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АССОЦИАЦИЯ ФЛЕБОЛОГОВ РОССИИ • Просмотр темы - Тезисы по эндоваскулярному лечению ХЗВ
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 Заголовок сообщения: Re: Тезисы по эндоваскулярному лечению ХЗВ
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 Заголовок сообщения: Эндоваскулярное лечение ХЗВ. Серьезные осложнения
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Arteriovenous fistula after endovenous laser treatment of the short saphenous vein.
Timperman PE.
Source
Arnett Clinic, 2600 Greenbush Avenue, Lafayette, Indiana 47904, USA. paultimperman@verizon.net
Abstract
Reports of major complications from endovenous laser treatment of saphenous veins with use of perivenous tumescent anesthesia are very rare. The author reports a major complication of endovenous laser treatment, the creation of an arteriovenous (AV) fistula. The fistula was created between the short saphenous vein (SSV) and the superficial sural artery in the popliteal fossa during endovenous laser treatment of the SSV. The proximity of the superficial sural artery and the SSV in the popliteal fossa increases the risk of fistula formation. Color-flow Doppler ultrasonography can demonstrate potentially dangerous anatomic relationships between the vein segment intended for treatment and adjacent arteries. Recognition of these relationships should increase the operator's ability to minimize the risk of AV fistula formation.
J Vasc Interv Radiol. 2004 Jun;15(6):625-7.

PMID:15178724 [PubMed - indexed for MEDLINE]


Eur J Vasc Endovasc Surg. 2009 Aug;38(2):234-6. Epub 2009 Jun 12.
Arterio-venous fistula following endovenous laser ablation for varicose veins.
Theivacumar NS, Gough MJ.
Source
Leeds Vascular Institute, The General Infirmary at Leeds, Leeds LS1 3EX, UK.
Abstract
Endovenous laser ablation (EVLA) obliterates incompetent truncal veins as an alternative to varicose veins surgery. We describe 3 patients who developed an arterio-venous fistula (AVF) following great (GSV: 1) or small (SSV: 2) saphenous vein EVLA. Two fistulae closed spontaneously with conservative management. Concomitant venous and arterial wall thermal injury or needle trauma during administration of tumescent anaesthesia may cause this rare complication. Haemodynamic effects appear minimal and spontaneous closure is likely, supporting a non-interventional policy.
PMID:
19524461
[PubMed - indexed for MEDLINE]
Ann Vasc Surg. 2009 May-Jun;23(3):412.e15-7. Epub 2008 Oct 29.
Iatrogenic arteriovenous fistula following endovenous laser therapy of the short saphenous vein.
Vaz C, Matos A, Oliveira J, Nogueira C, Almeida R, Mendonça M.
Source
Vascular Surgery Department, Hospital Santo António, Centro Hospitalar do Porto, Porto, Portugal. carolina_vaz@aeiou.pt
Abstract
Short saphenous vein incompetence is present in up to 20% of patients with varicose veins. Studies looking at the success and complication rates associated with endovenous laser ablation of the short saphenous vein included only a small number of patients. The authors report the case of a 51-year-old woman presenting with a painful right leg edema. She had a history of previous endovenous laser ablation of the right and left great saphenous veins and right short saphenous vein. Duplex scan was performed and showed an arteriovenous fistula between branches of the popliteal artery and vein. Surgical ligation of the fistula was performed. At 8-month follow-up, the patient remains asymptomatic.
PMID:
18973984
[PubMed - indexed for MEDLINE]
J Vasc Surg. 2010 Mar;51(3):715-9. Epub 2010 Jan 25.
A case of external iliac arteriovenous fistula and high-output cardiac failure after endovenous laser treatment of great saphenous vein.
Ziporin SJ, Ifune CK, MacConmara MP, Geraghty PJ, Choi ET.
Source
Department of Surgery, Washington University School of Medicine, St Louis, MO 63110, USA.
Abstract
Valvular incompetence in the great saphenous vein (GSV) is the most common cause of superficial venous insufficiency and symptomatic varicose vein development. Recently, less invasive modalities such as foam sclerotherapy, radiofrequency ablation (RFA), and endovenous laser treatment (EVLT) have gained popularity in the treatment of saphenofemoral junction and saphenous truncal incompetence over the traditional approach of surgical ligation and stripping. Here, we present the case of a 32-year-old woman who underwent EVLT and was diagnosed subsequently with ipsilateral external iliac arteriovenous (AV) fistula and high-output cardiac failure. She was stabilized medically and treated surgically with a covered stent placed in the external iliac artery with complete resolution of the fistula and cardiac failure. We reviewed the literature and discuss the complications of AV fistulae after EVLT.
PMID:
20100645
[PubMed - indexed for MEDLINE]
Cardiovasc Intervent Radiol. 2009 Jan;32(1):166-8. Epub 2008 May 28.
Treatment of an unusual complication of endovenous laser therapy: multiple small arteriovenous fistulas causing complete recanalization.
Yildirim E, Saba T, Ozulku M, Harman A, Aytekin C, Boyvat F.
Source
Department of Radiology, Baskent University Medical School, Selcuklu, Konya, Turkey. drerkany@yahoo.com
Abstract
A 67-year-old woman was admitted to our institution with pain, night cramping, and visible varicose veins on her left leg. Doppler ultrasonography revealed continuous reflux in the great saphenous vein when the patient did the Valsalva maneuver. Endovenous laser therapy was applied to the great saphenous vein. Doppler ultrasonography 7 days later showed recanalization of, and arterialized flow in, the great saphenous vein. There also were small arterial vessels adjunct to the recanalized side. A left femoral angiography via a right femoral approach showed multiple small arteriovenous fistulas between superficial femoral artery muscle branches and the great saphenous vein. A second endovenous laser treatment was done at 80 J/cm, but the recanalization persisted. We offered to treat this endovascularly, but the patient preferred a surgical option. To the best of our knowledge, this is the first report of the demonstration of such a complication with endovenous laser therapy.
Comment in
• Cardiovasc Intervent Radiol. 2010 Feb;33(1):227-8.
PMID:
18506521
[PubMed - indexed for MEDLINE]

