Online publication August 10, 2015 105 原 著 55 要 旨 : 18 29 31 27 87.1 EHIT class 1 class 2, 3 1 J Jpn Coll Angiol 2015; 55: 105 110 Key words: saphenous vein surgery, saphenous vein stump, endovenous heat-induced thrombosis (EHIT), varicose vein, deep vein thrombosis 序 言 1, 2 3, 4 対 象 と 方 法 2013 6 2014 3 29 43 6 4 16 11 14 18 29 Endovenous Heat-Induced Thrombosis EHIT 5, 6 EHIT class 1 class 1 55 2014 10 doi: 10.7133/jca.15-00017 InvisiGrip TM vein stripper Le Maitre Vascular 2 2 3 t p<0.05 2015 4 20 2015 6 26 THE JOURNAL of JAPANESE COLLEGE of ANGIOLOGY Vol. 55
106 結 果 Table 1 62.1±11.5 4 6 14 23 2 23 8 14 15 CEAP C2 8 C3 13 C4a 7 C5 1 14 4 class 3 Table 2 Fig. 1 6 31 27 87.1 EHIT Class 1 4 12.9 6 23 20 87.0 EHIT class 1 3 13.0 4 16 6 class 1 6 8 1 12.5 EHIT class 1 5 67.5 class 2 class 3 1 4 16 6 1 4 16 class 1 6 class 1 6 class 3 1 3 12 4 class 2 16 class 1 AT3 Table 1 Patients background Age 62.1±11.5 Sex male 4 (6 limbs, 6 veins) female 14 (23 limbs, 25 veins) Vein GSV 23 SSV 8 Side rt 14 lt 15 Anesthesia spinal 14 local 4 CEAP C2 8 classification C3 13 C4a 7 C5 1 GSV, great saphenous vein; SSV, small saphenous vein Table 2 Classification of thrombus Thrombus classification 6 days after operation 4 weeks after operation 16 weeks after operation Overall none 4 4 3 EHIT class 1 25 26 28 class 2 1 1 0 class 3 1 0 0 class 4 0 0 0 GSV none 3 3 3 EHIT class 1 20 20 20 class 2 0 0 0 class 3 0 0 0 class 4 0 0 0 SSV none 1 1 0 EHIT class 1 5 6 8 class 2 1 1 0 class 3 1 0 0 class 4 0 0 0 GSV, great saphenous vein; SSV, small saphenous vein β2gp1 C S CT 6 class 2 1 4 4 class 1 脈 管 学 Vol. 55
107 Figure 1 Classification of thrombus. A: Saphenous stump without thrombus. B: Class 1: Saphenous stump with thrombus not extending into deep vein. C: Class 2: Saphenous stump thrombosis with extension into deep vein of a cross-sectional area of less than 50%. D: Class 3: Saphenous stump thrombosis with non-occlusive extension into deep vein of a cross-sectional area of more than 50%. A C B D 1.26±0.28 cm 2.06±1.25 cm 6 class 2, 3 3.35 cm, 1.18 cm 6 27 1.46±0.70 cm 4 1.50±1.13 cm p=0.919 考 察 7~9 EHIT EHIT class 1 class 4 5, 6 0 15.5 EHIT THE JOURNAL of JAPANESE COLLEGE of ANGIOLOGY Vol. 55
108 7, 10 3, 4 31 27 87.1 EHIT class 1 4 12.9 EHIT class 2 class 3 2 2 11.1 6.5 Labropoulos 2335 98 15 15.3 75 2 2.7 2 EHIT class 1 EHIT class 1 1 class 1 14 7 5 2 class 1 4 16 class 1 1 6 class 1 25 80.1 3 16 class 1 EHIT class 2 3, 4 class 2, 3 1 EHIT 1, 6 EHIT 11 EHIT EHIT 1.26±0.28 cm 2.06±1.25 cm Mozes 12 class 1 脈 管 学 Vol. 55
109 4, 13 class 2 class 2, 3 3.35 cm 1.18 cm class 3 6 27 4 14 結 論 18 29 31 謝 辞 利 益 相 反 文 献 1 2011 90 2 Labropoulos N, Bishawi M, Gasparis A, et al: Great saphenous vein stump thrombosis after harvesting for coronary artery bypass graft surgery. Phlebology 2014; 29: 215 219 3 1 2003; 14: 297 301 4 2011; 22: 299 304 5 Kabnick LS, Ombrelino M, Agis H, et al: Endovenous heat induced thrombosis (EHIT) following endovenous vein obliteration: to treat or not to treat? A new thrombotic classification. 18th Annual Meeting American Venous Forum. February 23 2006, Miami, Florida 6 Endovenous heat-induced thrombus (EHIT). Thrombosis 2013; 8: 62 64 7 980 nm 2012; 21: 583 588 8 1470 nm radial 2ring fiber 2015; 26: 34 40 9 2014; 25: 291 296 10 Marsh P, Price BA, Holdstock J, et al: Deep vein thrombosis (DVT) after venous thermoablation techniques: rates of endovenous heat-induced thrombosis (EHIT) and classical DVT after radiofrequency and endovenous laser ablation in a single centre. Eur J Vasc Endovasc Surg 2010; 40: 521 527 11 Hingorani AP, Ascher E, Markevich N, et al: Deep venous thrombosis after radiofrequency ablation of greater saphenous vein: a word of caution. J Vasc Surg 2004; 40: 500 504 12 Mozes G, Kalra M, Carmo M, et al: Extension of saphenous thrombus into the femoral vein: a potential complication of new endovenous ablation techniques. J Vasc Surg 2005; 41: 130 135 13 Winterborn RJ, Campbell WB, Heather BP, et al: The management of short saphenous varicose veins: a survey of the members of the vascular surgical society of Great Britain and Ireland. Eur J Vasc Endovasc Surg 2004; 28: 400 403 14 Sutton PA, El-Dhuwaib Y, El-Duhwaib Y, et al: The incidence of post operative venous thromboembolism in patients undergoing varicose vein surgery recorded in Hospital Episode Statistics. Ann R Coll Surg Engl 2012; 94: 481 483 THE JOURNAL of JAPANESE COLLEGE of ANGIOLOGY Vol. 55
110 Thrombosis of Saphenous Vein Stump after Varicose Vein Surgery Hiroto Rikimaru Department of Vascular Surgery, Tome City Hospital, Miyagi, Japan Key words: saphenous vein surgery, saphenous vein stump, endovenous heat-induced thrombosis (EHIT), varicose vein, deep vein thrombosis We evaluated the extension of thrombus formed in the proximal stump of saphenous vein on day 6, 4 weeks, and 16 weeks after saphenous vein surgery from July 2013 to March 2014 (18 patients, 29 limbs, 31 stumps), using color Doppler echo. Extension of each thrombus was classified as endovenous heat-induced thrombosis (EHIT). Twenty-seven stumps (87.1%) formed thrombus and only four (12.9%) stumps remained without thrombus on day 6 after surgery. One stump formed thrombus EHIT class 2, and another one stump formed thrombus EHIT class 3. The rest of the 25 stumps formed thrombus EHIT class 1. No further extension of thrombus was found on 4 weeks and 16 weeks after surgery. The rate of thrombus formed in the proximal stump of saphenous vein after conventional surgery is relatively higher than that of after thermoablation techniques. Further study is needed to investigate adequate evaluation and appropriate therapy for stump thrombosis after varicose vein surgery. (J Jpn Coll Angiol 2015; 55: 105 110) Online publication August 10, 2015 脈 管 学 Vol. 55