目的:本综述文章提供了一种具有各种表现的相对常见病理的最新综述。浅表静脉疾病(SVD)是广泛的静脉血管疾病,主要影响人体下肢。这种疾病最严重的表现包括静脉曲张,慢性静脉功能不全,淤滞性皮炎,静脉性溃疡,浅静脉血栓形成,网状静脉,和蜘蛛毛细血管扩张。
方法:解剖学,病理生理学,并对SVD的危险因素进行了讨论。发生SVD的危险因素与种族有关,年龄,性别,生活方式,和某些遗传条件以及并发深静脉血栓形成(DVT)。列出了各种分类系统,专注于最常见的一种-修订的临床病因解剖学病理生理学(CEAP)分类。概述了SVD引起的临床特征,包括病史和体格检查结果。
结论:强调了SVD中使用的成像方式。双重超声是评估SVD的第一线,但MRI和CT静脉造影,体积描记术,在静脉双工超声研究不明确的情况下,常规静脉造影是可行的选择。这篇综述中强调的治疗选择包括保守治疗和压迫袜,这可能是主要的或辅助药物局部和全身药物,如壬二酸,利尿剂,植物提取物,医疗食品,NSAIDs,SVD不同阶段的抗凝剂和皮肤替代品。介入治疗方式包括热消融技术,如射频消融(RFA),腔内激光消融(EVLA),静脉内蒸汽消融(EVSA),和静脉内微波消融(EVMA)以及非热策略,如Varithena(Polidocanol微泡沫)硬化疗法,静脉(氰基丙烯酸酯)消融和静脉内机械化学消融(MOCA)。还提供手术治疗,包括清创术,静脉结扎,剥离,和植皮。
结论:浅表静脉疾病(SVD)普遍存在,主要在下肢表现多样。一些研究强调了这些疾病日益增长的临床和经济负担。这篇综述提供了病理生理学的最新信息,分类,临床特征,和影像学发现以及保守派,药理学,以及针对不同SVD病理的介入治疗方案。它旨在加快及时部署旨在降低SVD尤其是静脉曲张相关的显著发病率的治疗方法。静脉性溃疡,静脉功能不全,改善这些患者的生活质量并预防并发症。
BACKGROUND: This
review article provides an updated
review of a relatively common pathology with various manifestations. Superficial venous diseases (SVDs) are a broad spectrum of venous vascular disease that predominantly affects the body\'s lower extremities. The most serious manifestation of this disease includes varicose
veins, chronic venous insufficiency, stasis dermatitis, venous ulcers, superficial venous thrombosis, reticular
veins, and spider telangiectasias.
METHODS: The anatomy, pathophysiology, and risk factors of SVD were discussed during this
review. The risk factors for developing SVD were related to race, age, sex, lifestyle, and certain genetic conditions as well as comorbid deep vein thrombosis. Various classification systems were listed, focusing on the most common one-the revised Clinical-Etiology-Anatomy-Pathophysiology classification. The clinical features including history and physical examination findings elicited in SVD were outlined.
RESULTS: Imaging modalities utilized in SVD were highlighted. Duplex ultrasound is the first line in evaluating SVD but magnetic resonance imaging and computed tomography venography, plethysmography, and conventional venography are feasible options in the event of an ambiguous venous duplex ultrasound study. Treatment options highlighted in this review ranged from conservative treatment with compression stockings, which could be primary or adjunctive to pharmacologic topical and systemic agents such as azelaic acid, diuretics, plant extracts, medical foods, nonsteroidal anti-inflammatory drugs, anticoagulants and skin substitutes for different stages of SVD. Interventional treatment modalities include thermal ablative techniques like radiofrequency ablationss, endovenous laser ablation, endovenous steam ablation, and endovenous microwave ablation as well as nonthermal strategies such as the Varithena (polidocanol microfoam) sclerotherapy, VenaSeal (cyanoacrylate) ablation, and Endovenous mechanochemical ablation. Surgical treatments are also available and include debridement, vein ligation, stripping, and skin grafting.
CONCLUSIONS: SVDs are prevalent and have varied manifestations predominantly in the lower extremities. Several studies highlight the growing clinical and financial burden of these diseases. This review provides an update on the pathophysiology, classification, clinical features, and imaging findings as well as the conservative, pharmacological, and interventional treatment options indicated for different SVD pathologies. It aims to expedite the timely deployment of therapies geared toward reducing the significant morbidity associated with SVD especially varicose
veins, venous ulcers, and venous insufficiency, to improve the quality of life of these patients and prevent complications.