Résultats préliminaires d’une étude sur l’efficacité de l’échothérapie dans le traitement de l’insuffisance veineuse / Preliminary results of a study on the effectiveness of ultrasound therapy in the treatment of venous insufficiency
Séance du mercredi 05 avril 2023 (Place des ultrasons focalisés à haute intensité en thérapeutique)
N° de DOI : 10.26299/xa74-6b86/emem.2023.13.05
Résumé
L’échothérapie appliquée au traitement de l’insuffisance veineuse est une technique innovante de thermoablation utilisant les ultrasons focalisés de haute intensité. Son apport dans le traitement des varices réside dans l’absence de complications hémorragiques ou infectieuses par l’absence d’incisions cutanées. Elle permet également de traiter des patients contre indiqués sur le plan anesthésique notamment les personnes âgées puisqu’elle ne nécessite, si besoin, qu’une anesthésie locale. Enfin aucun arrêt de travail n’est nécessaire chez les patients actifs. Notre étude monocentrique analyse l’efficacité de l’échothérapie dans le traitement de l'insuffisance veineuse chez les patients symptomatiques éligibles à cette nouvelle technique. Entre septembre 2022 et mai 2023, tous les patients adressés en consultation de chirurgie vasculaire à l’Hôpital d’Argenteuil, pour la prise en charge chirurgicale d’une insuffisance veineuse symptomatique, sont inclus consécutivement. Sont éligibles les patients présentant une veine cible située entre un et deux centimètres de profondeur. Le critère de jugement principal est l’occlusion ou la diminution de diamètre de la veine cible avec abolition du reflux au contrôle écho doppler à 1 mois et le critère secondaire, l’amélioration de la qualité de vie selon le questionnaire AVVQ. A mi-parcours nous avons inclus 26 patients et traité 50 veines cibles. L'efficacité selon le critère de jugement principal est de 64% avec une nette amélioration de la qualité de vie chez 80% des patients. Ces résultats préliminaires sont encourageants au vu de la courbe d’apprentissage associée à cette technique et l’absence d’arrêt de travail mais restent à confirmer à la fin de notre période d’analyse. Docteur Mahine KASHI Service de Chirurgie Vasculaire, Hôpital Victor Dupouy , Argenteuil
Ultrasound therapy applied to the treatment of venous insufficiency is an innovative technique using high intensity focused ultrasound. Its contribution in the treatment of varicose veins lies in the absence of hemorrhagic or infectious complications due to the absence of skin incisions. It also allows to treat patients who are not indicated for anesthesia, especially the elderly, since it only requires local anesthesia if necessary. Finally, no work stoppage is required for active patients. Our single-center study analyses the effectiveness of ultrasound therapy in the treatment of venous insufficiency in symptomatic patients eligible for this new technique. Between September 2022 and May 2023, all patients referred for vascular surgery consultation at the Argenteuil Hospital Center for the surgical management of symptomatic venous insufficiency, are included consecutively. Patients with a target vein located between one and two centimeters depth were included. The primary endpoint was occlusion or reduction of the target vein diameter with abolition of reflux on Doppler ultrasound control at 1 month and the secondary endpoint was improvement in quality of life according to the AVVQ questionnaire. At mid-term we included 26 patients and treated 50 target veins. The efficacy according to the primary endpoint was 64% with a clear improvement in quality of life in 80% of patients. These preliminary results are encouraging in view of the learning curve associated with this technique and the absence of work stoppage but remain to be confirmed at the end of our analysis period. Dr Mahine KASHI, Vascular Surgery Departement, Victor Dupouy Hospital, Argenteuil
Ultrasound therapy applied to the treatment of venous insufficiency is an innovative technique using high intensity focused ultrasound. Its contribution in the treatment of varicose veins lies in the absence of hemorrhagic or infectious complications due to the absence of skin incisions. It also allows to treat patients who are not indicated for anesthesia, especially the elderly, since it only requires local anesthesia if necessary. Finally, no work stoppage is required for active patients. Our single-center study analyses the effectiveness of ultrasound therapy in the treatment of venous insufficiency in symptomatic patients eligible for this new technique. Between September 2022 and May 2023, all patients referred for vascular surgery consultation at the Argenteuil Hospital Center for the surgical management of symptomatic venous insufficiency, are included consecutively. Patients with a target vein located between one and two centimeters depth were included. The primary endpoint was occlusion or reduction of the target vein diameter with abolition of reflux on Doppler ultrasound control at 1 month and the secondary endpoint was improvement in quality of life according to the AVVQ questionnaire. At mid-term we included 26 patients and treated 50 target veins. The efficacy according to the primary endpoint was 64% with a clear improvement in quality of life in 80% of patients. These preliminary results are encouraging in view of the learning curve associated with this technique and the absence of work stoppage but remain to be confirmed at the end of our analysis period. Dr Mahine KASHI, Vascular Surgery Departement, Victor Dupouy Hospital, Argenteuil