АССОЦИАЦИЯ ФЛЕБОЛОГОВ РОССИИ

Странное на мой взгляд заключение, как может удаленная вена вновь реканализироваться, так сказать сделать reopened?
Пойду поищу полный текст...
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Удаленная посредством стриппинга ВСМ реканализироваться, конечно, не может.
Так авторы этого и не утверждают, напротив они точно указывают количество вен реканализированных полностью и частично только в группе больных , ВСМ у которых обработаны ЕВЛТ.
А это не только возможно, но об этом уже сообщает немало авторов.

Endovenous Ablation for the Treatment of Chronic Venous Insufficiency and Venous Ulcerations
Christopher J. Marrocco, Marvin D. Atkins, W. Todd Bohannon, Thomas R. Warren, Clifford J. Buckley and Ruth L. Bush

Objective
Conventional treatment of chronic venous disease with ulceration is layered compression dressings. Saphenous vein stripping is reserved for recurrent or nonhealing ulcers. This study examines outcomes of aggressive endovenous therapy in promoting ulcer healing and/or preventing ulcer recurrence. The role of additional perforator vein ablation also is analyzed.
Methods
This retrospective chart review occurred during a 2.5-year time frame during which 356 patients with venous insufficiency were seen in our vein center and underwent 412 venous operations (56 with bilateral disease treated on separate dates). A cohort of 75 (21.1%) patients with severe chronic venous disease underwent 83 (20.1%) procedures (C5: n = 52, 63%; C6: n = 31, 37%); 8 patients had bilateral procedures. Data analysis included body-mass index (BMI), history of deep vein thrombosis (DVT) or previous vein surgery, and type of procedure (radiofrequency ablation (RFA) of greater saphenous vein (GSV) alone or GSV and perforator ablation (GSVP)). Complications, ulcer healing rates, and recurrent ulcerations were examined. Descriptive statistics are reported and contingency tables used when appropriate.
Results
Overall, the patients were 63.5 ± 13.4 years of age (men: n = 36, women: n = 39) with a BMI of 32.4 (range, 20.8–53.4). All of the patients had GSV insufficiency and 30 (44%) patients had deep vein incompetence. Only 19 (28%) patients had a history of a DVT and 13 (19%) had previous vein procedures. The 31 extremities with C6 disease had been treated conservatively with compression for an average of 7.6 ± 4.2 (range, 1–156) months before undergoing ablation. Ablation site was GSV in 49 (72%) and GSVP in 19 (28%). Only two (2.9%) complications occurred: excessive hemosiderin staining and paresthesias each occurred in one patient. Of the C5 patients treated, two (4.7%) developed recurrent ulcerations and five (20%) C6 patients did not heal completely or developed a recurrent ulcer. There was no statistically significant difference in ulcer healing or recurrence rates between C5 and C6 patients treated with and without the addition of perforator interruption.
Conclusions
Chronic venous insufficiency with active or healed ulceration is commonly seen in our academic vein center. In this series, endovenous ablation allowed for excellent healing rates and acceptable recurrent ulcer rates. It is unclear from this small cohort whether the addition of perforator ablation was of benefit in improving venous hemodynamics.
This work was presented at the 22nd annual meeting of the American Venous Forum, Amelia Island, FL, February 2010.
World Journal of Surgery
Volume 34, Number 10, 2299-2304, DOI: 10.1007/s00268-010-0659-1

Уважаемый Виктор, мне бы было интересно узнать Ваше мнение по приведенной публикации. На мой взгляд - ноль информации. Обзор ретроспективный, исследование не сравнительное, критерии оценки попросту отсутствуют. Что мы получаем по прочтении? Что VNUS можно использовать для ликвидации вертикального рефлюкса? Это и так понятно. Считаю данную работу совершенно неинтересной и не информативной. Может быть я неверно ее понял, прокомментируйте?

