2008年学会資料

第28回日本静脈学会総会シンポジウム2（2008年 学会資料）

Treatment Outcomes of Endovenous Laser Therapy for Saphenous Varicose Vein of the Legs with Cutaneous Lesions

• Review. Stripping vs. Endovenous Laser Therapy (EVLT)
• Theme 1. Treatment Outcomes of EVLT for Varix with CEAP grading 4-6
• Theme 2. Proposal of Guideline for EVLT

Review

Conventional Stripping Surgery vs. Endovenous Laser Therapy

【Purpose】

Compare outcomes for saphenous varicose veins between EVLT and stripping surgery

• in 1) therapeutic effects
• in 2) risks of complications
• in 3) level of satisfaction for the treatment

【Materials】

【Surgical technique of EVLT】

• EVLT using 1320nm Nd:YAG
• Under guidance of ultrasonography
• Combined with high ligation
• All the procedure was performed in day-surgery
• The patients can be discharged 30 minutes after the surgery

【Results】

Obliteration rate and the risk of complications 6 months and 1 year after EVLT

【Results】

Conduct the questionnaire survey for the treated patients about the satisfaction level.

【Conclusions】

EVLT with 1320nm Nd:YAG was equally effective treatment modality to the conventional stripping surgery

• in terms of 1) therapeutic effects
• in terms of 2) risks of complications
• in terms of 3) level of satisfaction for the treatment

Satisfaction level of stripping is relatively high because of novelty in day surgery and affordable price of therapy. On the other hand, EVLT is more expensive, and the patients tend to expect higher level of effectiveness, reflecting relatively harsh results in their assessment.

Theme 1

Treatment Outcomes of EVLT for Varix with CEAP grading 4-6

【Purpose】

To evaluate the treatment outcomes of EVLT for varicose veins with CEAP grading 4-6

• in 1) obliteration rates
• in 2) risks of complications
• in 3) level of satisfaction for the treatment

【Materials】

【Rates of Obliteration and Complication】

【Complications】

【Improvement of pigmentation】

【Morbidity of Ulcer】

【Illustrative case of EVLT】

Before treatment		1 month after EVLT

【Results】

Conduct the questionnaire survey for the treated patients about the satisfaction level.

【Conclusions】

EVLT had an excellent result even for the saphenous varicose veins with CEAP 4-6

• in terms of 1) therapeutic effects
• in terms of 2) risks of complications
• in terms of 3) level of satisfaction for the treatment

Theme 2

Proposed Guideline for EVLT

【Pathological mechanism of recurrences】

20 patients were referred to our hospital for recurrent varix after their stripping surgery (mean time from first surgery: 10.2 years)

【Analysis of Risk factors for recurrence】

・Incompetent perforator vein in our patients

・Varicose vein diameter on CEAP classification

【Outcomes of EVLT in the previous literature】

・Results of EVLT for varicose veins in lower limbs

●We applied EVLT with high ligation especially for the varix with higher CEAP grading.

●Our results were comparable to the best ones in the past literature.

【Discussion】

• Residual tributaries, incompetent perforator, and neovascularization are important factors as cause of recurrence.
• EVLT can achieve the excellent results even for the CEAP 4-6 saphenous varicose vein in combination with high ligation.
• EVLT with high ligation is very effective for varicose with reflux from tributaries and incompetent perforators.

【Proposal of Guideline for EVLT】

Key Surgical Techniques to prevent neovasculogenesis after EVLT

• Perform proper high ligation.
• Leave epigastric vein in case of many tributaries.
• Create the efficient anatomical barrier with closure of the cribriform fascia.
• Avoid high ligation for less severe varicose veins.