Zamboni P, Marcellino M G, Cappelli M, Feo C V, Bresadola V, Vasquez G, Liboni A
Institute of General Surgery and Vascular Laboratory, University of Ferrara, Italy.
J Cardiovasc Surg (Torino). 1998 Apr;39(2):151-62.
Evaluation of saphenous vein sparing surgical procedures alternative to high ligation and distal stab avulsion, in terms of effectiveness and suitability for eventual bypass surgery.
Prospective evaluation of 421 operations for primary varicose veins, 64 external valve-plasties of the sapheno-femoral junction (EV-SFJ), (42 performed using the hand sewing technique and 22 using the Veno-cuff device), mean follow-up 52 months, and 357 hemodynamic correction of varicose veins (French acronymis CHIVA), mean follow-up 49 months. Moreover, a subgroup of 27 patients was operated on using the CHIVA technique in two steps, mean follow-up 18 months.
Institute of General Surgery, University of Ferrara. Institutional practice, one-day surgery.
Patients were selected using clinical and duplex scanning evaluations, and classified according to CEAP criteria. Patients with varicose veins due to sapheno-femoral reflux with duplex scanning evidence of mobile valve leaflets underwent EV-SFJ. The other patients were operated on using the hemodynamic correction technique.
EV-SFJ restores valve function correcting vein wall dilatation by applying an external prosthesis. CHIVA consists of selected ligatures of the superficial veins that allow superficial blood aspiration in the deep veins through the perforators as well as the preservation of saphenous drainage.
The outcome was evaluated with independent clinical and ultrasonographic examinations; pre and postoperative AVP and LRR-RT measurements were assessed in 125 cases. Data from self-assessment of the functional and cosmetic result of the patients of the CHIVA group were also obtained using a scoring system. Moreover, scanning the preserved long saphenous vein the rate of long saphenous vein suitable as arterial conduit following sparing surgery was also evaluated.
Overall long saphenous vein patency registered after EV-SFJ and CHIVA was 94%. Varicose veins recurrence rate was 12% and 11%, respectively. Postoperative AVP and LRR-RT improvement was statistically significant (p<0.001).
These two alternative procedures seem to be effective in varices treatment following the proposed indications and techniques. In addition, they appear able to preserve a more significant rate of saphenous veins suitable for eventual bypass surgery than high ligation and multiple cosmetic avulsion.
评估在大隐静脉高位结扎及远端挑出撕脱术之外的保留大隐静脉的手术方法，从有效性以及对最终旁路手术的适用性方面进行评估。
对421例原发性静脉曲张手术、64例大隐静脉-股静脉交界处的外部瓣膜修复术（EV-SFJ）（42例采用手工缝合技术，22例采用静脉袖带装置）进行前瞻性评估，平均随访52个月，以及对357例静脉曲张的血流动力学矫正术（法语缩写为CHIVA）进行评估，平均随访49个月。此外，对27例患者采用CHIVA技术分两步进行手术，平均随访18个月。
费拉拉大学普通外科研究所。机构常规做法，一日手术。
通过临床和双功超声扫描评估选择患者，并根据CEAP标准进行分类。双功超声扫描显示瓣膜活动叶有大隐静脉-股静脉反流的静脉曲张患者接受EV-SFJ手术。其他患者采用血流动力学矫正技术进行手术。
EV-SFJ通过应用外部假体恢复瓣膜功能并纠正静脉壁扩张。CHIVA包括对浅静脉进行选择性结扎，使浅静脉血通过穿通支进入深静脉，同时保留大隐静脉引流。
通过独立的临床和超声检查评估结果；对125例患者术前和术后进行平均静脉压（AVP）和反流率-反流时间（LRR-RT）测量。还使用评分系统获取CHIVA组患者对功能和美容效果自我评估的数据。此外，扫描保留的大隐静脉，评估保留手术之后适合作为动脉导管的大隐静脉比例。
EV-SFJ和CHIVA术后大隐静脉总体通畅率为94%。静脉曲张复发率分别为12%和11%。术后AVP和LRR-RT改善具有统计学意义（p<0.001）。
这两种替代手术方法按照所提出的适应症和技术在静脉曲张治疗中似乎是有效的。此外，与高位结扎和多次美容性撕脱相比，它们似乎能够保留更高比例的适合最终旁路手术的大隐静脉。
