The Early Results of Endovenous Radiofrequency Ablation Using the 7 Fr. VNUS $ClosureFAST^{(R)}$ System in Varicose Veins

혈관 내 고주파열치료법인 7 Fr. VNUS $ClosureFAST^{(R)}$ System을 이용한 하지 정맥류 치료의 조기 결과

  • Ryu, Sang-Woo (Department of Thoracic and Cardiovascular Surgery, Chonnam University Hospital, Chonnam National University Medical School) ;
  • Oh, Hye-Ryung (Department of Thoracic and Cardiovascular Surgery, Gwang-Ju Veterans Hospital) ;
  • Kim, Mi-Kyung (Department of Thoracic and Cardiovascular Surgery, Gwang-Ju Veterans Hospital) ;
  • Moon, Seung-Ho (Department of Thoracic and Cardiovascular Surgery, Dajung Clinic) ;
  • CheKar, Jay-Key (Department of Thoracic and Cardiovascular Surgery, Chonnam University Hospital, Chonnam National University Medical School) ;
  • Yun, Ju-Sik (Department of Thoracic and Cardiovascular Surgery, Chonnam University Hospital, Chonnam National University Medical School) ;
  • Hong, Seong-Beom (Department of Thoracic and Cardiovascular Surgery, Gwang-Ju Veterans Hospital)
  • 류상우 (전남대학교 의과대학 전남대학교병원 흉부외과학교실) ;
  • 오혜령 (광주보훈병원 흉부외과) ;
  • 김미경 (광주보훈병원 흉부외과) ;
  • 문승호 (다정외과 흉부외과) ;
  • 제갈재기 (전남대학교 의과대학 전남대학교병원 흉부외과학교실) ;
  • 윤주식 (전남대학교 의과대학 전남대학교병원 흉부외과학교실) ;
  • 홍성범 (광주보훈병원 흉부외과)
  • Published : 2009.04.05

Abstract

Background: Radiofrequency obliteration and endovenous laser therapy of the greater saphenous vein have recently been introduced as alternative, minimally invasive techniques for the treatment of saphenous vein incompetence. The 7 Fr. VNUS $ClosureFAST^{(R)}$ radiofrequency obliteration system was introduced in Gwang-Ju Veterans hospital. The purpose of this study is to evaluate the efficacy and complications of radiofrequency obliteration using the 7 Fr. VNUS $ClosureFAST^{(R)}$ system. Material and Method: Between May 2, 2007 and May 31, 2008, we performed radiofrequency obliteration on 90 patients. The number of males was 67 and their mean age was $57.9{\pm}11.0$ (range: $23{\sim}78$) years old. The patients underwent follow up exams at 3 weeks after the procedures and then every 3 months. The effects of treatment and the complications were reviewed. Result: The postoperative complications were ecchymosis (94.4%), pain (27.8%), paresthesia (25.6%), bullous formation (8.9%), edema (6.7%) and phlebitis (2.2%). One patient showed good blood flow after 3 weeks and one patient showed good blood flow after 3 months. The one-year success rate of radiofrequency obliteration in varicose veins was 97.6%. Conclusion: Our data showed acceptable operative results and short-term clinical results for treating varicose veins with radio frequency obliteration. Long-term follow-up and comparison of radio frequency obliteration with high ligation and stripping, previous radiofrequency ablation and endovenous laser therapy are needed in the future.

