2016, Number 2
Eficacia clínica y ultrasonográfica a largo plazo al comparar entre ablación endoluminal venosa con láser y ablación con radiofrecuencia en el tratamiento de la insuficiencia venosa crónica
Mondragón-Moreno I, Serrano-Lozano JA
Full text
Language: Spanish
References: 10
Page: 60-66
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ABSTRACT
Background. The treatment of varicose disease has submitted an evolution from the compression of infragenicular levels at the time of the Roman soldiers, continuing to the traditional well-known standard method known as stripping of the saphenous vein to new treatments as those minimally invasive like foam sclerotherapy and venous endoluminal ablation insufficiency. The endoluminal ablation uses thermal action to cause fibrosis in the vein segments with reflux. There are two types of techniques: 1) Endovenous laser, where in the thermal energy is derived from the action of a laser fibre. Radiofrequency, wherein the diathermy energy occurs between two electrodes. Track record of a long-term follow up evolution of patients treated by endoluminal ablation have described rare distal recurrences and stable clinical course of the disease but in Mexico there are few records of such kind of follow up. Is so that the present study has the objective to compare the clinical efficacy at a long term when using the two endoluminal venous ablation techniques: laser and radiofrequency.Objective. Confirm or rule out that endoluminal venous fibrosis keeps on being at a long term on treated segments and that there are not new vein reflux sites on venous segments causing a bad perception of quality of life.
Material and methods. A study was realized observational, descriptively of transverse cut opened with clinical application, including 35 patients of any age, rightful claimants of the Hospital Regional “Lic. Adolfo López Mateos” with the precedent of having being controlled by ablation endoluminal venous, already it is a type radio frequency or laser, in the period from April 1, 2007 to April 1, 2015, as managing of the venous chronic insufficiency that they were presenting. There was applied to them the generic questionnaire of quality of life called CIVIQ-20, also they there was realized an ultrasound venous Doppler in pelvic members to evaluate the presence or not of fibrosis in venous distances, and he attends or not of permeable distances with reflux in sites that they it were not presenting previously.
Results. A positive correlation between the use of endoluminal ablation of saphenous vein and the perception of quality of life in the domains of pain, psychological, physical and social survey at the CIVIQ- 20 was found with a significant p < 0.0001 between groups showed. In the multivariety analysis done there was no difference between groups for age, sex, clinical stage and time (p ‹ 0.98). Doppler ultrasound monitoring of all patients in this study enabled to stratify cases of recurrence according to different ultrasound stadiums. Thus, of the 35 patients evaluated, only two patients operated more than five years had recurrent presence of varicose vein reflux paths previously did not have it but now depending on the small saphenous vein and communicating vein. As for the morphological characteristics of the great saphenous vein 100% of patients had fibrosis of the wall, being the operated patients over 5 years ago (18 patients), seventeen of them had stage four and three occlusion saphenous vein and only one with stage 1 and referring to the survey of quality of life as poor. The remaining patients (15 patients) operated less than a year ago Twelve patients were in stage two with the presence of hyperechoic image, lack of compressibility of the vein wall and flow, and three patients in stage one, which coincided to be the patients reporting a bad for quality of life. Statistically significant association with p ‹ 0.0001 was demonstrated by statistical calculation as to maintain perception of quality of life in the long term after surgery as well as the morphology of the great saphenous vein after Doppler ultrasound control.
Conclusion. At a long-term evaluation the endoluminal venous fibrosis is maintained as the good clinical stages too.
REFERENCES
Caggiati A, Bergan JJ, Gloviczki P, Jantet G, Wendell- Smith CP, Partsch H, for the International Interdisciplinary Consensus Committee on Venous Anatomical Terminology. Nomenclature of the veins of the lower limbs: an international interdisciplinary consensus statement. J Vasc Surg 2002; 36: 416-22.
Khilnani NM, Grassi CJ, Kundu S, D’Agostino HR, Khan AA, McGraw JK, et al. Multi-society consensus quality improvement guidelines for the treatment of lower extremity superficial venous insufficiency with endovenous thermal ablation from the Society of Interventional Radiology, Cardiovascular Interventional Radiological Society of Europe, American college of phlebology, and Canadian Interventional Radiology as- Sociation. J Vasc Interv Radiol 2010; 21(1): 14-31.