Strategies and challenges in treatment of varicose veins and venous insufficiency

被引:35
作者
Gao, Rong-Ding [1 ]
Qian, Song-Yi [2 ]
Wang, Hai-Hong [3 ]
Liu, Yong-Sheng [4 ]
Ren, Shi-Yan [1 ]
机构
[1] China Med Univ, Dept Laser & Vasc Surg, Aviat Gen Hosp, 2 Beiyuan Rd, Beijing 100012, Peoples R China
[2] Fudan Univ, Zhongshan Hosp, Xiamen Brach, Dept Cardiac Surg, Xiamen 361015, Fujian, Peoples R China
[3] Shanxi Univ Chinese Med, Dept Peripheral Vasc Dis, Affiliated Hosp, Taiyuan 030024, Shanxi, Peoples R China
[4] China Med Univ, Aviat Gen Hosp, Dept Dermatol, Beijing 100012, Peoples R China
关键词
Varicose veins; Venous insufficiency; High ligation and stripping; Endovenous laser ablation; Radiofrequency ablation; Cure conservatrice et Hemodynamique de l'Insufficience Veineuse en Ambulatoire; ENDOVENOUS LASER-ABLATION; TRANSILLUMINATED POWERED PHLEBECTOMY; RANDOMIZED CLINICAL-TRIAL; FOAM SCLEROTHERAPY; COST-EFFECTIVENESS; HIGH LIGATION; RADIOFREQUENCY; GREAT; ANESTHESIA; MANAGEMENT;
D O I
10.12998/wjcc.v10.i18.5946
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Patients with varicose veins can be treated with conservative or surgical approaches based on the clinical conditions and patient preferences. In the recent decade, the recommendations for managing symptomatic varicose veins have changed dramatically due to the rise of minimally invasive endovascular techniques. The literature was systematically searched on Medline without language restrictions. All papers on the treatment of varicose veins and venous insufficiency with different procedures were included and reviewed. Endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) both are same safe and effective in terms of occlusion rate, and time to return to normal activity. In comparison with RFA or EVLT, Cure conservatrice et Hemodynamique de l'Insufficience Veineuse en Ambulatoire (CHIVA) may cause more bruising and make little or no difference to rates of limb infection, superficial vein thrombosis, nerve injury, or hematoma. In terms of recurrence of varicose veins, there is little or no difference between CHIVA and stripping, RFA, or EVLT. Great saphenous vein recanalization is highest in the ultrasound-guided foam sclerotherapy (FS) group (51%) during 1 year of follow-up. The 2013 National Institute for Health and Care Excellence clinical guidelines recommend surgery as a third-line therapeutic option after EVLA or RFA and sclerotherapy. Although the mechanochemical endovenous ablation (MOCA) is a non-thermal, non-tumescent option and appears to be of similar efficacy to stab avulsion with no potential risk of nerve damage, the overall success rate of MOCA is lower than those of other procedures such as EVLA, RFA, or high ligation and stripping. EVLA is the most cost-effective therapeutic option, with RFA being a close second for the treatment of patients with varicose veins. Endovenous thermal ablation (EVLA or RFA) is recommended as a first-line treatment for varicose veins and has substituted the high ligation of saphenofemoral junctional reflux and stripping of varicose veins. Ultrasound-guided FS is associated with a high recurrence rate and can be used in conjunction with other procedures. MOCA and cyanoacrylate embolization appear promising, but evidence of their effectiveness is required.
引用
收藏
页码:5946 / 5956
页数:11
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