Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Study of Subfascial Endoscopic Perforator Surgery Combined with Endovenous Laser Treatment in the Treatment of Great Saphenous Varicose Veins

Study of Subfascial Endoscopic Perforator Surgery Combined with Endovenous Laser Treatment in the... Hindawi Journal of Healthcare Engineering Volume 2022, Article ID 1801099, 7 pages https://doi.org/10.1155/2022/1801099 Research Article Study of Subfascial Endoscopic Perforator Surgery Combined with Endovenous Laser Treatment in the Treatment of Great Saphenous Varicose Veins Li Wang, Jianqing Du, and Hong Zhang Vascular and General Surgery, Affilited Hospital of Chengde Medical University, Chengde 067000, China Correspondence should be addressed to Hong Zhang; cdzh1977@163.com Received 4 March 2022; Revised 3 April 2022; Accepted 7 April 2022; Published 16 April 2022 Academic Editor: Hangjun Che Copyright © 2022 Li Wang et al. ,is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Great saphenous varicose vein (GSVV) is a venous reflux disease of the lower extremity. In order to explore the clinical effect of subfascial endoscopic perforator surgery (SEPS) with endovenous laser treatment (EVLT) in the treatment of GSVV, 80 patients who underwent unilateral saphenous varicose surgery are analyzed. ,e operation results show that the patients who used SEPS + EVLT have less operation time and mean blood loss, shorter postoperative active time and hospitalization stay, better curative effect, and higher notch aesthetics (P< 0.05). SEPS combined with EVLT has a remarkable curative effect in the treatment of saphenous varicose veins of lower extremity, which can significantly shorten the hospitalization time of patients and improve the coagulation index and stress index. inhibit venous blood backflow, thereby, improving venous 1. Introduction hypertension and blood stasis, quickly relieving patients’ GSVV is a venous reflux disease of the lower extremity that is symptoms and signs, and helping patients restore the caused by the inability of the deep venous valve to close function of the affected limb. High saphenous vein liga- tightly. GSVV can manifest as superficial varicose veins, tion is an effective method for the treatment of GSVV, segmental cystic, or columnar dilatation of the main or which can completely strip the diseased saphenous vein, branch of the veins, as well as lower extremity swelling, pain, but it will cause great trauma to the surrounding tissue hyperpigmentation, pruritus, and even ulceration [1, 2]. during the stripping process, and it is easy to damage the Factors that can cause increased intraabdominal pressure saphenous nerve and cause postoperative paresthesia such as smoking, long-term standing, or sedentary are all [7, 8]. In addition, the residual vascular bed after high risk factors for saphenous varicose veins [3]. Relevant ligation is prone to accumulation of blood and fluid, and the incision often affects the appearance. With the im- literature reports that the prevalence of GSVV in women is higher than that in men, with prevalence rates ranging provement of medical technology, the treatment of GSVV from 10% to 15% and 20% to 25%, respectively [4, 5]. If has gradually entered the era of minimally invasive GSVV is not treated in time, complications such as su- beauty. Subfascial endoscopic perforator surgery (SEPS) is perficial thrombophlebitis, venous heart ulcer, and vari- to cut the skin to the deep fascia and ligate the com- ceal bleeding can occur, which seriously affect the work municating vein under the guidance of direct vision. SEPS and life of patients [6]. has the advantages of simple operation, small trauma, Surgery is the main method for the treatment of clear visual field, low recurrence rate, and good curative GSVV. ,rough surgery, it can help patients restore the effect. Endovenous laser treatment (EVLT) is also one of the minimally invasive methods of endovenous treatment. venous valve closure function as much as possible and 2 Journal of Healthcare Engineering It is worth noting that surgical trauma can cause trau- ,e principle of treatment is to use the thermal effect released by the laser to damage the venous endothelium, matic stress in the body and make blood in a hypercoag- ulable state, which is not conducive to the postoperative damage the vein wall, and deposit thrombosis to occlude the varicose vein, which in turn obliterates the vena cava recovery of patients [18]. In this study, when comparing the [9, 10]. At present, most patients in clinical practice coagulation indexes of patients during the perioperative generally require combined treatment due to etiology, period, it is found that the levels of PT and TT in the two symptoms, severity, and other reasons. groups postoperative are lower than preoperative, but the ,e rest of this study is organized as follows: Section 2 levels in the patients who used SEPS + EVLT are higher than discusses related work and analysis, followed by the clinical those who used traditional communicating branch liga- treatment methods and evaluation indicators in Section 3. tion + EVLT. When comparing the stress indicators of the Comparative analysis and data statistics are given in Section two groups, it is found that contrast by preoperative, the levels of IL-6 and hs-CRP in the two groups are increased in 4. Section 5 concludes the study with summary and future research directions. postoperative, and the levels in the patients who used SEPS + EVLT are lower than those who used traditional communicating branch ligation + EVLT. Main serological 2. Related Work manifestations of surgical trauma stress response in GSVV Under the guidance of previous studies related to minimally patients with elevated levels of IL-6 and hs-CRP after sur- invasive surgery, this study used SEPS combined with EVLT gery. Elevated levels of IL-6 and hs-CRP can damage the to treat patients with unilateral GSVV. Comparing the vascular endothelial function of patients, promote platelet changes in perioperative indicators with traditional surgery, aggregation, affect the coagulation system of patients, and more comprehensive data for the treatment of GSVV can be are not conducive to the recovery of postoperative limb skills supported. [19, 20]. In addition, due to the hypercoagulability of blood in patients with GSVV, the body damage caused by surgery With the progression of the GSVV, it can also lead to skin pigmentation, eczema, and ulcers, and effective treat- may aggravate the disorder of the coagulation system, resulting in abnormal changes in the levels of PT and TT. ment should be implemented in time to relieve the pain of the patients [11, 12]. Surgical therapy can change the local hemodynamic state from the anatomical level and prevent 3. Clinical Treatment Methods and the pathological process. It is the main way of clinical Evaluation Indicators