs patients), the GSV was unavailable due to previous venous interventions. Almost 20% of patients may have both LEAD and VVs. Among those with VVs, most have the ipsilateral GSV unavailable as a potential conduit. Additionally, one fifth of limbs with VVs had GSVs destroyed previously due to saphenous ablative procedures.
大隐静脉（GSV）长期以来一直被认为是血管搭桥手术的最佳管道。合并静脉曲张疾病可能是大隐静脉无法使用的原因，这可能是由于静脉扩张和迂曲，也可能是由于在侵入性静脉治疗过程中其遭到破坏。——评估因静脉消融而先前失去大隐静脉的合并下肢动脉疾病（LEAD）的静脉曲张患者的比例。连续纳入了285例患有LEAD的患者（76例女性，209例男性）。共有111例患者（222条肢体）接受了下肢静脉的详细双功超声检查，以评估大隐静脉作为管道的适用性。我们记录了静脉曲张（VVs）的存在情况、先前侵入性手术的类型以及大隐静脉作为可能移植物的可用性。筛查患者的平均年龄为70.5±9.1岁。62例（21.75%）患者患有静脉曲张或先前因静脉曲张接受过手术。根据CEAP分类，共有42例患有静脉曲张的患者为C2期疾病，10例为C3期，9例为C4期，1例为C6期。通过双功超声检查了总共222条下肢，其中51条肢体有静脉曲张。尽管存在曲张属支，但在其中9条下肢中，大隐静脉适合用于搭桥。在无静脉曲张的LEAD组中，34条（19.9%）同侧下肢的大隐静脉无法作为管道使用；在有静脉曲张的LEAD组中，42条（82.6%）同侧下肢的大隐静脉无法作为管道使用（P = 0.0001）。静脉曲张疾病与大隐静脉无法使用的频率较高相关（优势比18.8，95%置信区间8.35 - 42.35）。在11条同侧肢体（占LEAD患者的5%，占患有静脉曲张的LEAD患者的21.6%）中，大隐静脉因先前的静脉干预而无法使用。几乎20%的患者可能同时患有LEAD和静脉曲张。在患有静脉曲张的患者中，大多数同侧大隐静脉无法作为潜在管道使用。此外，五分之一有静脉曲张的肢体的大隐静脉先前因大隐静脉消融手术而遭到破坏。
