Kronik venöz yetmezlik ve güncel tedavi seçenekleri

Kronik venöz yetmezlik (KVY) hem kozmetik sebepler hem de komplikasyonları nedeniyle yaşam kalitesini düşüren epidemiyolojik ve sosyoekonomik sonuçlarıyla önemli bir sağlık sorunudur. Konservatif tedavi ile semptomları azaltmak/kontrol altında tutmak ve komplikasyonları önlemek hedeflenirken, girişimsel tedavinin hedefi minimum komplikasyonla, venöz hipertansiyon kaynağının yok edilmesi, tüm varikozitlerin eksize edilmesi, tatminkar bir kozmetik sonuç sağlamaktır. KVY tedavisi için klasik tedavi yöntemlerinin yanı sıra perkütan uygulamalar da yaygınlaşmaya devam etmektedir. Endovenöz lazer ablasyon tedavisi, radyofrekans ablasyon tedavisi, buhar balsyon tedavisi, siyanoakrilat ile ablasyon tedavisi ve sklerozan madde ile ablasyon bu güncel yöntemlerin en bilinenlerindendir. Daha az invaziv olan bu yöntemler daha erken taburculuk ve daha konforlu bir tedavi süreci sunmaktadır. Ancak teknik açıdan yeni zorluklar ve yüksek maliyetler bu güncel seçeneklerin rutin bir uygulama olmasını engellemektedir. Öte yandan nüks ve başarılı sonuç anlamında kısa ve orta dönem sonuçları literatürde açık cerrahiye benzer olarak bildirilmeye başlamış olsa da henüz uzun dönem sonuçları için net veriler yoktur. Sonuçta, KVY için altın standart hala klasik açık cerrahi teknik olsa da yakın gelecekte değişik perkütan yöntemlerin ağırlık kazanacağı muhtemeldir.

Anahtar Kelimeler:

Kronik venöz yetmezlik, skleroterapi, endovenöz lazer tedavisi, radyofrekans ablasyon, siyanoakrilat

Chronic venous insufficiency and current treatment options

Chronic venous insufficiency (CVI) is an important health problem due to both epidemiological and socioeconomic outcomes that decrease the quality of life due to both cosmetic reasons and complications. When aiming to reduce / control symptoms and prevent complications with conservative treatment, the goal of interventional treatment is to achieve a satisfactory cosmetic result with minimal complications, elimination of venous hypertension, excision of all varicosities. In addition to classical treatment methods percutaneous applications comes to be widespread. Endovenous laser ablation therapy, radiofrequency ablation therapy, steam ablation therapy, cyanoacrylate ablation therapy and sclerosing agent ablation are the best known of these current methods. These less invasive methods offer earlier discharge and more comfortable treatment. However, new technical challenges and high costs are the major problem of these new generation methods. On the other hand, short and mid-term results in terms of recurrence and successful outcome have been reported in the literature as similar to open surgery, but there is no clear data for long-term results yet. In conclusion, although the gold standard for CVI is still a classic open surgical technique it is likely that different percutaneous methods will be more popular in the near future.

Keywords:

Chronic venous insufficiency, sclerotherapy, endovenous laser therapy, radiofrequency ablation, cyanoacrylate,