treatment of severe saphenous varicose veins. With the further development of minimally invasive technology and 3.1. Research Object. ,e data of 80 patients who under- equipment, a series of minimally invasive procedures have went unilateral GSVV surgery from January 2019 to been gradually applied in clinical practice. January 2021 are retrospectively analyzed. Patients are ,e traditional communicating branch vein ligation is a selected with the following rules: first, meet the relevant destructive treatment method, which requires high seg- diagnostic criteria of GSVV and have been confirmed by mental dissection of the trunk of the great saphenous vein. In imaging. Second, it is unilateral lesions. ,ird, clinical, addition, multiple surgical incisions are required to ligate the etiological, anatomical, pathophysiological classification communicating branch veins, and the intraoperative trauma (CEAP) grade C5-C6. Finally, the data of preoperative is large, which may easily cause damage to the skin, veins, examination, operation-related parameters, and postop- soft tissues, and nerves. ,ese injuries increase patient erative reexamination are complete. Exclusion criteria is distress and prolong postoperative active and hospitalization as follows: first, combined with other vascular diseases. time. ,ese injuries increase patient distress and prolong Second, insufficiency of important organs. ,ird, venous postoperative active and hospitalization. SEPS is performed vascular disease due to congenital factors. Fourth, com- by endoscopic ligation of the deep subfascial communicating bined with malignant tumors. Finally, the history of lower branch vein, and its precise positioning can reduce un- extremity venous surgery. necessary trauma, thereby shortening the time for patients to ,e number of patients in the study is 80. In the light of the get out of postoperative active and hospitalization stay after surgical methods, the patients are divided into the control surgery [13, 14]. It is found that SEPS can reduce the oc- (traditional communicating branch ligation + EVLT) and the clusion rate of the incidence of ulcers in patients after combine group (SEPS + EVLT). surgery. EVLT uses percutaneous puncture to occlude the superficial varicose vein under the action of cautery, which can preserve the normal saphenous vein and reduce the 3.2. (erapeutic Methods. ,e combined group is treated damage caused by ligation [15, 16]. Cavallini and other with SEPS + EVLT. ,e patient is placed in a supine position scholars believed that EVLT can reduce the risk of saphe- with the head loared and the feet high, the affected limb nofemoral valve regurgitation after ligation and stripping of flexed and the knee is abducted by 130 , the hip joint is the great saphenous vein [17]. ,e results of this study also slightly externally rotated, and the knee is properly elevated. show that compared with the patients who used traditional Routine sterile drape and anesthesia are performed. A communicating branch ligation + EVLT, the patients who transverse skin incision of about 1 cm in length is made 6 cm used SEPS + EVLT have more significant curative effects and below the tibial tuberosity and 4 cm medial to the tibia, and higher notch aesthetics. the subcutaneous tissue is incised successively until the deep Journal of Healthcare Engineering 3 saphenous vein is evaluated as effective. Patients with no fascia. ,e subfascial space is bluntly separated with the fingers, and the separation range is up to 5 cm medial to improvement in clinical symptoms, obvious varicose veins, and regurgitation of the great saphenous vein still visible on form an operating space. Between the deep fascia and the muscularis layer along vascular color ultrasound are evaluated as invalid. the incision, a laparoscopic system is placed, and CO is ,e self-made incision satisfaction questionnaire is used filled under the fascia to maintain a pressure of 12 mmHg. to evaluate the patients’ satisfaction with the notch aes- Under the direct vision of the endoscope, a second incision thetics. ,e incision aesthetics score ranged 0–10, and the with a length of about 0.5 cm is made at about 5 cm inside scores are proportional to satisfaction. and about 3 cm below the original incision, and a Trocar and Some things are measured 1 day before surgery and 1 day an ultrasonic scalpel are placed. Blunt dissection of the loose and 3 days after surgery: prothrombin time (PT), thrombin connective tissue is under the deep fascia, exposure of the time (TT), interleukin-6 (IL-6), and high-sensitive C-reac- tive protein (hs-CRP) levels. communicating veins, and separation of communicating veins of varying thickness. ,e communicating veins are separated one by one using the ultrasonic scalpel, and the 3.4. Statistical Methods. SPSS 25.0 and GraphPad Prism 8.3 separation range is from the anterior border of the tibia to statistical software are used to analyze the research data. the midline, down to the Achilles tendon and medial Qualitative data are expressed by frequency and percentage, malleolus, to avoid missing the communicating veins. ,e and the chi-square test and rank sum test are performed. endoscopy system is withdrawn, the residual gas in the cavity Quantitative data conforming to a normal distribution are is discharged, and the two surgical incisions are sutured expressed in the form of mean± standard deviation, and the t- intermittently. test is used. P< 0.05 indicated that the difference is significant. An incision is made 2 cm anterior to the medial malleolus and a laser fiber is placed. An 18G trocar is used to puncture the 4. Comparative Analysis and Data Statistics great saphenous vein at the medial malleolus, and a 5F catheter dilator is introduced. ,e laser fiber is inserted into the 5F 4.1. Baseline Data. ,e baseline data of patients with dif- straight catheter and sent to the saphenofemoral vein, the ferent treatment methods are compared before surgery, and catheter is retracted, and the fiber is pushed forward until the it is found that there is no great difference in the baseline catheter is exposed 3 cm. Connect the semiconductor laser data of the two groups of patients (P> 0.05). Table 1 pro- therapy instrument and adjust the laser wavelength to 810 nm vides the specific data. and the laser emission power to 12–15 W. Using a continuous pulse method, the fiber is withdrawn and the laser is cauterized 4.2. Patient Surgery-Related Indicators. Comparing the op- until the medial malleolus. ,e catheter and fiber are with- eration-related indicators between the two groups, it is drawn slowly at the same time to close the vein wall. After the found that the time of operation, mean bleeding volume, operation, the surgical area of the affected limb is compressed postoperative active time, and hospitalization time of the with an elastic bandage. patients who used SEPS + EVLT are