Zeynep GÜVENÇ, Cüneyt AYTEKİN, Fatih BOYVAT, Umut ÖZYER, Ali HARMAN

ALT EKSTREMiTEDE KRONiK SAFEN VE PERFORAN VEN YETMEZLİĞİ BULUNAN HASTALARDA ENDOVENÖZ LAZER ABLASYON TEDAViSiNiN ETKiNLiĞiNiN DEĞERLENDiRiLMESi

Giriş: Alt ekstremitede kronik venöz yetmezlik (KVY), toplumda çok yaygın olarak izlenen bir hastalıktır. Bu hastalarda, 2001 yılından beri oldukça etkili ve minimal invaziv işlem olarak kabul edilen endovenöz lazer ablasyon (EVLA) tedavisi diğer tedavilere ek olarak kullanılmaktadır. Bu yöntemde; renkli Doppler ultrasonografi (RDUS) ile yetmezlik saptanan damarlara ultrason görüntüleme (USG) eşliğinde girişim yapılarak termal ablasyon oluşturulur. Kısa zaman içinde; damarda oluşturulan geri dönüşümsüz hasar sebebiyle otoinhibisyon gelişir ve KVY semptomları giderilmiş olur. Hastaya yatış gerekmez ve hasta elasto-kompresyon uygulanarak mobilize olabilir. Yöntemler: Çalışmamıza; Mart 2008 ve Ağustos 2009 tarihleri arasında, CEAP (Clinical-Etiology-Anatomy-Pathophysiology) sınıflamasına göre derecelendirilen kronik venöz yetmezlik saptanan ve EVLA için kontrendikasyonu bulunmayan 50 hasta dahil edildi (89 damar, 71 bacak). Prosedür; 980 nm dalga boylu, 400 mikron fiberoptik başlıklı cihaz ile gerçekleştirildi. Ayrıca varisleri çok olan hastalara, tamamlayıcı tedavi olarak, yüzeysel damarlara yönelik skleroterapi de yapıldı. Bulgular: Beş-yirmi aylık klinik ve Doppler takiplerinde; lazer uygulanan 89 damarın, %87’sinde kalıcı tam oklüzyon, %6,5’inde semptomatik, %6,5’inde asemptomatik rekanalizasyon saptandı. İşleme bağlı olarak 3 hastada majör, 45 hastada minör komplikasyon gelişti. Sonuç: Semptomatik rekanalizasyon gelişen hastalar çıkarıldığında, tedavi başarısı, literatür ile uyumlu olarak %94,5 kabul edilmiştir. Sonuç olarak; bu prospektif çalışmada, EVLA yönteminin KVY tedavisinde etkili, güvenli ve hasta konforu açısından avantajlı olduğu için artan bir hızla cerrahinin yerini alan bir yöntem olduğu sonucuna varılmıştır.

Anahtar Kelimeler:

kronik venöz yetmezlik, varis, endovenöz lazer tedavisi, renkli Doppler ultrasonografi

EVALUATION OF THE EFFICACY OF ENDOVENOUS LASER ABLATION THERAPY FOR PATIENTS WITH LOWER LIMB CHRONIC SAPHENOUS AND PERFORATING VEIN INSUFFICIENCY

Introduction: Chronic venous insufficiency (CVI) in the lower extremities is a widely observed disease in society. In these patients, endovenous laser ablation (EVLA) treatment, which has been considered highly effective and minimally invasive since 2001, is used in addition to other treatments. In this method, thermal ablation is created by intervention under ultrasound imaging (USG) guidance on the veins identified with color Doppler ultrasonography (CDUS) to have insufficiency. Within a short period, irreversible damage is induced in the vein, leading to autoinhibition and the alleviation of CVI symptoms. Hospitalization is not required for the patient, and they can mobilize with elastocompressive support. Methods: Our study included 50 patients (89 veins, 71 legs) who were diagnosed with chronic venous insufficiency and classified according to the CEAP (Clinical-Etiology-Anatomy-Pathophysiology) classification between March 2008 and August 2009. Patients who did not have contraindications for EVLA were included. The procedure was performed using a device with a 980 nm wavelength and a 400- micron fiber-optic tip. Additionally, patients with a high number of varices underwent complementary treatment with sclerotherapy targeting superficial veins. Results: During the five to twenty months of clinical and Doppler follow-ups, among the 89 veins subjected to laser treatment, permanent complete occlusion was observed in 87%, symptomatic recanalization in 6.5%, and asymptomatic recanalization in 6.5%. Procedure-related major complications occurred in 3 patients, and minor complications occurred in 45 patients. Conclusion: Excluding patients with symptomatic recanalization, the treatment success rate was accepted as 94.5%, consistent with the literature. Consequently, in this prospective study, EVLA was found to be an effective, safe, and advantageous method in terms of patient comfort, rapidly replacing surgery in the treatment of CVI.

Keywords:

Chronic venous insufficiency, varice, color Doppler ultrasonography, endovenous laser ablation,

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