結論(CONCLUSIONS)
硬化治療、門診靜脈切除術,以及血管內靜脈燒灼技術,對於美容性與症狀性靜脈疾病都是絕佳的治療。雖然它們都需要一些額外的訓練以及對淺層靜脈解剖與生理學的知識,但在腿部的感覺與外觀上可以達成顯著的醫療與美容改善。因此,皮膚外科醫師現在能夠治療從最大到最小的所有形式腿部靜脈曲張與微血管擴張。
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Nelson EA, Bell-Syer SE. Compression for preventing of Varicose and Telangiectatic Leg Veins. 6th ed. London: Elsevier; 2016.2. Boisseau MR. Venous valves in the legs: hemodynamic
-
Sadick NS. Treatment of varicose and telangiectatic recurrence of venous ulcers. Cochrane Database Syst Rev. 2012(8):CD002303.14. O’Meara S, Cullum N, Nelson EA, Dumville JC.
and biological problems and relationship to physio pathology. J Mal Vasc. 1997;22:122–127.3. Griton P, Vanet P, Cloarec M. Anatomic and functional leg veins with hypertonic saline: a comparative study of heparin and saline. J Dermatol Surg Oncol. 1990;16:24–28.25. Sadick NS, Farber B. A microbiologic study of diluted
Compression for venous leg ulcers. Cochrane Database Syst Rev. 2012(11):CD000265.15. Veraart JC, Neumann H. Interface pressure measure- features of venous valves. J Mal Vasc. 1997;22:97–100.4. Labropoulos N, Giannoukas AD, Nicolaides AN, et al. The sclerotherapy solutions. J Dermatol Surg Oncol. 1993;19:450–454.26. Leach BC, Goldman MP. Comparative trial between ments underneath elastic and non-elastic bandages. Phlebologie. 1996;1(Suppl):56–59.16. Veraart JC, Koster D, Neumann H. Compression role of venous reflux and calf muscle pump function in nonthrombotic chronic venous insufficiency. Correlation with severity of signs and symptoms. Arch Surg. 1996;131:403–406.5. Labropoulos N, Delis K, Mansour MA, et al. Prevalence sodium tetradecyl sulfate and glycerin in the treatment of telangiectatic leg veins. Dermatol Surg. 2003;29:612– 614, discussion 615.27. Weiss MA, Weiss RA, Goldman MP. Sclerotherapy: how therapy and the pressure in the deep venous system. Phlebologie. 1996;1(Suppl):68–73.17. Weiss RA, Sadick NS, Goldman MP, Weiss MA.
minor varicosities cause leg pain. Contemp Ob Gyn. 1991;36:113–125.28. Brittenden J, Cooper D, Dimitrova M, et al. Five-year
Post-sclerotherapy compression: controlled comparative study of duration of compression and its effects on clinical outcome. Dermatol Surg. 1999;25:105–108.18. Carlin MC, Ratz JL. Treatment of telangiectasia:
and clinical significance of posterolateral thigh perforator vein incompetence. J Vasc Surg. 1997;26:743–748.6. Butie A. Clinical examination of varicose veins. Dermatol
Surg. 1995;21:52–56.7. Kistner RL, Eklof B, Masuda EM. Diagnosis of chronic outcomes of a randomized trial of treatments for varicose veins. N Eng. J Med. 2019;381:912–922.29. Weiss MA, Weiss RA. Sclerotherapy. Curr Opin Dermatol.
