Table 1 Patients preoperative characteristics Group LA group SR group No. of patients/legs 137/ /531 Age(yr), mean (range) 61.5 (23 82) 62.2 (20
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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 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) LA SR TLA 12 mm EVLA 12 mm SR HL EVLA 1 1 stab avulsion EVLA 1320 nm pulse YAG laser CoolTouch LA 0 SR EVLA J Jpn Coll Angiol, 2010, 50: Key words: endovenous laser ablation, varicose vein, stripping 目 的 EVLA EVLA EVLA 対 象 と 方 法 LA = ±11.4 SR = ±11.3 LA GSV 145 SSV 13 GSV SSV 2 GSV 6 SR GSV 395 SSV 120 GSV SSV 12 GSV 4 Table 1 CEAP C2 C3 C4 C5 C6 LA SR Fig. 1 CEAP EVLA 1 EVLA THE JOURNAL of JAPANESE COLLEGE of ANGIOLOGY Vol. 50 No
2 Table 1 Patients preoperative characteristics Group LA group SR group No. of patients/legs 137/ /531 Age(yr), mean (range) 61.5 (23 82) 62.2 (20 88) Female sex, n (%) 115 (83.9%) 328 (74.4%) Unilateral GSV Unilateral SSV Unilateral GSV & SSV 2 12 Bilateral GSV 6 4 Figure 1 Preoperative CEAP clinical class distribution. SFJ SPJ 3 cm 12 mm CEAP C6 SFJ SPJ 12 mm EVLA 12 mm Propofol bolus remifentanil hydrochloride 1 lidocaine hydrochloride TLA Klein pump EVLA 1320 nm pulse YAG laser CoolTouch GSV SSV 10 cm 22G GSV 1 cm stripping wire 3 5 mm SSV 1 cm EVLA mm Varady hook stab avulsion SD unpaired t test p< 脈 管 学 Vol. 50 No. 6
3 結 果 LA laser W 50 Hz mm/sec ± J 35.6±10.3 cm LEED 100.7±31.7 J/cm 573.7±218.2 sec Stab avulsion LA 3.2±2.2 SR 3.3±2.8 TLA 1 LA 425±81.8 ml SR 428±102 ml LT 56.4± SR 71.4± Table 2 Loxoprofen LT 2.1±2.9 SR 2.1±2.8 SFJ 1.5±2.5 cm SR SPJ LA SR LA 0 SR LA SR LA 0 SR Warfarin potassium Table 3 考 察 EVLA 22 RFA EVLA 95.9 RFA EVLA 4.5 RFA EVLA 1 SR 4 6 cm flush ligation EVLA 980 nm diode laser 2 SR 37 EVLA 26 venous clinical severity score Table 2 Procedural details Group LA group SR group Operative time, min 56.4± ±22.4 mean±s.d. (range) (21 144) (23 199) Micro-phlebectomy, No. 3.2± ±2.8 mean±s.d. TLA, ml (mean±s.d.) 425± ±102 Table 3 Postoperative complications and results Variable LA group SR group Severe pain (>30 days), n (%) 3 (1.8%) 2 (0.4%) Paresthesia (>30 days), n (%) 0 (0%) 6 (1.1%) Edema (>30 days), n (%) 1 (0.6%) 2 (0.4%) Wound infection, n (%) 0 (0%) 1 (0.2%) Deep venous thrombosis, n (%) 0 (0%) 0 (0%) Recurrence, n (%) 0 (0%) 6 (1.1%) Segmental recanalization, n (%) 2 (1.2%) 0 (0%) VCSS Short Form 36 SF36) 2 EVLA mm cutdown GSV 5 cm SSV 10 cm SFJ SPJ 1 cm HL flash ligation HL 1 2 HL HL flash ligation EVLA SR HL EVLT SR chronic venous insufficiency questionnaire CIVIQ December 25,
4 EVLA 1 SR HL EVLA 3 2 SR 6.6 EVLA 7 SR 18 EVLA 1 4 HL SFJ SPJ 1 cm HL 5 mm SR InvisiGrip 25 SR nm EVLA 19 EVLA SR 8 EVLA 0 SR 27 EVLA 13 EVLA 5 SR 94 EVLA 100 SR 20 EVLA 9 EVLA 6 EVLA SR Aberdeen Varicose Vein Symptom Score AVVSS EVLA 2 SR 7 EVLA 2 SR 17 EVLA 7 EVLA SR SF EVLA 12 Aberdeen Varicose Veins Questions Questionnaire AVVQ 6 12 EVLA QOL SR 8 EVLA EVLA Goode 73 EVLA RFA 9 EVLA 1.76 body mass index >30 kg/m mm 2 10 EVLA 12 mm SR HL SR EVLA EVLA 結 語 EVLA HL HL 文 献 1) Luebke T, Brunkwall J: Systematic review and meta-analysis of endovenous radiofrequency obliteration, endovenous laser therapy, and foam sclerotherapy for primary varicosis. J Cardiovasc Surg, 2008, 49: ) Rasmussen LH, Bjoern L, Lawaetz M et al: Randomised clinical trial comparing endovenous laser ablation with stripping of the great saphenous vein: clinical outcome and recurrence after 2 years. Eur J Vasc Endovasc Surg, 2010, 39: ) Kalteis M, Berger I, Messie-Werndl S et al : High ligation combined with stripping and endovenous laser ablation of the great saphenous vein: early results of a randomized controlled study. J Vasc Surg, 2008, 47: ) Theivacumar NS, Darwood R, Gough MJ: Neovascularisation and recurrence 2 years after varicose vein treatment for 762 脈 管 学 Vol. 50 No. 6
