Alt Ekstremite Venöz Yetmezlik tedavisinde n-butil siyanoakrilat embolizasyonu: Tek merkez kısa ve orta dönem retrospektif sonuçlarımız

Yıl 2021, Cilt: 8 Sayı: 4, 665 - 672, 31.12.2021

Mehmet Okan Donbaloğlu

https://doi.org/10.34087/cbusbed.910797

Öz

Giriş ve Amaç: Bu çalışma, siyanoakrilat embolizasyonunun etkinliğini değerlendirmeyi ve büyük safenöz ven yetmezliğini tedavi etmek için siyanoakrilat embolizasyon işlemlerinin kısa ve orta vadeli sonuçlarını analiz etmeyi amaçlamaktadır.
Gereç ve Yöntemler: Büyük safenöz venin ciddi yetersizliği nedeniyle siyanoakrilat embolizasyonu ile tedavi edilen 582 hasta çalışmaya dahil edildi ve geriye dönük olarak analiz edildi. Hastalar ameliyat sonrası birinci ay, altıncı ay, birinci yıl ve ikinci yılda klinik olarak değerlendirildi. Tedavi edilen uzuvlar ayrı ayrı değerlendirildi ve kaydedildi.
Bulgular: Postoperatif dönemde reflü 2 (% 0.3) hastada 12. ayda 0.5 sn, 24. ayda 2 (% 0.3) hastada 1 sn düzeyinde değerlendirildi. Hastalar ağrı, yanma, yorgunluk, kaşıntı gibi minör komplikasyonların 12. ayda% 98.8 oranında iyileştiğini belirtmişlerdir. Önemli bir komplikasyon olan derin ven trombozu, 12. ayda 1 (% 0.2) hastada görüldü. Preoperatif olarak belgelenen ortalama venöz klinik şiddet skoru 8.86 ± 1.59'dan 0.88 ± 0.61'e (p <0.05) ve ağrı skalası skoru 7.93 ± 0.75'ten 0.73 ± 0.73'e anlamlı olarak azaldı (p <0.05).
Sonuç: Yüksek oklüzyon oranları, çok az komplikasyon ve yüksek hasta konforu sağlamanın yanı sıra kozmetik sonuçlar açısından da başarılı bir uygulama olması nedeniyle büyük safen ven yetmezliğinin tedavisinde uygun endikasyonda güvenle kullanılabileceği düşünülmektedir.

Anahtar Kelimeler

venöz yetmezlik, siyanoakrilat, endovenöz tedavi

Destekleyen Kurum

bitlis devlet hastanesi

Teşekkür

Bitlis devlet hastanesi halk sağlığı daire başkanlığına ve namık kemal uygulama ve araştırma hastanesi kalp ve damar cerrahisi anabilim dalına teşekkür ediyorum.

Investigation of the Efficacy of the Use of Cyanoacrylate in the Treatment of Venous Insufficiency: Single Center Short and Mid-Term Retrospective Results

Öz

Objective: The present study aimed to evaluate the efficacy of cyanoacrylate embolization and to analyze the short- to mid-term results of cyanoacrylate embolization procedures to treat great saphenous vein insufficiency.
Materials and Methods: 582 patients treated with cyanoacrylate embolization due to severe incompetence of the great saphenous vein were included in the study and analyzed retrospectively. Patients were evaluated clinically on the first month, sixth month, first year and second year after the operation. The treated limbs were evaluated and recorded separately.
Results: In the postoperative period, reflux was assessed at the level of 0.5 sec in 2 (0.3%) patients in the 12th month, and 1 sec in 2 (0.3%) patients in the 24th month. The patients stated that minor complications such as pain, burning, fatigue, itching 98.8% healing in the 12th month. Deep vein thrombosis, which is a major complication, was seen in 1(0.2%) patient at the 12th month. Preoperatively documented mean venous clinical severity score from 8.86±1.59 to 0.88±0.61 (p < 0.05), and pain scale score significantly reduced from 7.93±0.75 to 0.73±0.73 (p < 0.05).
Conclusion: It is believed that it can be used safely in the appropriate indication for the treatment of great saphenous vein insufficiency as it is a successful application in terms of cosmetic results as well as providing high occlusion rates, very few complications, and high patient comfort.