Volume 23, Issue 3, Pages 412.e15-412.e17 (May 2009)




Iatrogenic Arteriovenous Fistula Following Endovenous Laser Therapy of the Short Saphenous Vein
Carolina Vaz , Arlindo Matos, João Oliveira, Clara Nogueira, Rui Almeida, Mergulhão Mendonça
published online 29 October 2008.
Short saphenous vein incompetence is present in up to 20% of patients with varicose veins. Studies looking at the success and complication rates associated with endovenous laser ablation of the short saphenous vein included only a small number of patients. The authors report the case of a 51-year-old woman presenting with a painful right leg edema. She had a history of previous endovenous laser ablation of the right and left great saphenous veins and right short saphenous vein. Duplex scan was performed and showed an arteriovenous fistula between branches of the popliteal artery and vein. Surgical ligation of the fistula was performed. At 8-month follow-up, the patient remains asymptomatic.
Vascular Surgery Department, Hospital Santo António, Centro Hospitalar do Porto, Porto, Portugal
Correspondence to Dr. Carolina S. Vaz, Centro Hospitalar do Porto, Cirurgia Vascular, Largo Professor Abel Salazar, Oporto, Portugal
PII: S0890-5096(08)00311-7
doi:10.1016/j.avsg.2008.08.010

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 Заголовок сообщения: Re: Тезисы по эндоваскулярному лечению ХЗВ
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Пара обзоров из Канады (Онтарио)

http://www.health.gov.on.ca/english/pro ... 100422.pdf
http://www.health.gov.on.ca/english/pro ... 100921.pdf

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 Заголовок сообщения: Re: Тезисы по эндоваскулярному лечению ХЗВ
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Чего говорят-то, Алексей? Читать то стоит?

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 Заголовок сообщения: Re: Тезисы по эндоваскулярному лечению ХЗВ
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 Заголовок сообщения: Re: Тезисы по эндоваскулярному лечению ХЗВ
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После вот этого метаанализа http://forums.rusmedserv.com/showthread.php?t=115115 я к обзорам отношусь очень осторожно. Нужно все перепроверять по включенным РКИ.