5 sapheno-femoral and great saphenous vein reflux: a comparison of surgery and endovenous laser ablation. Eur J Vasc Endovasc Surg, 2009, 38: ) van Groenendael L, van der Vliet JA, Flinkenflögel L et al: Treatment of recurrent varicose veins of the great saphenous vein by conventional surgery and endovenous laser ablation. J Vasc Surg, 2009, 50: ) van Groenendael L, Flinkenflögel L, van der Vliet JA et al: Conventional surgery and endovenous laser ablation of recurrent varicose veins of the small saphenous vein: a retrospective clinical comparison and assessment of patient satisfaction. Phlebology, 2010, 25: ) Darwood RJ, Theivacumar N, Dellagrammaticas D et al: Randomized clinical trial comparing endovenous laser ablation with surgery for the treatment of primary great saphenous varicose veins. Br J Surg, 2008, 95: ) Mekako AI, Hatfield J, Bryce J, et al: A nonrandomised controlled trial of endovenous laser therapy and surgery in the treatment of varicose veins. Ann Vasc Surg 2006, 20: ) Goode S D, Kuhan G, Altaf N et al: Suitability of varicose veins for endovenous treatments. Cardiovasc Intervent Radiol, 2009, 32: ) Fernández CF, Roizental M, Carvallo J et al: Combined endovenous laser therapy and microphlebectomy in the treatment of varicose veins: Efficacy and complications of a large single-center experience. J Vasc Surg, 2008, 48: Indication of Less Invasive Endovenous Laser Ablation for Primary Saphenous Varicose Veins without High Ligation Seiichi Tada Department of Cardiovascular Surgery, Nagasaki Heart Clinic, Nagasaki, Japan Key words: endovenous laser ablation, varicose vein, stripping This study was performed to compare the postoperative clinical outcomes of endovenous laser ablation (EVLA) with stripping to eliminate saphenous vein reflux and to establish a less invasive indication of EVLA. Between January 2008 and March 2009, 697 veins in 578 patients with saphenous varicose veins were treated in our clinic. The EVLA procedure was performed percutaneously under duplex guidance using a 1320 nm pulse YAG laser (CoolTouch) when the diameter of the saphenous vein was less than 12 mm near the saphenous junction. The stripping procedure was carried out through a 1 cm incision in the groin when the diameter of the saphenous vein was over 12 mm. All treatments were performed under tumescent local anesthesia and intravenous injection of propofol at the same time an additional phlebectomy was performed. There was no significant difference in the postoperative complications, the use of analgesic medication, and the recurrence rate. In conclusion, the EVLA procedure without high ligation is less invasive and an effective method for treating varicose veins. However, if a high ligation procedure is needed due to the large diameter of the saphenous vein, the stripping procedure is as effective as EVLA. (J Jpn Coll Angiol, 2010, 50: ) December 25, 2010 Online publication January 14,
EVLT Table 1 CEAP classification of treated legs C2 C3 C4 C5 C6 E group 19 18 25 1 0 S group 16 18 24 3 0 L group 26 8 8 1 1 P=0.013 * * Kruskal-Walli
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 1 2 3 3 3 要 旨 : endovenous
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