影像学检查在下肢静脉曲张患者穿支静脉术前评估中的应用进展
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摘要
下肢静脉曲张(VV)是血管外科常见的疾病,主要采取手术治疗。但术后复发率较高,穿支静脉功能不全(IPV)是静脉曲张术后复发的主要原因。在术前能够全面评估IPV,术中妥善处理穿支静脉(PV)是治疗和降低术后复发率的关键点。本研究基于目前主要几种对PV的评估方法主要包括下肢顺行静脉造影、计算机断层扫描血管造影(CTA)、多普勒超声(DUS)、计算机断层扫描静脉造影(CTV)和磁共振成像静脉造影(MRV)进行综述,为日后为制订治疗方案和选择手术方式提供客观依据。
Varicose vein(VV) is one of the most common vascular diseases that is mainly treated by surgery with a high postoperative recurrence rate. Incompetent perforating veins(IPV) is the main cause of postoperative recurrence of VV. IPV can be evaluated comprehensively before operation, and proper management of perforator veins(PV) during operation is the key point to treat and reduce the postoperative recurrence rate after operation. In this study, several main methods of PV evaluation were reviewed, including phlebography, computed tomography angiography(CTA), doppler ultrasonography(DUS), computed tomography venography(CTV) and magnetic resonance venography(MRV), in order to provide an objective basis for future treatment and selection of surgical methods.
Varicose vein(VV) is one of the most common vascular diseases that is mainly treated by surgery with a high postoperative recurrence rate. Incompetent perforating veins(IPV) is the main cause of postoperative recurrence of VV. IPV can be evaluated comprehensively before operation, and proper management of perforator veins(PV) during operation is the key point to treat and reduce the postoperative recurrence rate after operation. In this study, several main methods of PV evaluation were reviewed, including phlebography, computed tomography angiography(CTA), doppler ultrasonography(DUS), computed tomography venography(CTV) and magnetic resonance venography(MRV), in order to provide an objective basis for future treatment and selection of surgical methods.
引文
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[2]Lohr JM,Bush RL.Venous disease in women:epidemiology,manifestations,and treatment[J].J Vasc Surg,2013,57(4Suppl):37S-45S.
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[8]叶志东,陈洁,樊雪强,等.下肢静脉曲张的治疗现状及存在的问题[J].临床误诊误治,2014,27(3):73-76.
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[13]Massell TB,Ettinger J.Phlebography in the localization of incompetent communicating veins in patients with varicose veins[J].Ann Surg,1948,127(6):1217-1225.
[14]Brenner DJ,Hall EJ.Computed tomography-an increasing source of radiation exposure[J].N Engl J Med,2007,357(22):2277-2284.
[15]Rubin GD,Shiau MC,Leung AN,et al.Aorta and iliac arteries:single versus multiple detector-row helical CTangiography[J].Radiology,2000,215(3):670-676.
[16]Guideline developed in collaboration with the American College of Radiology,Society of Pediatric Radiology,Society of Radiologists in Ultrasound.AIUM practice guideline for the performance of peripheral venous ultrasound examinations[J].J Ultrasound Med,2015,34(8):1-9.
[17]Min SK,Kim SY,Park YJ,et al.Role of three-dimensional computed tomography venography as a powerful navigator for varicose vein surgery[J].J Vasc Surg,2010,51(4):893-899.
[18]Spinedi L,Broz P,Baldi T,et al.Evaluation of varicose veins of the lower extremity:the value of the duplex ultrasound(part 1)[J].Ultraschall Med,2016,37(4):348-365.
[19]Zhan HT,Bush RL.A review of the current management and treatment options for superficial venous insufficiency[J].World J Surg,2014,38(10):2580-2588.
[20]Lee DK,Ahn KS,Kang CH,et al.Ultrasonography of the lower extremity veins:anatomy and basic approach[J].Ultrasonography,2017,36(2):120-130.
[21]Arnoldussen CW,de Graaf R,Wittens CH,et al.Value of magnetic resonance venography and computed tomographic venography in lower extremity chronic venous disease[J].Phlebology,2013,28 Suppl 1:169-175.
[22]Delis KT,Ibegbuna V,Nicolaides AN,et al.Prevalence and distribution of incompetent perforating veins in chronic venous insufficiency[J].J Vasc Surg,1998,28(5):815-825.
[23]Lawrence PF,Alktaifi A,Rigberg D,et al.Endovenous ablation of incompetent perforating veins is effective treatment for recalcitrant venous ulcers[J].J Vasc Surg,2011,54(3):737-742.
[24]Van Rij AM,Hill G,Gray C,et al.A prospective study of the fate of venous leg perforators after varicose vein surgery[J].J Vasc Surg,2005,42(6):1156-1162.
[25]Kuo YS,Chen CJ,Chen JJ,et al.May-Thurner syndrome:correlation between digital subtraction and computed tomography venography[J].J Formos Med Assoc,2015,114(4):363-368.