lower than those who ,e control group is treated with traditional commu- used traditional communicating branch ligation + EVLT nicating branch vein ligation + EVLT: the patient position, (P< 0.05), as given in Table 2. EVLT treatment method, and postoperative treatment are the same as those in the combined group. Traditional communicating branch vein ligation: according to the 4.3. Curative Effect and Incision Aesthetics. It can be seen preoperative color Doppler ultrasound to locate the surface from Table 3 that the results of the rank sum test indicated that markings of the communicating branch vein, the commu- the curative effect of the two groups of patients is significantly nicating branch vein is separated with a small incision and different. Table 3 provides the curative effect and incision. ligated in the superficial fascia layer. ,e evaluation of the aesthetics of the incision in the two groups of patients and the patients who used SEPS + EVLT are significantly more satisfied with the 3.3. Observation Indexes. Time of operation, mean bleeding aesthetics of the incision than the patients who used volume, postoperative activity time, hospitalization time, traditional communicating branch ligation + EVLT and other related indicators are recorded. ,e operation (P< 0.05). Figure 1 shows the comparison of notch aes- time is from the start of anesthesia to the end of compression thetics. In Figure 1, P< 0.05. bandage with elastic bandage. ,e clinical efficacy is evaluated according to the pa- tients’ lower extremity symptoms and vascular color 4.4. Changes of Related Indexes of the Coagulation System Doppler ultrasonography 1 month after operation. ,e during the Perioperative Period. Comparing the changes of clinical symptoms basically disappeared, there is no obvious blood coagulation system-related indexes between the two varicose veins, and the color ultrasound shows that there is groups, it is found that at 1 and 3 days postoperative, the no regurgitation in the great saphenous vein, and it is levels of PT and TT in the two groups are lower than those evaluated as curative. ,e clinical symptoms are significantly preoperative, as given in Table 4. improved, slight varicose veins are seen, and the color ul- ,e levels in the patients who used SEPS + EVLT are trasound shows that the partial regurgitation of the great higher than those who used traditional communicating 4 Journal of Healthcare Engineering Table 1: Baseline data of patients. Baseline information Control (n � 40) Combine (n � 40) t/χ P Gender Male 14 (35.00) 17 (42.50) 0.474 0.491 Female 26 (65.00) 23 (57.50) Age 55.26± 5.93 56.31± 6.21 0.773 0.442 Disease duration (years) 6.09± 1.34 6.31± 1.28 0.751 0.455 BMI (kg/m ) 23.05± 0.97 22.98± 1.01 0.316 0.752 Affected limb Left 18 (45.00) 21 (52.50) 0.45 0.502 Right 22 (55.00) 19 (47.50) CEPA grade C5 31 (77.50) 29 (72.50) 0.267 0.606 C6 9 (22.50) 11 (27.50) Table 2: Surgery-related indicators of patients. Group Time of operation (min) Mean bleeding volume (mL) Postoperative activity time (d) Hospitalization time (d) Control (n � 40) 92.13± 9.15 41.26± 7.59 5.84± 1.13 9.25± 1.31 Combine (n � 40) 67.58± 8.06 19.26± 6.28 3.59± 0.95 6.74± 0.95 t 12.731 14.122 9.639 9.81 P <0.001 <0.001 <0.001 <0.001 Table 3: Curative effect and incision aesthetics. Group Curative Effective Invalid Notch aesthetics Control (n � 40) 15 (37.50) 18 (45.00) 7 (17.50) 7.31± 1.25 Combine (n � 40) 22 (55.00) 17 (42.50) 1 (2.50) 8.14± 0.97 Z/t −2.029 3.318 Control group Combine group Figure 1: Comparison of notch aesthetics. branch ligation + EVLT (P< 0.05). ,ose results are two groups are increased compared with those preoperative. plotted as a bar chart, as shown in Figure 2. In Figure 2, Table 5 provides the changes in the level of stress indicators. P< 0.05. ,e levels in the patients who used SEPS + EVLT are lower than those who used traditional communicating 4.5. Changes in the Level of Stress Indicators. Comparing branch ligation + EVLT (P< 0.05). ,ose results are the changes of stress indexes in the two groups, it is found that at plotted as a bar chart, as shown in Figure 3. In Figure 3, 1 and 3 days postoperative, the levels of IL-6 and hs-CRP in the P< 0.05. The Score of notch aesthetics Journal of Healthcare Engineering 5 Table 4: Changes of related indexes of the coagulation system during the perioperative period. Index Group Preoperative 1 day Postoperative 1 day Postoperative 3 day Control (n � 40) 11.79± 1.29 8.16± 0.94 9.51± 0.98 Combine (n � 40) 12.03± 1.31 9.75± 1.02 10.82± 1.14 PT (s) t 0.826 7.250 5.511 P 0.442 <0.001 <0.001 Control (n � 40) 15.22± 1.97 12.17± 1.06 14.22± 1.21 Combine (n � 40) 15.83± 1.92 13.84± 1.11 15.68± 1.27 TT (s) t 1.402 6.882 5.264 P 0.165 <0.001 <0.001 15 20 0 0 Control group Control group Combine group Combine group (a) (b) Figure 2: Changes of related indexes of the coagulation system in patients during the perioperative period: (a) changes of related indexes of the coagulation system in patients from 0 to 15; (b) changes of related indexes of the coagulation system in patients from 0 to 20. Table 5: Changes in the level of stress indicators. Index Group Preoperative 1 day Postoperative 1 day Postoperative 3 day Control (n � 40) 13.02± 1.26 30.25± 2.59 26.77± 2.05 Combine (n � 40) 12.85± 1.31 24.33± 2.47 19.32± 5.16 IL-6 (ng/L) t 0.592 10.460 8.486 P 0.556 <0.001 <0.001 Control (n � 40) 18.26± 3.52 38.22± 4.59 32.02± 4.16 Combine (n � 40) 18.97± 3.84 31.15± 4.05 26.55± 3.45 hs-CRP (mg/L) t 0.862 7.305 6.401 P 0.391 <0.001 <0.001 The levels of prothrombin time (s) Preoperative 1 day Postoperative 1 day Postoperative 3 day The levels of thrombin time (s) Preoperative 1 day Postoperative 1 day Postoperative 3 day 6 Journal of Healthcare Engineering 40 50 0 0 Control group Control group Combine group Combine group (a) (b) Figure 3: Changes in the level of stress indicators: (a) changes of related indexes of the coagulation system in patients from 0 to 40; (b) changes of related indexes of the coagulation system in patients from 0 to 50. 