Classification of proximal endovenous closure levels and treatment algorithm.
Lawrence PF, Chandra A, Wu M, Rigberg D, DeRubertis B, Gelabert H, Jimenez JC, Carter V.
Division of Vascular Surgery, David Geffen School of Medicine at UCLA, Los Angeles, Calif 90095-6908, USA. pflawrence@mednet.ucla.edu
Abstract
OBJECTIVES: Endovenous closure is a common method to treat saphenous vein incompetence. Despite attempts to prevent it, some patients have extension of thrombus above the ideal site of closure immediately below the epigastric vein. We have developed a classification system for the level of saphenous vein closure to guide further therapy after endovenous treatment.
METHODS: A six-tier classification system was developed, based on thrombus proximity to the epigastric or femoral vein, and an algorithm for treatment, based on level of closure was applied to all patients.
RESULTS: Five hundred consecutive patients underwent radio-frequency ablation of the saphenous vein; it was successfully closed in 498 (99.6%) patients. Thirteen patients (2.6%) experienced thrombus bulging into the femoral vein or adherent to its wall, which was treated with anticoagulation. All of these patients had thrombus retraction to the level of the saphenofemoral junction (SFJ) in an average of 16 days with concurrent anticoagulation. No femoral deep venous thrombosis (DVT) occurred in the series. There was a significantly higher rate of proximal thrombus extension in those patients with a history of DVT and those with a great saphenous vein (GSV) diameter of >8 mm (P < .02).
CONCLUSIONS: A classification system for saphenous endovenous closure which extends above the epigastric vein has been helpful in guiding management. A GSV diameter at the SFJ of >8 mm and a history of DVT results in significantly higher rates of proximal thrombus extension into the femoral vein. A short course of LMWH, until clot retracts back into the saphenous vein, is therapeutic. Management of the patients with thrombus flush with the femoral vein wall still needs to be defined, but the outcome from these patients is generally benign.
Vasc Surg. 2010 Aug;52(2):388-93. Epub 2010 Jun 19.
PMID: 20646894 [PubMed - indexed for MEDLINE]

Евгений, этот абстракт Вам понравится больше.
Randomised clinical trial comparing endovenous laser ablation with stripping of the great saphenous vein: clinical outcome and recurrence after 2 years.
Rasmussen LH, Bjoern L, Lawaetz M, Lawaetz B, Blemings A, Eklöf B.
The Danish Vein Centres - Areknudeklinikken Naestved and Copenhagen, Denmark. Larshrasmussen@yahoo.com
Abstract
OBJECTIVE: This study aims to compare the outcome 2years after treatment of varicose veins by endovenous laser ablation (EVLA) or surgery by assessing recurrence, venous clinical severity score (VCSS) and quality of life. METHODS: A total of 121 patients (137 legs) were randomised to either EVLA or saphenofemoral ligation and stripping of the great saphenous vein (GSV). Follow-up included clinical and duplex ultrasound examinations, VCSS and quality of life questionnaires. RESULTS: A total of 18 (26%) and 25 patients (37%) in the EVLA and surgery group, respectively, developed recurrent varicose veins (not significant (NS) between groups). The source of reflux was not significantly different between the groups. Technical failure occurred in three EVLA and two surgery patients, reflux in the anterior accessory GSV, the groin, thigh and calf perforators was found in six, two, four, and three EVLA patients, and in three, three, nine and six surgery patients. VCSS, Aberdeen Varicose Vein Severity Score and several domains of the Medical Outcomes Study Short Form 36 (SF36) quality of life score improved significantly in both groups. CONCLUSIONS: No significant differences in clinical or ultrasound recurrences were found between EVLA and surgery groups. Our study also shows that similar improvements in clinical severity scores and quality of life were gained in both treatments. Copyright (c) 2009 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.
Eur J Vasc Endovasc Surg. 2010 May;39(5):630-5. Epub 2010 Jan 12.

PMID: 20064730 [PubMed - indexed for MEDLINE]

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