EVLT Table 1 CEAP classification of treated legs C2 C3 C4 C5 C6 E group S group L group P=0.013 * * Kruskal-Walli
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1 Online publication January 14, 2011 原 著 第 50 回 総 会 シンポジウム 6 日 本 静 脈 学 会 :ここまで 来 た 下 肢 静 脈 瘤 治 療 下 肢 静 脈 瘤 に 対 する 血 管 内 レーザー 治 療,ストリッピング 術 および 結 紮 術 の 初 期 成 績 デイサージャリーにおける 比 較 要 旨 : endovenous laser treatment EVLT EVLT 980 nm venous filling index EVLT EVLT J Jpn Coll Angiol, 2010, 50: Key words: varicose vein, endovenous laser treatment, day surgery, venous filling index 序 言 endovenous laser treatment EVLT QOL 対 象 EVLT EVLT E = S = L = 方 法 Oh EVLT 1 E GSV SSV tumescent local anesthesia TLA 980 nm ELVeS TM Biolitec 14 W SFJ SPJ 1.5 cm 2 4 mm/sec THE JOURNAL of JAPANESE COLLEGE of ANGIOLOGY Vol. 50 No
2 EVLT Table 1 CEAP classification of treated legs C2 C3 C4 C5 C6 E group S group L group P=0.013 * * Kruskal-Wallis test Table 2 Variety of procedures of each group Patients/ Bilateral Unilateral GSV SSV Additional treatment * limbs (patients) (patients) (limbs) (limbs) (limbs) E group 51/ S group 47/ L group 39/ GSV, great saphenous vein; SSV, small saphenous vein; * manipulate the perforator Figure 1 Comparison of operation time in the unilateral greater saphenous vein cases. *Student t test S + SFJ GSV SPJ SSV L 1 GSV SFJ 2 3 SSV SPJ numerical rating scale NRS E 7 9 ± t repeated measure ANOVA Kruskal-Wallis p<0.05 結 果 CEAP C2 C3 C4 C5 C 脈 管 学 Vol. 50 No. 6
3 4 Figure 2 Comparison of changes in venous filling index before and after the operation in the greater saphenous vein cases. *p value for data was not significant (repeated measure ANOVA) Figure 3 Comparison of postoperative NRS in the greater saphenous vein cases. *Student t test L Table 1 E 8 S 3 Table 2 E 44.45±22.49 S 51.02±19.93 L 36.46±21.62 GSV E 38.9±21.8 S 47.2±16.4 L 33.4±17.2 S L p=0.004 Fig. 1 VFI E 7.3±4.0 ml/sec 2.9±2.6 ml/sec S 8.1±4.9 ml/sec 3.1±2.9 ml/sec L 6.9±5.8 ml/sec 4.0±2.9 ml/sec GSV E 7.3±4.1 ml/sec 2.9±2.7 ml/sec S 9.0±4.9 ml/sec 3.3±3.2 ml/sec L 7.6±6.0 ml/sec 4.4±3.1 ml/sec Fig. 2 NRS E 0.68±0.72 S 1.43±1.25 L 1.00±1.23 GSV E 0.75±0.72 S 1.50±1.24 L 0.71±0.49 S E p=0.02 Fig. 3 E 77.8±28.1 S 74.2±28.3 L 34.8±20.1 E S L p< Fig. 4 December 25,
4 EVLT Figure 4 Comparison of postoperative stay time. *Student t test E E 97 考 察 Boné Min EVLT 5 7 EVLT steam bubble 8 1, nm 980 nm 1320 nm 1470 nm 980 nm 10 1, 9, Oh Kabnick Desmyttere , 11, 16 1, 11, 16 EVLT nm EVLT QOL SSV VFI NRS GSV EVLT TLA 1, 6 TLA TLA 17 TLA TLA 756 脈 管 学 Vol. 50 No. 6
5 4 E L E 77.8 QOL S E L E S VFI VFI QOL EVLT EVLT EVLT EVLT EVLT EVLT 文 献 1 Oh CK, Jung DS, Jang HS et al: Endovenous laser surgery of the incompetent greater saphenous vein with a 980-nm diode laser. Dermatol Surg, 2003, 29: Rose SS: Historical development of varicose vein surgery. In: Varicose Veins and Telangiectasias: Diagnosis and Treatment. Bergan JJ, Goldman MP eds, Quality Medical Publishing, St. Louis, Missouri, 1993, , 14: Proebstle TM, Paepcke U, Weisel G et al: High ligation and stripping of the long saphenous vein using tumescent technique for local anesthesia. Dermatol Surg, 1998, 24: Navarro L, Min RJ, Bone C: Endovenous laser: a new minimally invasive method of treatment for varicose veins preliminary observations using an 810 nm diode laser. Dermatol Surg, 2001, 27: Min RJ, Zimmet SE, Isaacs MN et al: Endovenous laser treatment of the incompetent greater saphenous vein. J Vasc Interv Radiol, 2001, 12: Boné C: Tratamiento endoluminal de las varices con laser de Diodo. Estudio preliminar. Rev Patol Vasc, 1999, V: Proebstle TM, Sandhofer M, Kargl A et al: Thermal damage of the inner vein wall during endovenous laser treatment: key role of energy absorption by intravascular blood. Dermatol Surg, 2002, 28: Gérard JL, Desgranges P, Becquemin JP et al: Feasibility of ambulatory endovenous laser for the treatment of greater saphenous varicose veins: one-month outcome in a series of 20 outpatients. J Mal Vasc, 2002, 27: Navarro L, Min RJ, Boné C: Endovenous laser: a new minimally invasive method