5. Conclusions Data Availability ,e therapeutic effect of SEPS + EVLT and traditional ,e simulation experiment data used to support the findings communicating branch vein ligation + EVLT on GSVV of this study are available from the corresponding author patients are compared in this study. ,e results show that upon request. SEPS + EVLT could significantly reduce the operation time and mean bleeding volume of patients and shorten Conflicts of Interest the postoperative active time and hospitalization time. In ,e authors declare that there are no conflicts of interest. addition, due to the hypercoagulability of blood in GSVV patients, the body injury caused by surgery can aggravate the disorder of the coagulation system, which will lead to Acknowledgments abnormal changes in the levels of PT and TT. ,e tra- ,is work was supported by S&T Program of Chengde ditional communicating branch vein ligation can cause (201904A049). great damage to the vein wall, strong stress in the body, and the function of vascular endothelial cells. At the same References time, the traditional communicating branch vein ligation has many incisions, and a large number of bandages are [1] A. Kundal, N. Kumar, D. Rajput, and U. Chauhan, “Great used to wrap the wound after surgery, which limits the saphenous vein sparing versus stripping in Trendelenburg movement of the body and may aggravate blood coag- operation for primary varicose veins: a prospective study,” ulation. ,e surgical operation of SEPS combined with Polish Journal of Surgery, vol. 93, no. 1, pp. 34–39, 2020. EVLT is more precise, which can effectively avoid damage [2] S. Yoshida, I. Koshima Haddad, H. Imai et al., “Combined to the surrounding normal veins and soft tissues, lymphovenous anastomosis and great saphenous vein strip- maintain the stability of the vascular endothelium, and ping for comorbid lymphedema and varicose veins,” Lym- reduce the stress response. ,e treatment mode of SEPS phatic Research and Biology, vol. 3, p. 31, 2020. [3] Y. Tseng, C. Chen, M. Wong et al., “Blood flow analysis of the combined with EVLT therapy can reduce the postoper- great saphenous vein in the su-pine position in clinical ative stress response of patients and is not easy to have manifestations of varicose veins of different severities: ap- serious adverse effects on the coagulation system, so that plication of phase-contrast magnetic resonance imaging a higher clinical effect can be obtained. data,” Diagnostics, vol. 102, no. 7, p. 118, 2020. To sum up, SEPS combined with EVLT has a sig- [4] P. Sandhya, R. Mohil, and R. Sricharan, “Randomised con- nificant curative effect in the treatment of saphenous trolled study to compare radiofrequency ablation with min- varicose veins of lower extremity. It can significantly imally invasive ultrasound-guided non-flush ligation and shorten the hospitalization time of patients, improve the stripping of great saphenous vein in the treatment of varicose treatment effect and notch aesthetics, and improve the veins,” Annals of the Royal College of Surgeons of England, coagulation index and stress index. vol. 39, no. 2, pp. 105–111, 2020. The levels of interleukin-6 (ng/L) Preoperative 1 day Postoperative 1 day Postoperative 3 day The levels of high sensitive C-reactive protein (mg/L) Preoperative 1 day Postoperative 1 day Postoperative 3 day Journal of Healthcare Engineering 7 [5] S. D. Bendix, E. L. Peterson, L. S. Kabbani, M. R. Weaver, and [18] V. Manou-Stathopoulou, M. Korbonits, and G. L. Ackland, J. C. Lin, “Effect of endovenous ablation assessment stratified “Redefining the perioperative stress response: a narrative review,” British Journal of Anaesthesia, vol. 123, no. 5, by great saphenous vein size, gender, clinical severity, and pp. 570–583, 2019. patient-reported outcomes,” Journal of Vascular Surgery: [19] J. Crippa, G. M. Mari, A. Miranda, A. T. M. Costanzi, and Venous and Lymphatic Disorders, vol. 9, no. 1, pp. 128–136, D. Maggioni, “Surgical stress response and enhanced recovery after laparoscopic surgery-a systematic review,” Chirurgia, [6] M. Leo, R. Stefano, and A. I. Raffaele, “Foam sclerotherapy of vol. 113, no. 4, pp. 455–463, 2018. the great saphenous vein in association with pre-terminal [20] H. Bielas, R. E. Meister-Langraf, J.-P. Schmid et al., “Acute saphenous junction ligation/division as an office-based pro- stress disorder and C-reactive protein in patients with acute cedure: 12-Month results,” Phlebology: (e Journal of Venous myocardial infarction,” European Journal of Preventive Car- Disease, vol. 33, no. 5, pp. 321–329, 2018. diology, vol. 25, no. 3, pp. 298–305, 2018. [7] S. Rajendran, H. R. Nair, M. Irshad K, M. Unais T, and N. J. ,aikattil, “Ultrasound-assisted varicose vein surgery and endovenous laser ablation using 1470-nm laser for treatment of great saphenous vein incompetence has similar outcomes at 1 year in a single-center prospective randomized study,” Journal of Vascular Surgery: Venous and Lymphatic Disorders, vol. 10, no. 2, pp. 370–375, 2022. [8] F. Su, L. Cheng, and Q. Tong, “Effectiveness of tumescent solution combined with negative pressure wound therapy in traditional high ligation and stripping of the great saphenous vein,” Medicine, vol. 99, no. 1, Article ID e19040, 2020. [9] H. Kusagawa, N. Haruta, and R. Shinhara, “Surgical methods and clinical results of subfascial endoscopic perforator surgery in Japan,” Phlebology, vol. 14, no. 3, pp. 678–686, 2018. [10] G. Gao, L. Cao, X. Du et al., “Comparison of minimally in- vasive surgery transforaminal lumbar interbody fusion and TLIF for treatment of lumbar spine stenosis,” Journal of Healthcare Engineering, vol. 2022, pp. 1–12, Article ID 9389239, 2022. [11] M. Fresa, E. Ezzi, A. Roessingh, S. D. Qanadli, B. Ney, and L. Mazzolai, “Ultrasound-guided percutaneous endovenous laser treatment combined with sclerotherapy for the treat- ment of large intramuscular venous malformations,” Inter- national Angiology, vol. 41, no. 1, pp. 1–8, 2021. [12] J. Cragg, Z. Yang, X. Xie, J. Zhao, and P. Kang, “Adductor canal block provides better performance after total knee arthroplasty compared with femoral nerve block: a systematic review and meta-analysis,” International Orthopaedics, vol. 40, no. 5, pp. 925–933, 2016. [13] D. McCarthy and I. Nyamekye, “,e recommended goal in the United Kingdom’s National Institute for Health and Care Excellence Clinical Guideline 168 for immediate referral of patients with bleeding varicose veins is not being achieved,” Journal of Vascular Surgery Venous Lymphat Disord, vol. 9, no. 2, pp. 377–382, 2021. ˇ ´ [14] K. Novotny, ´ M. Rocek, R. Padr et al., “Treating great and small saphenous vein insufficiency with histoacryl in patients with symptomatic varicose veins and increased risk of surgery,” VASA. Zeitschrift fur Gefasskrankheiten, vol. 47, no. 5, pp. 416–424, 2018. [15] P. Zhang, H. Zhang, Y. Li, W. Chen, X. Y. Zhang, and H. J. Li, “Improved LHS based cumulant method for probabilistic load flow calculation,” Acta Energiae Solaris Sinica, vol. 42, no. 1, pp. 14–20, 2021. [16] E. Tanda, G. Ruiu, G. Pistincu, and S. Camparini, “Images in vascular medicine: foreign body reaction to surgical clips after subfascial endoscopic perforator surgery,” Vascular Medicine, vol. 26, no. 6, pp. 670-671, 2021. [17] A. Cavallini, D. Marcer, and S. Ferrari Ruffino, “Endovenous laser treatment of groin and popliteal varicose veins recur- rence,” Phlebology: (e Journal of Venous Disease, vol. 33, no. 3, pp. 195–205, 2018. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Healthcare Engineering Hindawi Publishing Corporation

Study of Subfascial Endoscopic Perforator Surgery Combined with Endovenous Laser Treatment in the Treatment of Great Saphenous Varicose Veins

Loading next page...