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 Заголовок сообщения: Re: Тезисы по эндоваскулярному лечению ХЗВ
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 Заголовок сообщения: Re: Тезисы по эндоваскулярному лечению ХЗВ
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 Заголовок сообщения: Re: Тезисы по эндоваскулярному лечению ХЗВ
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 Заголовок сообщения: Re: Тезисы по эндоваскулярному лечению ХЗВ
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 Заголовок сообщения: Re: Тезисы по эндоваскулярному лечению ХЗВ
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 Заголовок сообщения: Re: Тезисы по эндоваскулярному лечению ХЗВ
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Абстракт не очень свежий, но показалось интересным влияние температуры тумесцентного раствора на течение послеоперационного периода.

Vasa. 2010 Aug;39(3):249-55.
1470 nm diode laser for endovenous ablation (EVLA) of incompetent saphenous veins - a prospective randomized pilot study comparing warm and cold tumescence anaesthesia.
Pannier F, Rabe E, Maurins U.
Source

Department of Dermatology, MUMC+ Maastricht, Maastricht, the Netherlands. felizitas.pannier@googlemail.com
Abstract
BACKGROUND:

Major side effects after endovenous laser ablation (EVLA) are pain and bruising. Low temperature of the tumescence fluid might cause additional venous constriction and a cooling effect around the vein. The aim of this study was to show outcome and side effects after EVLA of incompetent great saphenous veins (GSV) with a 1470 nm Diode laser (Ceralas E, biolitec) using cold or warm tumescence fluid for anaesthesia.
PATIENTS AND METHODS:

Between August and November 2007, 85 consecutive patients (85 legs) with an incompetent GSV were treated by EVLA. The patients were randomized in two groups. In 42 patients (Group A) a warm (37 degrees C) and in 43 patients (Group B) a cold (5 degrees C) tumescence fluid (TF) was used for local anaesthesia in the track of GSV. All patients were re-examined after 1, 10 and 30 days clinically and by duplex for complications and occlusion in the treated vein segment. Patient's satisfaction was assessed on a 0 to 4 points scale.
RESULTS:

In each group one patient was lost to follow-up. There was no significant difference concerning gender, age, C of CEAP, BMI or diameter of the treated vein. In Group A a mean of 462 ml TF and in Group B a mean of 428 ml TF were used. In Group A the mean LEED (average linear endovenous energy density) was 114 J / cm and in Group B 115 J / cm. In both groups occlusion of the treated veins was achieved for all patients. The diameter of the GSV at 3 cm below the sapheno-femoral junction shrunk from 1.0 to 0.7 cm in both groups. The modified CEAP clinical score improved in Group A from 2.9 to 0.7 (mean value) and in Group B from 3.0 to 1.1. The mean pain score on a scale from 0 to 4 during day 2 to day 10 was 1.2 in Group A and 1.0 in Group B. At this time patients in Group A took a mean of 3.4 and in Group B 1.7 analgetic tablets. Ecchymoses were rare in both groups (4 in Group A, 7 in Group B).
CONCLUSIONS:

In this prospective randomized comparative study the temperature of the tumescence fluid did not influence the occlusion rate when a high LEED was used. In both groups pain and ecchymoses are less frequent in this study with a 1470 nm diode laser than reported in studies with 810-980 nm systems. Cold tumescence fluid reduced pain slightly and reduced the intake of analgetics significantly.


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 Заголовок сообщения: Re: Тезисы по эндоваскулярному лечению ХЗВ
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Серж, это ж известная работа Мауринша, после выхода которой многие, как я понимаю, попробовали охлаждать раствор для тумисценции. Лично я довольно быстро от этого отказался :)

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 Заголовок сообщения: Re: Тезисы по эндоваскулярному лечению ХЗВ
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Так, собственно, и вывод о том, что болевой синдром снижается незначительно :D :D


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Холодный раствор альтернатива, когда у больного аллергия на лидокаин.

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