重视下肢慢性静脉功能不全的规范化诊治

Standardized diagnosis and treatment of chronic venous insufficiency in the lower extremities

慢性下肢静脉功能不全(CVI)是最常见的周围血管疾病之一。由于其临床表现多样,病理生理改变复杂,可供选择的治疗方式繁多,导致诊疗不规范。因此,CVI的诊断和治疗迫切需要规范。首先,应重视使用CEAP分级和彩色多普勒超声等相关手段准确诊断CVI。其次,在明确诊断的基础上,应充分考虑选择适当的治疗方法。CVI的主要治疗仍然是处理浅静脉功能不全。在各种治疗方式中,腔内热闭合是治疗CVI的一线选择,但需要关注与热相关的并发症。由于新型的非热、非膨胀技术在围手术期无热相关并发症的优势,可能成为将来治疗CVI的重要有效手段。硬化剂治疗和静脉加压治疗是重要的辅助手段,但始终需要考虑与硬化剂治疗相关的严重并发症,如血栓和肺栓塞的发生。关于交通静脉和深静脉的治疗仍然是CVI研究和探讨的领域,需要更多严格的临床证据来指导治疗。

Chronic venous insufficiency(CVI) in the lower extremities is one of the most prevalent peripheral vascular diseases.Due to its diverse clinical manifestations and the complexity of pathophysiological changes,the available treatment options are extensive,leading to non-standardized diagnosis and management.Therefore,there is an urgent demand to standardize the diagnosis and treatment of CVI.Firstly,emphasis should be placed on the accurate diagnosis of CVI using the CEAP classification and related methods such as color Doppler ultrasound.Secondly,upon confirming the diagnosis,careful consideration should be given to selecting appropriate treatment methods.The primary treatment for CVI is the management of superficial venous insufficiency.Among various treatment modalities,endovenous thermal closure is the first-line choice for treating CVI,but attention must be paid to heat-related complications.Due to the advantages of no heat-related perioperative complications,novel non-thermal,non-expansile techniques may become important and effective methods for treating CVI in the future.Sclerotherapy and venous pressure therapy are important auxiliary methods,but consideration must always be given to serious complications associated with sclerotherapy,such as the occurrence of thrombosis and pulmonary embolism.Treatment of communicating veins and deep veins is major area of research and discussion in CVI,requiring more rigorous clinical evidence to guide therapy.