 
/lp/hindawi-publishing-corporation/study-of-subfascial-endoscopic-perforator-surgery-combined-with-y1t7bXdk5O
Publisher
Hindawi Publishing Corporation
Copyright
Copyright © 2022 Li Wang et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
ISSN
2040-2295
eISSN
2040-2309
DOI
10.1155/2022/1801099
Publisher site
See Article on Publisher Site

Abstract

Hindawi Journal of Healthcare Engineering Volume 2022, Article ID 1801099, 7 pages https://doi.org/10.1155/2022/1801099 Research Article Study of Subfascial Endoscopic Perforator Surgery Combined with Endovenous Laser Treatment in the Treatment of Great Saphenous Varicose Veins Li Wang, Jianqing Du, and Hong Zhang Vascular and General Surgery, Affilited Hospital of Chengde Medical University, Chengde 067000, China Correspondence should be addressed to Hong Zhang; cdzh1977@163.com Received 4 March 2022; Revised 3 April 2022; Accepted 7 April 2022; Published 16 April 2022 Academic Editor: Hangjun Che Copyright © 2022 Li Wang et al. ,is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Great saphenous varicose vein (GSVV) is a venous reflux disease of the lower extremity. In order to explore the clinical effect of subfascial endoscopic perforator surgery (SEPS) with endovenous laser treatment (EVLT) in the treatment of GSVV, 80 patients who underwent unilateral saphenous varicose surgery are analyzed. ,e operation results show that the patients who used SEPS + EVLT have less operation time and mean blood loss, shorter postoperative active time and hospitalization stay, better curative effect, and higher notch aesthetics (P< 0.05). SEPS combined with EVLT has a remarkable curative effect in the treatment of saphenous varicose veins of lower extremity, which can significantly shorten the hospitalization time of patients and improve the coagulation index and stress index. inhibit venous blood backflow, thereby, improving venous 1. Introduction hypertension and blood stasis, quickly relieving patients’ GSVV is a venous reflux disease of the lower extremity that is symptoms and signs, and helping patients restore the caused by the inability of the deep venous valve to close function of the affected limb. High saphenous vein liga- tightly. GSVV can manifest as superficial varicose veins, tion is an effective method for the treatment of GSVV, segmental cystic, or columnar dilatation of the main or which can completely strip the diseased saphenous vein, branch of the veins, as well as lower extremity swelling, pain, but it will cause great trauma to the surrounding tissue hyperpigmentation, pruritus, and even ulceration [1, 2]. during the stripping process, and it is easy to damage the Factors that can cause increased intraabdominal pressure saphenous nerve and cause postoperative paresthesia such as smoking, long-term standing, or sedentary are all [7, 8]. In addition, the residual vascular bed after high risk factors for saphenous varicose veins [3]. Relevant ligation is prone to accumulation of blood and fluid, and the incision often affects the appearance. With the im- literature reports that the prevalence of GSVV in women is higher than that in men, with prevalence rates ranging provement of medical technology, the treatment of GSVV from 10% to 15% and 20% to 25%, respectively [4, 5]. If has gradually entered the era of minimally invasive GSVV is not treated in time, complications such as su- beauty. Subfascial endoscopic perforator surgery (SEPS) is perficial thrombophlebitis, venous heart ulcer, and vari- to cut the skin to the deep fascia and ligate the com- ceal bleeding can occur, which seriously affect the work municating vein under the guidance of direct vision. SEPS and life of patients [6]. has the advantages of simple operation, small trauma, Surgery is the main method for the treatment of clear visual field, low recurrence rate, and good curative GSVV. ,rough surgery, it can help patients restore the effect. Endovenous laser treatment (EVLT) is also one of the minimally invasive methods of endovenous treatment. venous valve closure function as much as possible and 2 Journal of Healthcare Engineering It is worth noting that surgical trauma can cause trau- ,e principle of treatment is to use the thermal effect released by the laser to damage the venous endothelium, matic stress in the body and make blood in a hypercoag- ulable state, which is not conducive to the postoperative damage the vein wall, and deposit thrombosis to occlude the varicose vein, which in turn obliterates the vena cava recovery of patients [18]. In this study, when comparing the [9, 10]. At present, most patients in clinical practice coagulation indexes of patients during the perioperative generally require combined treatment due to etiology, period, it is found that the levels of PT and TT in the two symptoms, severity, and other reasons. groups postoperative are lower than preoperative, but the ,e rest of this study is organized as follows: Section 2 levels in the patients who used SEPS + EVLT are higher than discusses related work and analysis, followed by the clinical those who used traditional communicating branch liga- treatment methods and evaluation indicators in Section 3. tion + EVLT. When comparing the stress indicators of the Comparative analysis and data statistics are given in Section two groups, it is found that contrast by preoperative, the levels of IL-6 and hs-CRP in the two groups are increased in 4. Section 5 concludes the study with summary and future research directions. postoperative, and the levels in the patients who used SEPS + EVLT are lower than those who used traditional communicating branch ligation + EVLT. Main serological 2. Related Work manifestations of surgical trauma stress response in GSVV Under the guidance of previous studies related to minimally patients with elevated levels of IL-6 and hs-CRP after sur- invasive surgery, this study used SEPS combined with EVLT gery. Elevated levels of IL-6 and hs-CRP can damage the to treat patients with unilateral GSVV. Comparing the vascular endothelial function of patients, promote platelet changes in perioperative indicators with traditional surgery, aggregation, affect the coagulation system of patients, and more comprehensive data for the treatment of GSVV can be are not conducive to the recovery of postoperative limb skills supported. [19, 20]. In addition, due to the hypercoagulability of blood in patients with GSVV, the body damage caused by surgery With the progression of the GSVV, it can also lead to skin pigmentation, eczema, and ulcers, and effective treat- may aggravate the disorder of the coagulation system, resulting in abnormal changes in the levels of PT and TT. ment should be implemented in time to relieve the pain of the patients [11, 12]. Surgical therapy can change the local hemodynamic state from the anatomical level and prevent 3. Clinical Treatment Methods