PDF

___

1. Yung-Feng Lo, Chih-Hsun Yang. Stripping And Ligation Of The Saphenous Vein. Semin Cutan Med Surg 2005;24:200-8.
2. Nicolaidesan, Allegra C, Bergan J, Bradbury A, Cairols M, Carpantier P And Et Al. Management Of Chronic Venous Disorders Of The Lower Limbs: Guidlines According To Scientific Evi-Dence. Int Angiol 2008;27:1–59.
3. Beaglehole R, Prior Ia, Salmond Ce, Davidson F. Varicose Veins İn The Southpacific Int J Epidemiol 1975; 4:295–299.
4. Scott Te, Lamorte Ww, Gorin Dr, Menzoian Jo. Risk Factors For Chronic Venous İnsufficiency: A Dual Case-Control Study. J Vasc Surg 1995;22:622–8.
5. Petitti DB, Wingerd J, Pellegrin F, Ramcharan S. Oral Contraceptives, Smoking and Other Factors In Relation To Risk Of Venous Thromboembolic Disease. Am J Epidemiol 1978; 480-5.
6. Allegra C, Antignani Pl, Carlizza A. Recurrent Varicose Veins Following Surgical Treatment: Our Experience With Five Years Follow-Up. Eur J Vasc Endovasc Surg 2007;33:751-6.
7. Fowkes Fg, Evans Cj, Lee Aj. Prevalence And Risk Factors For Chronic Venous İnsufficiency. Angiology 2001; 52: S5–S15.
8. Gloviczki P, Rhodes Jm. Management Of Perforating Vein İncompetence. In: Rutherford Rb, Editor. Rutherford’s Textbook On Vascular Surgery. 5th Ed. Philadelphia: W. B. Saunders; 2000. P. 2021-36.
9. Padberg F. The Physiology And Hemodynamics Of The Normal Venous Circulation.In Gloviczki P, Yao Js, Eds. Handbook Of Ve-Nous Disorders. 2nd Ed. New York, Ny: Arnold; 2001: 25–35.
10. Kaira M, Gloviczki P. Endoscopic subfascial ligation of perforating veins. In: Ascher E, Hollier LH, Strandness DE Jr, Towne JB, Calligaro K, Kent KC, et al., editors. Haimovici’s vascular surgery. 5th ed. New York: Wiley-Blackwell; 2003. p. 1115-29.
11. Turkish Association of Cardiovascular Surgery Peripheral Artery and Venous Disease Treatment Guide. (Türk Kalp Damar Cerrahisi Derneği Periferik Arter ve Ven Hastalıklari Tedavi Kılavuzu). Ankara: Öncü Basımevi 2008:97–123.
12. Pappas PJ, Duran WN, Hobson RW. Pathology and cellular physiology of chronic venous insufficiency.In Gloviczki P, Yao JS, eds. Handbook of Venous Disorders. 2nd ed. New York, NY: Arnold; 2001: 58–67.
13. Chiesa R, Marone EM, Limoni C, Volontè M, Petrini O. Chronic venous disorders: correlation between visible signs, symptoms and presence of functional disease. J Vasc Surg 2007; 46:322.
14. Shami SK, Sarin S, Cheatle TR, et al. Venous ulcers and the süperfisyal venous system. J Vasc Surg 1993; 17: 87-490.
15. Marston WA. PPG, APG, duplex: which noninvasive tests are most appropriate for the management of patients with chronic venous insufficiency? Semin Vasc Surg 2002; 15: 13–20.
16. Porter JM, Moneta GL. Reporting standards in venous disease: an update. International Consensus Committee on Chronic Venous Disease. J Vasc Surg 1995; 21: 635–45.
17. Köksal C, Alsalehi S, Kocamaz Ö, Sunar H. Treatment of Chronic Venous Insufficiency (Kronik venöz yetmezlik tedavisi). Kosuyolu Heart J 2010; 13:28–33.
18. Motykie GD, Caprini JA, Arcelus JI, Reyna JJ, Overom E, Mokhtee D. Evaluation of therapeutic compression stockings in the treatment of chronic venous insufficiency. Dermatol Surg 1999; 25: 116–20.
19. Karlsmark T, Agerslev RH, Bendz SH, Larsen JR, Roed-Pe-tersen J, Andersen KE. Clinical performance of a new silver dressing, Contreet Foam, for chronic exuding venous leg ulcers. J Wound Care. 2003;12: 351–54.
20. Mayberry JC, Moneta GL, Taylor LM, Porter JM. Fifteen year results of ambulatory compression therapy for chronic venous ulcers. Surgery. 1991; 109: 575–81.
21. Margolis DJ, Bilker W, Santanna J, Baumgarten M. Venous leg ulcer: incidence and prevalence in the elderly. J Am Acad Dermatol 2002; 46:381–386.
22. Bergan JJ. Varicose veins, treatment by surgery and sclerotherapy. Rutherford. RB. Vascular surgery 2000;2007-2020.
23. Bergan JJ. Varicose veins: treatment by intervention including sclerotherapy. In: Rutherford RB. Vascular Surgery. Sixth edition, volume two. Philadelphia: WB Saunders Co; 2005; Section 21;157: 2251-67.
24. Garen G,Yellin AE, Primary varicose veins Topographic and hemodynamic correlations. J Cardiovasc Surg 1990:31;672-9.
25. Lapropoulos N, Touloupulos E, GiannoulesAD et al. Recur-rent varicose veins; investigations of the pattern and extent of ref-lux with color-şow duplex scanning. Surgery 1996:119;406-10.9.
26. Recek C . Saphenofemoral junction ligation supplemented by postoperative sclerotherapy: a review of long term clinical and hemodynamic results. Vasc Endovasc Surg 2004;38:533-40.