배경: 하지 정맥류의 치료에 있어 최소 침습 술기의 발달로 고주파 열폐쇄술이나 혈관 내 레이저)를 이용한 수술이 시행되고 있다. 빠른 시간 내에 효과적으로 혈관을 폐쇄시킬 수 있는 7 Fr. VNUS $ClosureFAST^{(R)}$ 고주파 열폐쇄 System이 국내에 소개되었으며, 본 연구는 이 시스템을 이용한 하지정맥류 치료의 조기 결과를 알아보고자 시행되었다. 대상 및 방법: 2007년 5월 2일부터 2008년 5월 31일까지 고주파 열폐쇄술을 이용하여 수술을 받은 90예의 환자를 대상으로 본 연구를 시행하였다. 남자가 67명(74.4%)이었고 환자들의 평균 연령은 $57.9{\pm}11.0\;(23{\sim}78)$세였다. 수술 후 3주와 이후 3개월 간격으로 혈관 초음파와 임상 양상을 분석하였다. 결과: 수술 후 합병증은 반상 출혈(85예, 94.4%)이 가장 많았으며, 통증을 호소하는 경우가 27.8%, 감각 이상 25.6%, 수포 형성 8.9%, 부종 6.7%, 정맥염 2.2% 등이었다. 술후 3주에 시행한 초음파에서 정맥의 역류나 부분적 혈류 재개가 있었던 환자는 1예로, 치료 성공률은 98.9%였다. 3개월 후 초음파 검사상 혈류 재개가 1예에서 더 관찰되었으며, 이후 3개월 간격으로 시행한 혈관 초음파상 혈류 재개가 관찰되었던 환자는 없었으며, 1년 치료 성공률은 97.6%를 보였다. 혈류 재개를 보였던 2예의 환자는 계속 외래 추적 관찰 중이며, 현재까지는 수술 전 보였던 하지 부종이나 저림 등의 증상을 호소하지 않고 있다. 결론: 저자들은 국내에 처음으로 도입된 7 Fr. VNUS $ClosureFAST^{(R)}$ System을 이용하여 하지 정맥류 수술을 효과적으로 시행하였으며, 고위 결찰이나 기존의 고주파 열폐쇄술, 그리고 혈관내 레이저 치료와 장기적인 비교 분석이 필요할 것으로 사료된다.

Keywords

References

  1. Lurie F, Creton D, Eklof B, et al. Prospective randomised study of endovenous radiofrequency obliteration (closure) versus ligation and vein stripping (EVOLVes): two-year follow-up. Eur J Vasc Endovasc Surg 2005;29:67-73 https://doi.org/10.1016/j.ejvs.2004.09.019
  2. Lurie F, Creton D, Eklof B, et al. Prospective randomized study of endovenous radiofrequency obliteration versus ligation and stripping in a selected patient population. J Vasc Surg 2003;38:207-14 https://doi.org/10.1016/S0741-5214(03)00228-3
  3. Alessandra P, Manju K, Michele C, Geza M, Peter G. Endovenous laser therapy and radiofrequency ablation of the great saphenous vein: analysis of early efficacy and complications. J Vasc Surg 2005;42:488-93 https://doi.org/10.1016/j.jvs.2005.05.014
  4. Sarin S, Scurr JH, Coleridge Smith PD. Assessment of stripping the long saphenous vein in the treatment of primary varicose veins. Br J Surg 1992;79:889-93 https://doi.org/10.1002/bjs.1800790911
  5. Hammarsten J, Pedersen P, Cederlund CG, Campananello M. Long saphenous vein saving surgery for varicose veins. A long-term follow-up. Eur J Vasc Surg 1990;4:361-4 https://doi.org/10.1016/S0950-821X(05)80867-9
  6. Dwerryhouse S, Davies B, Harradine K, Earnshaw JJ. Stripping the long saphenous vein reduces the rate of reoperation for recurrent varicose veins: five-year results of randomized trial. J Vasc Surg 1999;29:589-92 https://doi.org/10.1016/S0741-5214(99)70302-2
  7. Campbell WB, Vijay Kumar A, Colin TW, Allington KL, Michaels JA. Randomised and economic analysis of conservative and therapeutic interventions for varicose veins study. The outcome of varicose vein surgery at years: Clinical findings, symptoms and patient satisfaction. Am R Coll Surg Engl 2003;85:52-7
  8. Huh SH, Kim DI, Lee BB. Endoluminal procedure using radiofrequency for varicose vein treatment. J Korean Soc Phlebol 2002;1:24-7
  9. Kim KI, Lee WY, Jo TJ, Lee JW, Hong KW. Endovenous 980-nm diode laser treatment of incompetent great saphenous vein. Korean J Thorac Cardiovasc Surg 2007;40:97-102
  10. Lee SY, Song IH, Lee SJ, Park HJ, Lee CS, Lee KR. Short-term result of endovenous 980-nm diode laser treatment in varicose vein of lower extremities. Korean J Thorac Cardiovasc Surg 2005;38:557-63