Derin Venöz Reflü Tedavisinde Hyaluran-Siyanoakrilat Kompleks Jelin Perivasküler Uygulaması

Amaç: Derin venöz yetmezlik dünya çapında popülasyonu etkileyen önemli bir sağlık sorunudur. Bu çalışmada primer derin ven yetmezliği olan hastalarda yeni bir antireflü tedavi prosedürünün etkinliğini ve güvenilirliğini değerlendirmeyi amaçladık. Yöntemler: Ekim 2016-Aralık 2018 tarihleri arasında primer derin venöz yetmezliği olan 81 hastaya perivenöz sert jel enjeksiyonundan oluşan 81 venöz valvüler kaçak operasyonu uygulandı. Hastaların klinik semptomları CEAP klinik sınıflamasına göre C3-C6 arasındaydı. Sadece bir derin venöz kapakla ilişkili venöz yetmezlik Doppler ultrasonografi ile doğrulandı. Hastalar 3. gün, 1., 6. ve 12. aylarda yapılan kontrollerde fizik muayene ve ultrasonografi ile değerlendirildi. Tedavi edilen kapak seviyesinde reflü olmaması işlemin başarısı olarak tanımlandı. 0,5 saniye veya daha uzun süren herhangi bir reflü, başarısızlık olarak kabul edildi. Bulgular: Hastaların yaşları 32 ile 78 arasında değişiyordu. Hastaların tamamında derin ven yetmezliği vardı. Takip tüm hastalarda sağlanabildi. Uygulanan jelin ortalama hacmi 2,4±0,9 ml idi. Ortalama işlem süresi 22,3±8,9 (dağılım 14-42) dakikaydı. Hastaların tamamında işlem başarıyla uygulandı ve perioperatif olarak ve takibin 3. gününde reflünün ortadan kalkması ile doğrulandı. Altıncı ay kontrolünde, reflü olmaksızın tedavi sonrası aynı damar çapı ile birinci ay kontrolü ile aynı bulgular saptandı. Tedavi, herhangi bir önemli morbidite veya mortalite ile ilişkili değildi. VCSS, işlem öncesi ve 12. ay VCSS karşılaştırıldığında sırasıyla 21,8 ± 4,8 ve 3,8±0,7 olarak anlamlı olarak azaldı (p<0,001). Sonuçlar: Venöz yetmezliğin yeni sert jel hyaluronik asit ve n-bütil-siyanoakrilat enjeksiyonları ile tedavisi güvenli, etkili ve uygulanabilir görünmektedir ve erken ve orta vadeli takip sonuçları ile doğrulanmıştır.

Anahtar Kelimeler:

Venöz yetmezlik, Femoral ven, Venöz kapaklar, Alt ekstremite, N-bütil-siyanoakrilat, Venous insufficiency, Femoral vein, Venous valves, Lower extremity, N-butyl-cyanoacrylate

Perivascular Administration of Hyaluran-Cyanoacrylate Complex Gel for Deep Venous Reflux

Objective: Deep venous insufficiency is an important health issue affecting the population worldwide. In this study we aimed to assess the effectiveness and safety of a novel antireflux treatment procedure in patients with primary deep vein insufficiency. Methods: Between October 2016 and December 2018, 81 valvular leak operations consisting of perivenous hard gel injection were performed in 81 patients with primary deep venous insufficiency. The clinical symptoms of the patients were between C3-C6 according to the CEAP clinical classification. Venous insufficiency associated with only one deep venous valve was verified with Doppler ultrasonography. Patients were assessed with physical and ultrasound examination on the follow-up visits, which were achieved on the third day and at the first, sixth, and twelfth months. The nonexistence of reflux in the treated valve level was defined as the success of the procedure. Any reflux, which lasted 0.5 seconds or more, was regarded as a lack of success. Results: The ages of the patients ranged between 32 and 78. All the patients had deep venous insufficiency. The follow-up could be achieved in all the patients. The mean volume of the gel administered was 2.4±0.9 ml. The mean procedure duration was 22.3±8.9 (range 14–42) minutes. The procedures could be performed successfully in all of the patients confirmed perioperatively and on the third day of follow-up with the elimination of reflux. The sixth-month follow-up, with the same vein diameter after the treatment without any reflux, revealed the same findings as to the first-month follow-up. The treatment was not associated with any significant morbidity or mortality. The VCSS decreased significantly when preprocedural and twelfth-month VCSS were compared as 21.8 ± 4.8 and 3.8±0.7, respectively (p<0.001). Conclusions: Treatment of venous insufficiency with the novel hard gel injections of hyaluronic acid and n-butyl-cyanoacrylate seems safe, effective, and feasible confirmed with early and midterm follow up results.

Keywords:

Venous insufficiency, Femoral vein, Venous valves, Lower extremity, N-butyl-cyanoacrylate,

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