[2]Lohr JM,Bush RL.Venous disease in women:epidemiology,manifestations,and treatment[J].J Vasc Surg,2013,57(4Suppl):37S-45S.
[3]Gloviczki P,Comerota AJ,Dalsing MC,et al.The care of patients with varicose veins and associated chronic venous diseases:clinical practice guidelines of the society for vascular surgery and the American venous forum[J].J Vasc Surg,2011,53(5 Suppl):2S-48S.
[4]Proebstle TM,Alm J,G?ckeritz O,et al.Three-year European follow-up of endovenous radiofrequency-powered segmental thermal ablation of the great saphenous vein with or without treatment of calf varicosities[J].J Vasc Surg,2011,54(1):146-152.
[5]Brake M,Lim CS,Shepherd AC,et al.Pathogenesis and etiology of recurrent varicose veins[J].J Vasc Surg,2013,57(3):860-868.
[6]Perrin MR,Labropoulos N,Leon LR.Presentation of the patient with recurrent varices after surgery(REVAS)[J].JVasc Surg,2006,43(2):327-334.
[7]O'Donnell TF.The role of perforators in chronic venous insufficiency[J].Phlebology,2010,25(1):3-10.
[8]叶志东,陈洁,樊雪强,等.下肢静脉曲张的治疗现状及存在的问题[J].临床误诊误治,2014,27(3):73-76.
[9]Linton RR.The communicating veins of the lower leg and the operative technic for their ligation[J].Ann Surg,1938,107(4):582-593.
[10]Harlander-Locke M,Lawrence P,Jimenez JC,et al.Combined treatment with compression therapy and ablation of incompetent superficial and perforating veins reduces ulcer recurrence in patients with CEAP 5 venous disease[J].J Vasc Surg,2012,55(2):446-450.
[11]Seren M,Dumantepe M,Fazliogullari O,et al.Combined treatment with endovenous laser ablation and compression therapy of incompetent perforating veins for treatment of recalcitrant venous ulcers[J].Phlebology,2017,32(5):307-315.
[12]Rueda CA,Bittenbinder EN,Buckley CJ,et al.The management of chronic venous insufficiency with ulceration:the role of minimally invasive perforator interruption[J].Ann Vasc Surg,2013,27(1):89-95.
[13]Massell TB,Ettinger J.Phlebography in the localization of incompetent communicating veins in patients with varicose veins[J].Ann Surg,1948,127(6):1217-1225.
[14]Brenner DJ,Hall EJ.Computed tomography-an increasing source of radiation exposure[J].N Engl J Med,2007,357(22):2277-2284.
[15]Rubin GD,Shiau MC,Leung AN,et al.Aorta and iliac arteries:single versus multiple detector-row helical CTangiography[J].Radiology,2000,215(3):670-676.
[16]Guideline developed in collaboration with the American College of Radiology,Society of Pediatric Radiology,Society of Radiologists in Ultrasound.AIUM practice guideline for the performance of peripheral venous ultrasound examinations[J].J Ultrasound Med,2015,34(8):1-9.
[17]Min SK,Kim SY,Park YJ,et al.Role of three-dimensional computed tomography venography as a powerful navigator for varicose vein surgery[J].J Vasc Surg,2010,51(4):893-899.
[18]Spinedi L,Broz P,Baldi T,et al.Evaluation of varicose veins of the lower extremity:the value of the duplex ultrasound(part 1)[J].Ultraschall Med,2016,37(4):348-365.
[19]Zhan HT,Bush RL.A review of the current management and treatment options for superficial venous insufficiency[J].World J Surg,2014,38(10):2580-2588.
[20]Lee DK,Ahn KS,Kang CH,et al.Ultrasonography of the lower extremity veins:anatomy and basic approach[J].Ultrasonography,2017,36(2):120-130.
[21]Arnoldussen CW,de Graaf R,Wittens CH,et al.Value of magnetic resonance venography and computed tomographic venography in lower extremity chronic venous disease[J].Phlebology,2013,28 Suppl 1:169-175.
[22]Delis KT,Ibegbuna V,Nicolaides AN,et al.Prevalence and distribution of incompetent perforating veins in chronic venous insufficiency[J].J Vasc Surg,1998,28(5):815-825.
[23]Lawrence PF,Alktaifi A,Rigberg D,et al.Endovenous ablation of incompetent perforating veins is effective treatment for recalcitrant venous ulcers[J].J Vasc Surg,2011,54(3):737-742.
[24]Van Rij AM,Hill G,Gray C,et al.A prospective study of the fate of venous leg perforators after varicose vein surgery[J].J Vasc Surg,2005,42(6):1156-1162.
[25]Kuo YS,Chen CJ,Chen JJ,et al.May-Thurner syndrome:correlation between digital subtraction and computed tomography venography[J].J Formos Med Assoc,2015,114(4):363-368.