comparison of sclerosing agents. J Dermatol Surg Oncol. 1987;13:1181–1184.19. Sadick NS. Advances in sclerosing solutions. Cosmet venous disease of the lower extremities: the “CEAP” classification. Mayo Clin Proc. 1996;71:338–345.8. Furderer CR, Marescaux J, Pavis d’Escurac X, Stemmer
1997;4:167–174.30. Goldman MP, Weiss RA, Bergan JJ. Diagnosis and
Dermatol. 1996;20:313–316.20. Sadick NS. Hyperosmolar versus detergent sclerosing
R. Junctions of the saphenous vein. Anatomy and treatment concepts. Phlebologie. 1986;39:3–14.9. Weiss RA. Evaluation of the venous system by Doppler treatment of varicose veins: a review. J Am Acad Dermatol. 1994;31:393–413, quiz 414–16.31. Goldman MP, Bennett RG. Treatment of telangiectasia: a agents in sclerotherapy. Effect on distal vessel obliteration. J Dermatol Surg Oncol. 1994;20:313–316.21. Goldman MP. A comparison of sclerosing agents.
ultrasound and photoplethysmography or light reflection rheography before sclerotherapy. Semin Dermatol. 1993;12:78–87.10. Weiss RA. Vascular studies of the legs for venous or review. J Am Acad Dermatol. 1987;17:167–182.32. Baccaglini H, Spreafico G, Castro C, Sorrentino P.
Clinical and histologic effects of intravascular sodium morrhuate, ethanolamine oleate, hypertonic saline (11.7%), and sclerodex in the dorsal rabbit ear vein. J Dermatol Surg Oncol. 1991;17:354–362.22. Sadick NS. Sclerotherapy of varicose and telangiectatic arterial disease. Dermatol Clin. 1994;12:175–190.11. Weiss RA, Weiss MA. Continuous wave venous Doppler
Consensus conference on sclerotherapy of varicose veins of the lower limbs. Phlebologie. 1997;12:2–16.33. Guex JJ. Microsclerotherapy. Semin Dermatol.
1993;12:129–134.34. Duffy DM. Sclerotherapy. Clin Dermatol. 1992;10:373–380.35. Bodian EL. Techniques of sclerotherapy for leg veins. Minimal sclerosant concentration of hypertonic saline and its relationship to vessel diameter. J Dermatol Surg Oncol. 1991;17:65–70.23. Weiss RA, Goldman MP. Advances in sclerotherapy.
examination for pretreatment diagnosis of varicose and telangiectatic veins. Dermatol Surg. 1995;21:58–62.12. Thibault PK. Duplex examination. Dermatol Surg.
1995;21:77–82.
Dermatol Clin. 1995;13:431–445.
sunburst venous blemishes. J Dermatol Surg Oncol. 1985;11:696–704.36. Duffy DM. Small vessel sclerotherapy: an overview. Adv
Dermatol. 1988;3:221–242.
超音波導引泡沫硬化治療(ultrasound-guided foam sclerotherapy, UGFS)是一種利用超音波導引,以泡沫化製劑(如 sodium tetradecyl sulfate 或 polidocanol)將 GSV 硬化的技術。此術式可有效消除 SFJ 功能不全,並改善靜脈疾病病人的臨床結果。與傳統手術相比,UGFS 在改善逆流方面療效相當,但可能需要多次治療療程。以蒸氣進行的血管內熱燒灼術是一項較近期引入的技術,已被用於達成 SFJ 功能不全在影像學與臨床上的改善。初步報告顯示其不劣於 EVLA。
已有數項無需腫脹麻醉的新穎技術被發展出來以閉合 GSV。注射 polidocanol 血管內微泡沫 1%(Varithena®;細節見前述章節)已使 SFJ 功能不全所致的臨床症狀學以及美觀外觀均獲得改善。同樣地,一種專利的氰基丙烯酸酯黏著劑(VenaSeal™)已被發展出來,用於永久閉合功能不全的淺層主幹腿部靜脈,並於 2015 年獲得 FDA 核准。此黏著劑經由一支疏水性導管遞送,導管推進至 SFJ 下方 5 cm 處。機械化學血管內燒灼術是一種結合旋轉導線與液態硬化劑灌注,以同時誘發內皮損傷的技術。它目前正在進行與射頻燒灼術的比較性試驗。