Erkan İRİZ, Levent OKTAR, Emrah EREREN, Velit HALİT, Suna OKTAR, Mustafa İLHAN

Perforan venöz yetmezlikte miniflebektomi ile ligasyon

Amaç: Yüzeyel varis gelişiminde ve ilerlemesinde perforan ven yetmezliği önemli bir faktördür. Bu çalışmada miniflebektomi ile perforan ven ligasyonunun orta dönem sonuçları değerlendirildi.Çalışma planı: Çalışmaya varis nedeniyle miniflebektomi ile perforan ven ligasyonu uygulanan 29 hasta (15 erkek, 14 kadın; ort. yaş 39±11) alındı. CEAP sınıflamasına göre iki hastada sınıf 2, üç hastada sınıf 3, 21 hastada sınıf 4, üç hastada sınıf 5 venöz yetmezlik vardı. Ligasyon uygulanacak perforan venler ameliyat günü venöz Doppler ultrasonografi (USG) ile işaretlendi. On hastaya lokal anestezi, 19'una spinal anestezi uygulandı. Lokal anestezi uygulanan dokuz hastada ciddi safen yetmezliği olmaması nedeniyle sadece miniflebektomi ve Cockett I-II-III perforan ligasyonları yapıldı. Diğer tüm hastalara, ciddi yetmezlik nedeniyle safena magna venine stripping safenektomi de uygulandı. Ortalama takip süresi 18.7±16.5 ay idi.Bulgular: Toplam 76 adet perforan vene ligasyon uygulandı. Bunların 26'sı (%34.2) Cockett I, 24'ü (%31.6) Cockett II, 22'si (%29) Cockett III perforan venlerine, dördü (%5.3) de Boyd perforan venine uygulandı. On iki hastada insizyon yerlerinde hiperpigmentasyon gözlendi. Yirmi altı hastanın (%89.7) klinik şikayetlerinde belirgin düzelme sağlandı. Derin ven yetmezliği de olan üç hastada ağrı yakınması ameliyat sonrası dönemde de devam etti. Takip döneminde hiçbir hastada yeni yüzeyel varis gelişimi gözlenmedi; ayrıca, 14 hastada var olan dizaltı kronik venöz yetmezlik tablosunda düzelme izlendi. Ameliyat sonrası dönemde tüm hastalara kompresyon çorabı önerilmesine rağmen, takip süresince sadece 14 hastanın (%48.3) varis çorabını düzenli olarak kullandığı öğrenildi.Sonuç: Günümüzde venöz yetmezlik nedeniyle perforan ven ligasyonu uygulanan hastalarda yaygın olarak subfasiyal endoskopik perforan ven cerrahisi kullanılmaktadır. Daha ucuz ve uygulanması kolay olan miniflebektomi ile perforan ven ligasyonunun seçilmiş olgularda güvenli ve etkili bir yöntem olduğunu düşünüyoruz.

Ligation with mini-phlebectomy in perforating vein insufficiency

Background: Perforating vein insufficiency is an important factor for the development and progression of varicose veins. The aim of this study was to evaluate the mid-term results of perforating vein ligation with mini-phlebectomy.Methods: Twenty-nine patients (15 males, 14 females; mean age 39±11 years) underwent perforating vein ligation with mini-phlebectomy for varicose veins. According to the CEAP classification, 2, 3, 21, and 3 patients had class 2, 3, 4, and 5 venous disease, respectively. The incompetent perforating veins were marked with Doppler ultrasonography on the day of operation. Operations were performed under local and spinal anesthesia in 10 patients and 19 patients, respectively. Nine patients underwent only mini-phlebectomy and Cockett I-II-III perforating vein ligations under local anesthesia, while the remaining patients also underwent great saphenous vein stripping for severe venous insufficiency. The mean follow-up period was 18.7±16.5 months.Results: A total of 76 perforating veins were ligated, including 26 (34.2%) Cockett I, 24 (31.6%) Cockett II, 22 (29%) Cockett III perforating veins, and four (5.3%) Boyd's perforating veins. Hyperpigmentation at the incision sites was seen in 12 patients. Clinical complaints of 26 patients (89.7%) improved significantly. Three patients with deep venous insufficiency complained of pain in the postoperative period. None of the patients developed varicose vein recurrences, and pre-existing chronic venous insufficiency affecting below the knee improved in 14 patients. Although the use of compression stockings was recommended to all the patients in the postoperative period, only 14 patients (48.3%) reported regular use.Conclusion: Even though subfascial endoscopic perforator vein surgery is widely used for perforating vein ligation in patients with varicose veins due to venous insufficiency, perforating vein ligation with mini-phlebectomy can be a good alternative in selected cases because it is cheaper, easier, safe, and effective.

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