Nonocclusion and Early Reopening of the Great Saphenous Vein After Endovenous Laser Treatment Is Fluence Dependent
Nonocclusion and Early Reopening of the Great Saphenous Vein After Endovenous Laser Treatment Is Fluence Dependent
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静脉内激光治疗后大隐静脉的非闭塞和早期重新开放与流量相关
DOI：
10.1111/j.1524-4725.2004.30051.x
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发表时间：
2004
影响因子：
2.4
通讯作者：
J. Knop
中科院分区：
文献类型：
--
作者：
T. Proebstle;Doendue Gül;J. Knop
影响大隐静脉腔内激光治疗(ELT)失败和再通率的背景参数仍有待确定。目的评价经皮冠状动脉腔内成形术(ELT)治疗早期闭塞失败或GSVs再通的相关参数。方法连续77例患者在连续拉回激光纤维的情况下，对106例GSV进行ELT治疗。分别于术后1天、4周、3个月行双功能检查。通过多因素Logistic回归分析评估ELT的临床患者和血管特征以及技术参数。结果平均静脉长度60 cm(18~90 cm)，平均回缩速度0.6 cm/s(0.4~1.3)，平均能量输出23.4 J/cm(11.8~35.5)，平均激光能量11.8 J/cm2(2.8~37.3)。在ELT后第1天，6个GSVs(6%)未闭塞。在ELT后1个月和3个月，彩色双工检查分别发现9个GSV(9%)和11个GSVs(10%)开放。单因素分析显示，ELT术后3个月无闭塞的危险因素为激光剂量、激光能量/厘米静脉长度、治疗前静脉管径、治疗后第1天血栓到隐股交界处的距离。最后，多元回归分析选择激光剂量(p=0.004，优势比=0.40J/cm~2)作为ELT失败或再通的相关危险因素。结论ELT失败可能与低剂量激光照射有关。
BACKGROUND Parameters influencing failure and recanalization rates of endovenous laser treatment (ELT) of the great saphenous vein (GSV) are still to be determined. OBJECTIVE To evaluate treatment-related parameters of ELT with respect to early failure of occlusion or recanalization of GSVs. METHODS A series of 77 consecutive patients received ELT of 106 GSVs with continuous pullback of the laser fiber. Duplex examination was performed at 1 day, 4 weeks, and 3 months after the procedure. Clinical patient and vessel characteristics as well as technical parameters of the ELT procedure were evaluated via multiple logistic regression analysis. RESULTS A median vein length of 60 cm (range of 18 to 90) was treated with a median pullback velocity of 0.6 cm/sec (range of 0.4 to 1.3), resulting in a median energy delivery of 23.4 J/cm (range of 11.8 to 35.5) and a median laser fluence of 11.8 J/cm2 (range of 2.8 to 37.3). At day 1 after ELT, 6 GSVs (6%) were not occluded. At 1 and 3 months after ELT, 9 GSVs (9%) and 11 GSVs (10%), respectively, were found open by color duplex examination. Risk factors for nonocclusion 3 months after ELT, by univariate analysis, were laser fluence, laser energy per centimeter of vein length, diameter of the vein before treatment, and distance of the thrombus to the sapheno-femoral junction at day 1 after treatment. Finally, multiple regression analysis selected laser fluence (p=0.004, odds ratio=0.40 J/cm2) as the relevant risk factor for ELT failure or recanalization. CONCLUSION ELT failure seems to be related to the administration of low laser fluences.