and the pathological process. It is the main way of clinical Evaluation Indicators treatment of severe saphenous varicose veins. With the further development of minimally invasive technology and 3.1. Research Object. ,e data of 80 patients who under- equipment, a series of minimally invasive procedures have went unilateral GSVV surgery from January 2019 to been gradually applied in clinical practice. January 2021 are retrospectively analyzed. Patients are ,e traditional communicating branch vein ligation is a selected with the following rules: first, meet the relevant destructive treatment method, which requires high seg- diagnostic criteria of GSVV and have been confirmed by mental dissection of the trunk of the great saphenous vein. In imaging. Second, it is unilateral lesions. ,ird, clinical, addition, multiple surgical incisions are required to ligate the etiological, anatomical, pathophysiological classification communicating branch veins, and the intraoperative trauma (CEAP) grade C5-C6. Finally, the data of preoperative is large, which may easily cause damage to the skin, veins, examination, operation-related parameters, and postop- soft tissues, and nerves. ,ese injuries increase patient erative reexamination are complete. Exclusion criteria is distress and prolong postoperative active and hospitalization as follows: first, combined with other vascular diseases. time. ,ese injuries increase patient distress and prolong Second, insufficiency of important organs. ,ird, venous postoperative active and hospitalization. SEPS is performed vascular disease due to congenital factors. Fourth, com- by endoscopic ligation of the deep subfascial communicating bined with malignant tumors. Finally, the history of lower branch vein, and its precise positioning can reduce un- extremity venous surgery. necessary trauma, thereby shortening the time for patients to ,e number of patients in the study is 80. In the light of the get out of postoperative active and hospitalization stay after surgical methods, the patients are divided into the control surgery [13, 14]. It is found that SEPS can reduce the oc- (traditional communicating branch ligation + EVLT) and the clusion rate of the incidence of ulcers in patients after combine group (SEPS + EVLT). surgery. EVLT uses percutaneous puncture to occlude the superficial varicose vein under the action of cautery, which can preserve the normal saphenous vein and reduce the 3.2. (erapeutic Methods. ,e combined group is treated damage caused by ligation [15, 16]. Cavallini and other with SEPS + EVLT. ,e patient is placed in a supine position scholars believed that EVLT can reduce the risk of saphe- with the head loared and the feet high, the affected limb nofemoral valve regurgitation after ligation and stripping of flexed and the knee is abducted by 130 , the hip joint is the great saphenous vein [17]. ,e results of this study also slightly externally rotated, and the knee is properly elevated. show that compared with the patients who used traditional Routine sterile drape and anesthesia are performed. A communicating branch ligation + EVLT, the patients who transverse skin incision of about 1 cm in length is made 6 cm used SEPS + EVLT have more significant curative effects and below the tibial tuberosity and 4 cm medial to the tibia, and higher notch aesthetics. the subcutaneous tissue is incised successively until the deep Journal of Healthcare Engineering 3 saphenous vein is evaluated as effective. Patients with no fascia. ,e subfascial space is bluntly separated with the fingers, and the separation range is up to 5 cm medial to improvement in clinical symptoms, obvious varicose veins, and regurgitation of the great saphenous vein still visible on form an operating space. Between the deep fascia and the muscularis layer along vascular color ultrasound are evaluated as invalid. the incision, a laparoscopic system is placed, and CO is ,e self-made incision satisfaction questionnaire is used filled under the fascia to maintain a pressure of 12 mmHg. to evaluate the patients’ satisfaction with the notch aes- Under the direct vision of the endoscope, a second incision thetics. ,e incision aesthetics score ranged 0–10, and the with a length of about 0.5 cm is made at about 5 cm inside scores are proportional to satisfaction. and about 3 cm below the original incision, and a Trocar and Some things are measured 1 day before surgery and 1 day an ultrasonic scalpel are placed. Blunt dissection of the loose and 3 days after surgery: prothrombin time (PT), thrombin connective tissue is under the deep fascia, exposure of the time (TT), interleukin-6 (IL-6), and high-sensitive C-reac- tive protein (hs-CRP) levels. communicating veins, and separation of communicating veins of varying thickness. ,e communicating veins are separated one by one using the ultrasonic scalpel, and the 3.4. Statistical Methods. SPSS 25.0 and GraphPad Prism 8.3 separation range is from the anterior border of the tibia to statistical software are used to analyze the research data. the midline, down to the Achilles tendon and medial Qualitative data are expressed by frequency and percentage, malleolus, to avoid missing the communicating veins. ,e and the chi-square test and rank sum test are performed. endoscopy system is withdrawn, the residual gas in the cavity Quantitative data conforming to a normal distribution are is discharged, and the two surgical incisions are sutured expressed in the form of mean± standard deviation, and the t- intermittently. test is used. P< 0.05 indicated that the difference is significant. An incision is made 2 cm anterior to the medial malleolus and a laser fiber is placed. An 18G trocar is used to puncture the 4. Comparative Analysis and Data Statistics great saphenous vein at the medial malleolus, and a 5F catheter dilator is introduced. ,e laser fiber is inserted into the 5F 4.1. Baseline Data. ,e baseline data of patients with dif- straight catheter and sent to the saphenofemoral vein, the ferent treatment methods are compared before surgery, and catheter is retracted, and the fiber is pushed forward until the it is found that there is no great difference in the baseline catheter is exposed 3 cm. Connect the semiconductor laser data of the two groups of patients (P> 0.05). Table 1 pro- therapy instrument and adjust the laser wavelength to 810 nm vides the specific data. and the laser emission power to 12–15 W. Using a continuous pulse method, the fiber is withdrawn and the laser is cauterized 4.2. Patient Surgery-Related Indicators. Comparing the op- until the medial malleolus. ,e catheter and fiber are with- eration-related indicators between the two groups, it is drawn slowly at the same time to close the vein wall. After the found that the time of operation, mean bleeding volume, operation, the surgical area of the affected limb is compressed postoperative