of treatment for varicose veins preliminary observations using an 810 nm diode laser. Dermatol Surg, 2001, 27: Desmyttere J, Grard C, Mordon S: A 2 years follow-up study of endovenous 980 nm laser treatment of the great saphenous vein: role of blood content in the GSV. Med Laser Appl, 2005, 20: Agus GB, Mancini S, Magi G et al: The first 1000 cases of Italian Endovenous-laser Working Group (IEWG). Rationale, and long-term outcomes for the period. Int Angiol, 2006, 25: Prince EA, Ahn SH, Dubel GJ et al: An investigation of the relationship between energy density and endovenous laser ablation success: does energy density matter? J Vasc Interv Radiol, 2008, 19: Viarengo LMA, Potério-Filho J, Potério GM et al: Endovenous laser treatment for varicose veins in patients with active ulcers: measurement of intravenous and perivenous December 25,
6 EVLT temperatures during the procedure. Dermatol Surg, 2007, 33: Kim HS, Nwankwo IJ, Hong K et al: Lower energy endovenous laser ablation of the great saphenous vein with 980 nm diode laser in continuous mode. Cardiovasc Intervent Radiol, 2006, 29: Kabnick LS: Outcome of different endovenous laser wavelengths for great saphenous vein ablation. J Vasc Surg, 2006, 43: EVLT Endovenous Laser Treatment day surgery 2005, 16: Jakobsen BH: The value of different forms of treatment for varicose veins. Br J Surg, 1979, 66: Sarin S, Scurr JH, Coleridges Smith PD: Stripping of the long saphenous vein in the treatment of primary varicose veins. Br J Surg, 1994, 81: Jones L, Braithwaite BD, Selwyn D et al: Neovascularisation is the principal cause of varicose vein recurrence: results of a randomised trial of stripping the long saphenous vein. Eur J Vasc Endovasc Surg, 1996, 12: Dwerryhouse S, Davies B, Harradine K et al: Stripping the long saphenous vein reduces the rate of reoperation for recurrent varicose veins: five-year results of a randomized trial. J Vasc Surg, 1999, 29: Preliminary Results of Endovenous Laser Treatment, Stripping, and Ligation Surgery to Treat Varicose Veins of the Lower Limbs: Comparative Evaluation of Day Surgery Treatments Susumu Makimura, 1 Toshiya Nishibe, 2 Hiroyoshi Komai, 3 Yukio Obitsu, 3 and Hiroshi Shigematsu 3 1 Tokyo Vascular Clinic, Tokyo, Japan 2 Division of Cardiovascular Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan 3 Division of Vascular Surgery, Tokyo Medical University, Tokyo, Japan Key words: varicose vein, endovenous laser treatment, day surgery, venous filling index We conducted three varicose vein treatments as day surgeries endovascular laser treatment (EVLT), surgical stripping, and ligation of the saphenous vein and evaluated their preliminary results. 63 extremities were treated with EVLT using a 980-nm diode laser. Stripping (S group) was performed on 61 extremities, while 44 extremities were treated with ligation (L group). The change of venous filling index before and after the operation ranged from 7.3±4.1 to 2.9±2.7 ml/sec, 9.0±4.9 to 3.3±3.2 ml/sec, and 7.6±6.0 to 4.4±3.1 ml/sec for the E, S, and L groups, respectively, without any significant difference among the groups. The duration of the operation was longer in the S group, with a significant difference between the S and E groups. The prevalence of postoperative pain, assessed by a numeric rating scale, was significantly higher in the S group than the E group. The preliminary clinical efficacy of EVLT in day surgery appears to be the same as stripping or even better when it comes to the duration of the operation as well as the postoperative pain. (J Jpn Coll Angiol, 2010, 50: ) Online publication January 14, 脈 管 学 Vol. 50 No. 6
Table 1 Patients preoperative characteristics Group LA group SR group No. of patients/legs 137/166 441/531 Age(yr), mean (range) 61.5 (23 82) 62.2 (20
Online publication January 14, 2011 原 著 第 50 回 総 会 シンポジウム 6 日 本 静 脈 学 会 :ここまで 来 た 下 肢 静 脈 瘤 治 療 下 肢 静 脈 瘤 に 対 する 血 管 内 レーザー 治 療 の 適 応 高 位 結 紮 術 をするなら 抜 去 術 でもよいのではないか 要 旨 : endovenous laser ablation EVLA)
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