Büyük Safen Ven Yetmezliğinde Endovenöz Lazer Ablasyon (EVLA) ve Geleneksel Cerrahi Tedavilerinin Kısa ve Orta Dönem Sonuçlarının Karşılaştırılması

Amaç: Bu retrospektif çalışmada izole ve tek taraflı semptomatik büyük safen ven yetmezliği olan hastalarda, endovenöz lazer ablasyon ve geleneksel cerrahi tedavi (büyük safen vene yüksek ligasyon ve safenektomi) sonrası kısa ve orta dönem klinik sonuçların karşılaştırılması amaçlandı. Gereç ve Yöntemler: Mart 2013 - Ağustos 2013 tarihleri arasında kliniğimizde geleneksel cerrahi tedavi (Grup 1; 35 hasta: 16 kadın, 19 erkek, ortalama yaş; 44. 3±12. 6 yaş, 20-68 yaş arası) ve endovenöz lazer ablasyon (EVLA) (Grup 2; 30 hasta: 20 kadın, 10 erkek, ortalama yaş; 39. 8±11.7 yaş, 20-65 yaş arası) tedavileri uygulanan 65 hasta bu çalışmaya dahil edildi. Her iki gruptaki hastalar özelliklerine göre karşılaştırıldı. Bulgular: Postoperatif 1. hafta ve 1. ay ağrı skorları karşılaştırıldığında EVLA yapılan hastalarda, diğer gruba göre istatistiksel olarak ağrı skorlarının daha düşük olduğu saptandı (p< 0.01). Buna karşın endovenöz lazer ablasyon uygulanan hastalarda preoperatif ağrı skorları arasında farklılık yoktu. 6. ay kontrolünde her iki grup hastada ağrı gözlenmediği saptandı. Postoperatif 1. hafta takibinde komplikasyon gelişme sıklığı EVLA yapılan hastalarda daha düşük saptandı fakat 1. ay ve 6. ay kontrollerinde istatistiksel farklılık saptanmadı. CEAP skorları EVLA hastalarında postoperatif takiplerinde istatistiksel olarak anlamlı olarak daha düşük iken preoperatif her iki grup arasında farklılık gözlenmedi. Sonuç: İzole, semptomatik ve tek taraflı büyük safen ven yetmezliklerinde, endovenöz lazer ablasyon tedavisinin kısa ve orta vadedeki daha iyi sonuçlarla geleneksel cerrahi tedaviye göre daha iyi tedavi metodu olduğunu gözlemledik.

Comparison of Early and Mid-term Outcomes of Endovenous Laser Ablation (EVLA) Treatment Versus Traditional Surgical Treatment in Vena Saphena Magna Insufficiency

Objective: In this retrospective study, we aimed to compare the short- term and mid- termclinical outcomes of endovenous laser ablation with traditional surgical treatment (high ligationand saphenectomy of Vena Saphena Magna) in patients with isolated unilateral symptomaticVena Saphena Magna insufficiency.Materials and Methods: Sixty five patients who underwent traditional surgical treatment(Group 1; n: 35; 16 women, 19 men, mean age; 44.3 ± 12.6 years, range; 20 - 68 years) andendovenous laser ablation treatment (Group 2; n = 30; 20 women, 10 men, mean age; 39.8 ±11.7 years, range; 20 - 65 years) between May 2013 and December 2013 were included in thestudy. Groups were compared according to their differences.Results: Pain scores of EVLA patients were significantly lower at postoperative first week andfirst month (p< 0.01), whereas, there was no significant difference preoperatively. No patientstated to have pain at postoperative 6th month. Frequency of complication development ofEVLA patients was found to be lower at postoperative first week follow up but there was nostatistically significant difference at 1st month and 6th month controls. CEAP scores of EVLApatients were significantly lower at postoperative follow-ups but there was no significantdifference preoperatively.Conclusion: We observed that endovenous laser ablation is a better treatment modality withbetter short and mid-term outcomes than traditional surgical treatment in isolatedsymptomatic unilateral Vena Saphena Magna insufficiencies.

PDF

___

1. Nicolaides AN, Allegra C, Bergan J, Bradbury A, Cairols M, Carpantier P, et al. Management of chronic venous disorders of the lower limbs: Guidelines according to scientific evidence. International Angiology 2008;27:1- 59.
2. Van Den Bos RR, Kockaert MA, Neumann HAM, Nijsten T. Technical review of endovenous laser therapy for varicose veins. Eur J Vasc Endovasc Surg 2008;35:88-95.
3. Eris C, Yavuz S, Gucu A, Yumun G, Toktas F. Recurrent varicose veins after surgery: an analysis of 247 patients. Turk Gogus Kalp Dama 2014;22:347-53.
4. Porter JM, Moneta GL. International Consensus Committee on Chronic Venous Disease: Reporting standards in venous disease: an update. J. Vasc Surg 1995;21:635–45.
5. Rutherford RB, Padberg FT, Comerota AJ, Kistner RB, Meisner MH and Moneta GL. Venous severity scoring: An adjunct to venous outcome assessment. J Vasc Surg 2000;31:1307-12
6. Stirling M, Shortell CK. Endovascular treatment of varicose veins. Semin Vasc Surg 2006;19:109-15.
7. Van den Bos R, Arends L, Kockaert M, Neumann M, Nijsten T. Endovenous therapies of lower extremity varicosities: a meta-analysis. J Vasc Surg 2009;49:230-9.
8. Elias S. Minimally invasive vein surgery: latest options for vein disease. Mt Sinai J Med 2010;77:270-8.
9. Pannier F, Rabe E, Maurins U. First results with a new 1470- nm diode laser for endovenous ablation of incompetent saphenous veins. Phlebology 2009;24:26– 30.
10. Pannier F, Rabe E, Rits J, Kadiss A, Maurins U. Endovenous laser ablation of great saphenous veins using a 1470 nm diode laser and the radial fibre--followup after six months. Phlebology 2011;26:35-9.
11. Leopardi D, Hoggan BL, Fitridge RA, Woodruff PW, Maddern GJ. Systematic review of treatments for varicose veins. Ann Vasc Surg 2009;23:264-76.
12. Doganci S, Demirkilic U. Comparison of 980 nm Laser and Bare-tip Fibre with 1470 nm Laser and Radial Fibre in the Treatment of Geat Saphenous Vein Varicosities: A Prospective Randomised Clinical Trial. Eur J Vasc Surg 2010;40:254-59.
13. Etlik O, Korkmaz AA, Uckurt Y, Indelen Y, Gundogdu R, Ozturk A, et al. Endovenous laser ablation for saphenous vein insufficiency: long-term results. Turk J Med Sci 2013;43:470-73.
14. Proebstle TM, Gul D, Lehr HA, Kargl A and Knop J. Infrequent early recanalization of greater saphenous vein after endovenous laser treatment. J Vasc Surg 2003;38:511-