active time, and hospitalization time of the with an elastic bandage. patients who used SEPS + EVLT are lower than those who ,e control group is treated with traditional commu- used traditional communicating branch ligation + EVLT nicating branch vein ligation + EVLT: the patient position, (P< 0.05), as given in Table 2. EVLT treatment method, and postoperative treatment are the same as those in the combined group. Traditional communicating branch vein ligation: according to the 4.3. Curative Effect and Incision Aesthetics. It can be seen preoperative color Doppler ultrasound to locate the surface from Table 3 that the results of the rank sum test indicated that markings of the communicating branch vein, the commu- the curative effect of the two groups of patients is significantly nicating branch vein is separated with a small incision and different. Table 3 provides the curative effect and incision. ligated in the superficial fascia layer. ,e evaluation of the aesthetics of the incision in the two groups of patients and the patients who used SEPS + EVLT are significantly more satisfied with the 3.3. Observation Indexes. Time of operation, mean bleeding aesthetics of the incision than the patients who used volume, postoperative activity time, hospitalization time, traditional communicating branch ligation + EVLT and other related indicators are recorded. ,e operation (P< 0.05). Figure 1 shows the comparison of notch aes- time is from the start of anesthesia to the end of compression thetics. In Figure 1, P< 0.05. bandage with elastic bandage. ,e clinical efficacy is evaluated according to the pa- tients’ lower extremity symptoms and vascular color 4.4. Changes of Related Indexes of the Coagulation System Doppler ultrasonography 1 month after operation. ,e during the Perioperative Period. Comparing the changes of clinical symptoms basically disappeared, there is no obvious blood coagulation system-related indexes between the two varicose veins, and the color ultrasound shows that there is groups, it is found that at 1 and 3 days postoperative, the no regurgitation in the great saphenous vein, and it is levels of PT and TT in the two groups are lower than those evaluated as curative. ,e clinical symptoms are significantly preoperative, as given in Table 4. improved, slight varicose veins are seen, and the color ul- ,e levels in the patients who used SEPS + EVLT are trasound shows that the partial regurgitation of the great higher than those who used traditional communicating 4 Journal of Healthcare Engineering Table 1: Baseline data of patients. Baseline information Control (n � 40) Combine (n � 40) t/χ P Gender Male 14 (35.00) 17 (42.50) 0.474 0.491 Female 26 (65.00) 23 (57.50) Age 55.26± 5.93 56.31± 6.21 0.773 0.442 Disease duration (years) 6.09± 1.34 6.31± 1.28 0.751 0.455 BMI (kg/m ) 23.05± 0.97 22.98± 1.01 0.316 0.752 Affected limb Left 18 (45.00) 21 (52.50) 0.45 0.502 Right 22 (55.00) 19 (47.50) CEPA grade C5 31 (77.50) 29 (72.50) 0.267 0.606 C6 9 (22.50) 11 (27.50) Table 2: Surgery-related indicators of patients. Group Time of operation (min) Mean bleeding volume (mL) Postoperative activity time (d) Hospitalization time (d) Control (n � 40) 92.13± 9.15 41.26± 7.59 5.84± 1.13 9.25± 1.31 Combine (n � 40) 67.58± 8.06 19.26± 6.28 3.59± 0.95 6.74± 0.95 t 12.731 14.122 9.639 9.81 P <0.001 <0.001 <0.001 <0.001 Table 3: Curative effect and incision aesthetics. Group Curative Effective Invalid Notch aesthetics Control (n � 40) 15 (37.50) 18 (45.00) 7 (17.50) 7.31± 1.25 Combine (n � 40) 22 (55.00) 17 (42.50) 1 (2.50) 8.14± 0.97 Z/t −2.029 3.318 Control group Combine group Figure 1: Comparison of notch aesthetics. branch ligation + EVLT (P< 0.05). ,ose results are two groups are increased compared with those preoperative. plotted as a bar chart, as shown in Figure 2. In Figure 2, Table 5 provides the changes in the level of stress indicators. P< 0.05. ,e levels in the patients who used SEPS + EVLT are lower than those who used traditional communicating 4.5. Changes in the Level of Stress Indicators. Comparing branch ligation + EVLT (P< 0.05). ,ose results are the changes of stress indexes in the two groups, it is found that at plotted as a bar chart, as shown in Figure 3. In Figure 3, 1 and 3 days postoperative, the levels of IL-6 and hs-CRP in the P< 0.05. The Score of notch aesthetics Journal of Healthcare Engineering 5 Table 4: Changes of related indexes of the coagulation system during the perioperative period. Index Group Preoperative 1 day Postoperative 1 day Postoperative 3 day Control (n � 40) 11.79± 1.29 8.16± 0.94 9.51± 0.98 Combine (n � 40) 12.03± 1.31 9.75± 1.02 10.82± 1.14 PT (s) t 0.826 7.250 5.511 P 0.442 <0.001 <0.001 Control (n � 40) 15.22± 1.97 12.17± 1.06 14.22± 1.21 Combine (n � 40) 15.83± 1.92 13.84± 1.11 15.68± 1.27 TT (s) t 1.402 6.882 5.264 P 0.165 <0.001 <0.001 15 20 0 0 Control group Control group Combine group Combine group (a) (b) Figure 2: Changes of related indexes of the coagulation system in patients during the perioperative period: (a) changes of related indexes of the coagulation system in patients from 0 to 15; (b) changes of related indexes of the coagulation system in patients from 0 to 20. Table 5: Changes in the level of stress indicators. Index Group Preoperative 1 day Postoperative 1 day Postoperative 3 day Control (n � 40) 13.02± 1.26 30.25± 2.59 26.77± 2.05 Combine (n � 40) 12.85± 1.31 24.33± 2.47 19.32± 5.16 IL-6 (ng/L) t 0.592 10.460 8.486 P 0.556 <0.001 <0.001 Control (n � 40) 18.26± 3.52 38.22± 4.59 32.02± 4.16 Combine (n � 40) 18.97± 3.84 31.15± 4.05 26.55± 3.45 hs-CRP (mg/L) t 0.862 7.305 6.401 P 0.391 <0.001 <0.001 The levels of prothrombin time (s) Preoperative 1 day Postoperative 1 day Postoperative 3 day The levels of thrombin time (s) Preoperative 1 day Postoperative 1 day Postoperative 3 day 6 Journal of Healthcare Engineering 40 50 0 0 Control group Control group Combine group Combine group (a) (b) Figure 3: Changes in the level of stress indicators: (a) changes of related indexes of the coagulation system in patients from 0 to 40; (b) changes of related indexes of the coagulation system in patients from 0 to 50. 