Olgar BAYSERKE, Deniz DÖNMEZ, Uğur FİLİZCAN

Kronik venöz yetersizlik tedavisinde lale uçlu fiber ile endovenöz lazer ablasyon

Amaç: Kronik venöz yetmezlikte KVY yeni bir yaklaşım olan lale uçlu fiber ven duvarı ile direkt teması önleyerek venöz ve perivenöz ülser ve perforasyonu engeller. Çalışmamızın amacı KVY’de lale uçlu fiberle endovenöz laser ablasyonun etkilerini göstermektir. Metod: Mart 2014 ve Haziran 2014 tarihleri arasındaki grade 4 vena safena manga reflusu olan 70 hasta çalışmaya dahil edildi ve lale fiberle endovenous laser ablasyon uygulandı. Hastalar birinci haftanın sonunda ağrı ekimoz ülser tromboflebit ve derin ven trombozu için ve altıncı ayın sonunda KVY için Doppler ultrasonografi ile kontrol edildi. Preoperatif ve postoperatif renkli Doppler ultrasonografi aynı radyolog tarafından uygulandı. Bulgular: Hastaların hiçbirinde ekimoz ülser ve enfeksiyon yoktu, bir hastada analjezik ihtiyacı olmayan ağrı bildirildi. DVT bildirilmedi. Altıncı ayın sonunda bir hastada vena safena manganın yeterince oblitere olmadığı saptandı. Sonuç: Lale uçlu fiber ile endovenöz lazer ablasyon kronik venöz yetmezlik tedavisinde güvenli ve etkin bir yöntemdir.

Anahtar Kelimeler:

endovenöz lazer ablasyon, lale fiber, kronik venöz yetmezlik

Endovenous laser ablation with tulip fibre on treatment of chronic venous disease

Aim: Tulip Fibre as a new aproach to Chronic Venous Insufficiency CVI , avoids venous and perivenous ulceration and perforation by preventing the lasers direct contact to the vein walls . The aim of our study is to show the efficiacy of the Endovenous Laser Ablation EVLA with Tulip Fibre in CVI. Methods: Between March 2012 and June 2012, 70 patients with the grade 4 vena saphena magna reflux were included to the study and Endovenous Laser Ablation with Tulip Fibre was applied. Patients were checked twice after the operation once for ecchymosis, pain , ulcer, thrombophlebitis and deep vein thrombosis DVT at the end of the first week and second at the end of the sixth month for CVI with doppler ultrasonography. Preoperative and postoperative colored doppler ultrasonography was performed by the same radiologist. Result: None of the patients had ecchymosis , ulceration and infection , in one of the patients pain without need of an analgesic was reported . DVT was not reported. In one of the patients at the end of the six months Vena Saphena Magna was reported as not obliterated enough. Conclusion: Endovenous Laser Ablation EVLA with Tulip Fiber in CVI is a safe and effective treatment method.

Keywords:

Endovenous laser ablation, tulip fibre, chronic venous insufficiency,

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Callam MJ. Epidemiology of varicose veins. Br J Surg 1994;(81):167-173.
Vuylsteke M, Van Dorpe J, Roelens J, De Bo T, Mordon S, Fourneau I.Eur J Vasc Endovasc Surg 2010;40(1):110-116.
Kambaal AA, De’Ath HD, Albon H, Watson A, Shandall A, Greenstein D. Endovenous laser ablation for persistent and recurrent venous ulcers after varicose vein surgery. Phlebology 2008;23(4):193-195.
Vulysteke M.E.,Thomis S.,Mahieu P.,Fourneau I. Endovenous laser ablation of the great saphe- nous vein using a bare fibre versus tulip fibre: A randomised clinical trial. Eur J Vas Endovasc Surg 2012;44(6):587-592.
Perkowski P, Ravi R, Gowda R, Olsen D, Ra- maiah W, Lopez JAR, et al. ENdovenous laser ablation of the saphenous vein for treatment of venous insuffiency and varicose veins. J Endovasc Ther 2004;11:132-138.
Theivacumer NS, Darwood R, Gough MJ. Ne- ovascularisation and reccurrence 2 years after varicose vein treatment for sapheno-femoral and great saphenous vein reflux: a comparison of surgery and endovenous laser ablation. Eur J Vas eNdovasc Surg 2009 Aug ;38(2):203-237
Rass K, Frings N, Glowacki P, Hamsch C, Graber S, Vogt T, et al. Comparable effectiveness of endovenous laser ablation and high ligation with stripping of the great saphenous vein. Arch Dermatol 2012;148 (1):49-58.
Lohr J, Kulwicki A. Radiofrequency ablation: evolution of a treatment. Semin VAsc Surg. 2010 Jun;23 (2):90-100.
Min RJ. Endovenous laser treatment of vari- cose vein: midterm results on 300 incompetent greater saphenous veins. J Vas Interv Radıol. 2002 ;13:563-568.
Memetoğlu ME, Kurtcan S, Erbasan O, Özel D. Endovenous ablation with a 940 nm laser fort he treatment of great saphenous vein insuf- fiency: sohrt to mid-term reults. Diagn Interv Radiol 2012 ;18:106-110.
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(1):26-30.
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 follow up after six months. Phlebo- logy 2011;26 (9):35-39.
Vulysteke M, De Bo T H, Dompe G, Di Crisci D, Abbad C M, Mordon S. Endovenous laser treatment : is there a clinical difference be- tween using a 1500 nm and a 980 nm diode laser? A multicenter randomised clinical trial. International Angiology 2011;30(4):327-334.
Prince EA, Ahn SH, Dubel GJ, Soares GM. An investigation of the relationship between energy density and endovenous laser ablation success: does energy density matter?. J Vasc Interv Radiol, 2008; 19 (10): 1449-1453 .
Thievacumar NS, Gough MJ. Arterio-venous fistula endovenous laser ablation for varicose veins. Eur J VascEndovasc Surg. 2009;38 (2) :234-236.
Ress EH, Veensalu M, Wacheck V, Tzaneva S, Kittler H, Kapiotis S, et al.Does endovenous laser ablation induce endotelial damage at the saphenofemoral junction? Dermatolodic Surgery 2011; 37(10):1456-1463.
Davidson JAH, Gillespie JA. Tracheal intubation after induction of anaesthesia with propo- fol, alfentanyl and iv lignocaine. Br J Anaesth 1993; 70:163.
Stevens JB, Wheatley LD. Tracheal ıntubation in Ambulatary Surgery Patients: Using Remifen- tanyl and Propofol without muscle relaksants. Anesth Analg 1998;86:45-49.
Klemda UM, Mennander S, Sarnivaara L. Tracheal intubation without the use of muscle relaksants. remifentanyl or alfentanyl in combi- nation with propofol. Acta Anaesthesiol Scand 2000; 44: 465-469.
Rajan S, Gotluru P, Andews S, Paul J. Evalu- ation of endotracheal intubating conditions without the use of muscle relaxants follow- ing induction with propofol and sevoflurane in pediatric cleft lip and palate surgeries. J Anaesthesiol Clin Pharmacol 2014; 30(3):360- 365.
Pang L, Zhuang YY, Dong S, Ma HC, Ma HS, Wang YF. Intubation without muscle relax- ation for suspension laryngoscopy: a rand- omized, controlled study. Niger J Clin Pract 2014;17(4):456-61.
Ledowski T, Ong JS, Flett T. Neuromuscular monitoring, muscle relaxant use, and reversal at a tertiary teaching hospital 2.5 years after introduction of sugammadex: changes in opin- ions and clinical practice. Anesthesiol Res Pract 2015;367937.