27. Sarin S, Scurr JH, Coleridge Smith PD. Stripping of the long saphenous vein in the treatment of primary varicose veins. Br J Surg 1994; 81: 1455–8.
28. Padberg FT Jr, Pappas PJ, Araki CT, Back TL, Hobson RW. Hemodynamic and clinical improvement after superficial vein ablation in primary combined insufficiency with ulceration. J Vasc Surg 1996; 24: 711–8.
29. MacKenzie RK, Allan PL, Ruckley CV, Bradbury AW. The effect of long saphenous vein stripping on deep venous reşux. Eur J Vasc Endovasc Surg 2004; 28: 104–7.
30. MC Mullin GM, Coloridge Smith P, Scurr JH: Objective as-sesment of high ligation without stripping the long saphenous vein, Br J Surg 1991;78:1139-42.
31. Oğuzkurt L. Endovenous laser ablation for the treatment of varicose veins. Diagn Interv Radiol 2012; 18:417–422.
32. Morrison N. Laser treatment of the incompetent sapheno-us vein. In: Gloviczki P, Dalsing MC, Eklöf B, Moneta GL, Wake-field TW (eds). Handbook of Venous Disorder. Third edition. American Venous Forum. London: Edward Arnold; 2009;37:418-28.
33. Pannier F, Rabe E. Endovenous laser therapy and radiofrequency ablation of saphenous varicose veins. J Cardiovasc Surg 2006;47:3–8.
34. Van den Bos RR, Kockaert MA, Neumann HA, Nijsten T. Technical review of endovenous laser therapy for varicose veins. Eur J Vasc Endovasc Surg 2008; 35:88– 95.
35. Kabnick LS. Outcome of different endovenous laser wavelengths for great saphenous vein ablation. J Vasc Surg 2006; 43:88–93.
36. Merchant RF and Kistner RL. Radiofrequency treatment of the incompetent saphenous vein. In: Gloviczki P, Dalsing MC, Eklöf B, Moneta GL, Wakefield TW. Handbook of Venous Disorder. Third edition. American Venous Forum. London: Ed-ward Arnold; 2009;36:409-17.
37. Durukan AB. What is popular may no longer be popular: Cyanoacrylate and other alternatives in surgical treatment of chronic venous insufficiency. Turkish Journal of Thoracic and Cardiovascular Surgery 2017;159-163.
38. Parsi K, Exner T, Connor D E, Ma D D, Joseph JE. In vitro effects of detergent sclerosants on coagulation, platelets and microparticles. Eur J Vasc Endovasc Surg 2007; 34:731–740.
39. Carlin MC, Ratz JL. Treatment of telengiectasias,comparison of sclerosing agents. J.Dermatol. Surg Oncol. 1987:13;1181.
40. Yasim A, Eroglu E, Bozoglan O, Mese B, Acipayam M, Kara H. A new non-tumescent endovenous ablation method for varicose vein treatment: Early results of N-butyl cyanoacrylate (VariClose®). Phlebology, 2016; 0268355516638577.
41. Koramaz İ, Kılıç H, Gökalp F, Bitargil M, Bektaş N, Engin E, Bozkurt AK. Ablation of the great saphenous vein with nontumescent n-butyl cyanoacrylate versus endovenous laser therapy. J Vasc Surg Venous and Lymphatic Disorders 2017.
42. Gale SS, Lee JN, Walsh ME, Wojnarowski DL, Comerota AJ. A randomized, controlled trial of endovenous thermal ablation using the 810-nm wavelength laser and the ClosurePLUS radiofrequency ablation methods for superficial venous insufficiency of the great saphenous vein. J Vasc Surg 2010; 52: 645-50.
43. 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.
44. Brown KR, Rossi PJ. Superficial venous disease. Surg Clin North Am 2013; 93: 963-82. Gloviczki P, Gloviczki ML. Guidelines for the management of varicose veins. Phlebology 2012; 27: 2-9.
45. Min RJ, Khilnani N, Zimmet SE. Endovenous laser treatment of saphenous vein reflux: long term results. J Vasc Interv Radiol 2003; 14: 991-6.
46. Mundy L, Merlin TL, Fitridge RA, Hiller JE. Systematic review of endovenous laser treatment for varicose veins. Brit J Surg 2005;92, 1189-1194.
47. Timperman PE. Prospective evaluation of higher energy great saphenous vein endovenous laser treatment. J Vasc Interv Radiol. 2005; 16: 791-794.
48. Proebstle TM, Herdemann S. Early results and feasibility of incompetent perforator vein ablation by endovenous laser treatment. Dermatol Surg 2007;33:162–8
49. Yamaki T, Nozaki M, Iwasaka S. Comparative study of duplex-guided foam sclerotherapy and duplex-guided liquid sclerotherapy for the treatment of superficial venous insufficiency. Dermatol Surg 2004; 30:718–722.
50. Tessari L, Cavezzi A, Frullini A. Preliminary Experience with a New Sclerosing Foam in the Treatment of Varicose Veins. Dermatol Surg 2001; 27: 58-60.
51. Yin H, He H, Wang M, Li Z, Hu Z, Yao C, Chang G. Prospective Randomized Study of Ultrasound-Guided Foam Sclerotherapy Combined with Great Saphenous Vein High Ligation in the Treatment of Severe Lower Extremity Varicosis. Ann Vasc Surg 2017; 39, 256-263.