5. Conclusions Data Availability ,e therapeutic effect of SEPS + EVLT and traditional ,e simulation experiment data used to support the findings communicating branch vein ligation + EVLT on GSVV of this study are available from the corresponding author patients are compared in this study. ,e results show that upon request. SEPS + EVLT could significantly reduce the operation time and mean bleeding volume of patients and shorten Conflicts of Interest the postoperative active time and hospitalization time. In ,e authors declare that there are no conflicts of interest. addition, due to the hypercoagulability of blood in GSVV patients, the body injury caused by surgery can aggravate the disorder of the coagulation system, which will lead to Acknowledgments abnormal changes in the levels of PT and TT. ,e tra- ,is work was supported by S&T Program of Chengde ditional communicating branch vein ligation can cause (201904A049). great damage to the vein wall, strong stress in the body, and the function of vascular endothelial cells. At the same References time, the traditional communicating branch vein ligation has many incisions, and a large number of bandages are [1] A. Kundal, N. Kumar, D. Rajput, and U. Chauhan, “Great used to wrap the wound after surgery, which limits the saphenous vein sparing versus stripping in Trendelenburg movement of the body and may aggravate blood coag- operation for primary varicose veins: a prospective study,” ulation. ,e surgical operation of SEPS combined with Polish Journal of Surgery, vol. 93, no. 1, pp. 34–39, 2020. EVLT is more precise, which can effectively avoid damage [2] S. Yoshida, I. Koshima Haddad, H. Imai et al., “Combined to the surrounding normal veins and soft tissues, lymphovenous anastomosis and great saphenous vein strip- maintain the stability of the vascular endothelium, and ping for comorbid lymphedema and varicose veins,” Lym- reduce the stress response. ,e treatment mode of SEPS phatic Research and Biology, vol. 3, p. 31, 2020. [3] Y. Tseng, C. Chen, M. Wong et al., “Blood flow analysis of the combined with EVLT therapy can reduce the postoper- great saphenous vein in the su-pine position in clinical ative stress response of patients and is not easy to have manifestations of varicose veins of different severities: ap- serious adverse effects on the coagulation system, so that plication of phase-contrast magnetic resonance imaging a higher clinical effect can be obtained. data,” Diagnostics, vol. 102, no. 7, p. 118, 2020. To sum up, SEPS combined with EVLT has a sig- [4] P. Sandhya, R. Mohil, and R. Sricharan, “Randomised con- nificant curative effect in the treatment of saphenous trolled study to compare radiofrequency ablation with min- varicose veins of lower extremity. It can significantly imally invasive ultrasound-guided non-flush ligation and shorten the hospitalization time of patients, improve the stripping of great saphenous vein in the treatment of varicose treatment effect and notch aesthetics, and improve the veins,” Annals of the Royal College of Surgeons of England, coagulation index and stress index. vol. 39, no. 2, pp. 105–111, 2020. The levels of interleukin-6 (ng/L) Preoperative 1 day Postoperative 1 day Postoperative 3 day The levels of high sensitive C-reactive protein (mg/L) Preoperative 1 day Postoperative 1 day Postoperative 3 day Journal of Healthcare Engineering 7 [5] S. D. Bendix, E. L. Peterson, L. S. Kabbani, M. R. Weaver, and [18] V. Manou-Stathopoulou, M. Korbonits, and G. L. Ackland, J. C. Lin, “Effect of endovenous ablation assessment stratified “Redefining the perioperative stress response: a narrative review,” British Journal of Anaesthesia, vol. 123, no. 5, by great saphenous vein size, gender, clinical severity, and pp. 570–583, 2019. patient-reported outcomes,” Journal of Vascular Surgery: [19] J. Crippa, G. M. Mari, A. Miranda, A. T. M. Costanzi, and Venous and Lymphatic Disorders, vol. 9, no. 1, pp. 128–136, D. Maggioni, “Surgical stress response and enhanced recovery after laparoscopic surgery-a systematic review,” Chirurgia, [6] M. Leo, R. Stefano, and A. I. Raffaele, “Foam sclerotherapy of vol. 113, no. 4, pp. 455–463, 2018. the great saphenous vein in association with pre-terminal [20] H. Bielas, R. E. Meister-Langraf, J.-P. Schmid et al., “Acute saphenous junction ligation/division as an office-based pro- stress disorder and C-reactive protein in patients with acute cedure: 12-Month results,” Phlebology: (e Journal of Venous myocardial infarction,” European Journal of Preventive Car- Disease, vol. 33, no. 5, pp. 321–329, 2018. diology, vol. 25, no. 3, pp. 298–305, 2018. [7] S. Rajendran, H. R. Nair, M. Irshad K, M. Unais T, and N. J. ,aikattil, “Ultrasound-assisted varicose vein surgery and endovenous laser ablation using 1470-nm laser for treatment of great saphenous vein incompetence has similar outcomes at 1 year in a single-center prospective randomized study,” Journal of Vascular Surgery: Venous and Lymphatic Disorders, vol. 10, no. 2, pp. 370–375, 2022. [8] F. Su, L. Cheng, and Q. Tong, “Effectiveness of tumescent solution combined with negative pressure wound therapy in traditional high ligation and stripping of the great saphenous vein,” Medicine, vol. 99, no. 1, Article ID e19040, 2020. [9] H. Kusagawa, N. Haruta, and R. Shinhara, “Surgical methods and clinical results of subfascial endoscopic perforator surgery in Japan,” Phlebology, vol. 14, no. 3, pp. 678–686, 2018. [10] G. Gao, L. Cao, X. Du et al., “Comparison of minimally in- vasive surgery transforaminal lumbar interbody fusion and TLIF for treatment of lumbar spine stenosis,” Journal of Healthcare Engineering, vol. 2022, pp. 1–12, Article ID 9389239, 2022. [11] M. Fresa, E. Ezzi, A. Roessingh, S. D. Qanadli, B. Ney, and L. Mazzolai, “Ultrasound-guided percutaneous endovenous laser treatment combined with sclerotherapy for the treat- ment of large intramuscular venous malformations,” Inter- national Angiology, vol. 41, no. 1, pp. 1–8, 2021. [12] J. Cragg, Z. Yang, X. Xie, J. Zhao, and P. Kang, “Adductor canal block provides better performance after total knee arthroplasty compared with femoral nerve block: a systematic review and meta-analysis,” International Orthopaedics, vol. 40, no. 5, pp. 925–933, 2016. [13] D. McCarthy and I. Nyamekye, “,e recommended goal in the United Kingdom’s National Institute for Health and Care Excellence Clinical Guideline 168 for immediate referral of patients with bleeding varicose veins is not being achieved,” Journal of Vascular Surgery Venous Lymphat Disord, vol. 9, no. 2, pp. 377–382, 2021. ˇ ´ [14] K. Novotny, ´ M. Rocek, R. Padr et al., “Treating great and small saphenous vein insufficiency with histoacryl in patients with symptomatic varicose veins and increased risk of surgery,” VASA. Zeitschrift fur Gefasskrankheiten, vol. 47, no. 5, pp. 416–424, 2018. [15] P. Zhang, H. Zhang, Y. Li, W. Chen, X. Y. Zhang, and H. J. Li, “Improved LHS based cumulant method for probabilistic load flow calculation,” Acta Energiae Solaris Sinica, vol. 42, no. 1, pp. 14–20, 2021. [16] E. Tanda, G. Ruiu, G. Pistincu, and S. Camparini, “Images in vascular medicine: foreign body reaction to surgical clips after subfascial endoscopic perforator surgery,” Vascular Medicine, vol. 26, no. 6, pp. 670-671, 2021. [17] A. Cavallini, D. Marcer, and S. Ferrari Ruffino, “Endovenous laser treatment of groin and popliteal varicose veins recur- rence,” Phlebology: (e Journal of Venous Disease, vol. 33, no. 3, pp. 195–205, 2018.

Journal

Journal of Healthcare EngineeringHindawi Publishing Corporation

Published: Apr 16, 2022

References