Anahtar Kelimeler

Cyanoacrylate embolization, Endovenous therapy, Great saphenous vein

Kaynakça

• Gulati, O.P, Pycnogenol, A nutraceutical for venous health, Biomedical Review, 2008, 19, 33-43.
• Bergan, J.J, Schmid-Schönbein, G.W, Smith, P.D, et al., Chronic venous disease. The New England Jornal of Medicine 2006, 355(5), 488-98.
• Callam, M.J, Epidemiology of varicose veins, British Journal of Surgery, 1994, 81, 167-73.
• Decousus, H, Epinat, M, Guillot, K, et al., Superficial vein thrombosis: risk factors, diagnosis, and treatment, Current Opinion in Pulmonary Medicine, 2003, 393-397.
• Verlato, F, Zucchetta, P, Prandoni, P, et al., An unexpectedly high rate of pulmonary embolism in patients with superficial thrombophlebitis of the thigh, Journal of Vascular Surgery, 1999, 30, 1113-1115.
• Puggioni, A, Kalra, M, Carmo, M, et al., Endovenous laser therapy and radiofrequency ablation of the great saphenous vein: analysis of early efficacy and complications, Journal of Vascular Surgery, 2005, 42, 488- 93.
• Santler, B, Goerge, T, Chronic venous insufficiency - a review of pathophysiology, diagnosis, and treatment, Journal der Deutschen Dermatologischen Gesellschaft, 2017, 15, 538-56.
• Montanaro, L, Arciola, C.R, Cenni, E, et al., Cytotoxicity, blood compatibility and antimicrobial activity of two cyanoacrylate glues for surgical use, Biomaterials, 2001, 22, 59-66.
• Pursifulla, N.F, Moreyb, A.F, Tissue glues and nonsuturing techniques, Current Opinion in Urology, 2007, 17, 396-401.
• Pascual, G, Sotomayor, S, Rodríguez, M, et al., Cytotoxicity of cyanoacrylate-based tissue adhesives and short-term preclinical in vivo biocompatibility in abdominal hernia repair, PLoS One, 2016, 11, e0157920.
• Padberg, F.T Jr, CEAP classification for chronic venous disease, Disease-a- Month, 2005, 51, 176-82.
• Gloviczki, P, Yao, J.S.T, (ed), Handbook of venous disorders,2nd edition, Arnold publishers. 2001.
• Garratt, A.M, Macdonald, L.M, Ruta, D.A, et al., Towards measurement of outcome for patients with varicose veins, Qual Health Care, 1993, 2, 5e10.
• Brown, K, Moore, C.J, Update on the Treatment of Saphenous Reflux: Laser, RFA, or Foam?, Perspectives Vascular Surgery and Endovascular Therapy, 2009, December, 16.
• Van den Bos, R, Arends, L, Kockaert, M, et al., Endovenous therapies of lower extremity varicosities: a meta-analysis, Journal of Vascular Surgery 2009, 49, 230.
• Carroll, C, Hummel, S, Leaviss, J, et al., Systematic review, network metaanalysis and exploratory cost-effectiveness model of randomized trials of minimally invasive techniques versus surgery for varicose veins, British Jornal of Surgery, 2014, 101, 1040-52.
• Uncu, H, Ocak, F.T, Karaca, S, et al., Variköz ven cerrahisinde 980 nm dalga boyu endovenöz lazer ablasyon ve radyofrekans ablasyonun orta dönem sonuçlarının karşılaştırılması, Türk Gögüs Kalp Damar Cerrahisi Dergisi, 2015, 23, 678-82.
• Morrison, N, Gibson, K, McEnroe, S, et al., Randomized trial comparing cyanoacrylate embolisation and radiofrequency ablation for incompetent great saphenous veins (VeClose), Journal of Vascular Surgery, 2015, 61, 985–94.
• Bozkurt, A.K, Yılmaz, M.F, A prospective comparison of a new cyanoacrylate glue and laser ablation for the treatment of venous insufficiency, Phlebology, 2016, 31(1 Suppl), 106-113.
• Agus, G.B, Mancını, S, Magı, G, et al., The first 1000 cases of Italian Endovenous-laser Working Group (IEWG), Rationale, and long-term outcomes for the 1999-2003 period, International Angiology, 2006, 25, 209-215.
• Ravi R, Rodriguez–Lopez JA, et al., Endovenous ablation of incompetent saphenous veins: a large single-center experience, Journal of Endovascular Therapy, 2006, 13, 244-248.
• Sharıf, M.A, Soong, C.V, Lau, L.L, et al., Endovenous laser treatment for long saphenous vein incompetence, British Journal of Surgery, 2006, 93, 831-835.
• Çalık, E.S, Arslan, Ü, Ayaz, F, et al., N-butyl cyanoacrylate in the treatment of venous insufficiency--the effect of embolisation with ablative polymerisation, Vasa European Jornal of Vascular Medicine, 2016, 45, 241-6.
• Ovalı, C, Treatment of saphenous vein insufficiency with n-butyl cyanoacrylate embolization: one center experience, Cukurova Medical Journal, 2018, 43(4), 886-891.
• Şenol, S, Türker, F.S, Temiztürk, Z, Azboy, D, Endovenous ablation technique using N-butyl cyanoacrylate in varicose veins, Damar Cerrahisi Dergisi, 2018, 27, 61-64.