Perforan Ven Yetmezliğinde; Küçük Kesi ile Ligasyon, Lazer Ablasyon ve Siyanoakrilat ile Embolizasyon Tekniklerinin Karşılaştırılması

Abstract

Amaç: Bu çalışma inkompetan perforan ven tedavisinin üç ana yönteminin erken ve orta dönem sonuçlarını karşılaştırmak amacı ile planlanmıştır. Yöntemler: Ocak 2012 ve Ocak 2015 arasında sadece inkompetan perforan ven cerrahisi için operasyona alınmış ardışık 84 hastada uygulanmış 174 işlemin verileri retrospektif olarak analiz edilmiştir. Hastalar uygulanan yönteme göre 3 gruba ayrıldı; küçük kesi ile ligasyon 40 (%47,6), lazer ile endovenöz ablasyon 22 (%26,2), siyanoakrilat ile embolizasyon 22 (%26,2). Preoperatif, operatif ve erken dönem takip verileri kayıt edildi. Hastalar polikliniğe çağrılarak ultrason ile nüks açısından tekrar değerlendirildi. Bulgular: Operasyon süresi, küçük kesi ile ligasyon grubunda daha uzundu (p<0.001). Siyanoakrilat grubunda daha kısa süreliğine hastanede kalış (p<0.001), az analjezi ihtiyacı (p<0.001) ve erken işe dönme süresi (p<0.001) gözlendi. Ligasyon grubunda nükse rastlanmazken (p <0.001), Endovenöz lazer grubunda siyanoakrilat grubuna göre daha yüksek nüks saptanmıştır (p<0.001). Kozmetik yakınmalar (hiperpigmentasyon veya skar dokusu) küçük kesi ile ligasyon grubunda daha yüksek bulundu (p =0.003). Endovenöz lazer sonrası parestezi saptandı (p=0.001) Sonuç: Perforan ven yetmezliği tedavisinde ligasyon halen en düşük nüks oranına sahip olsa da kozmetik problemler nedeniyle yerini endovasküler yöntemlere terk etmektedir. Endovenöz ablasyon sonrası yüksek nüks oranı ve parestezi gibi komplikasyonlar siyanoakrilat ile embolizasyonu iyi bir alternatif yapmaktadır.

Keywords

• venöz yetmezlik, lazer ablasyon, tedavi amaçlı embolizasyon, ligasyon

A Comparison Of Mini-incisional Ligation, Laser Ablation And Cyanoacrylate Embolization For Incompetent Perforating Vein Closure

Abstract

Objective: Our aim was to compare the short- and the midterm results of three main methods of incompetent perforating vein treatment. Methods: Data of 174 procedures performed between January 2012 and January 2015, in a 84 consecutive patients with incompetent perforating veins were retro­spectively analyzed. Patients were divided into 3 groups according to surgical technique: mini-incisional ligation 40 (47.6%), 22 (26.2%) endovenous laser ablation and 22 (26.2%) cyanoacrylate embolization. Preoperative, op­erative and early follow up data was recorded. All patients were called to assess by ultrasonography for recurrence. Results: Operation time was significantly longer in the mini-incisional ligation group (p<0.001). Cyanoacrylate group showed significantly lower hospital stay (p<0.001), duration of analgesia (p<0.001) and disability (p<0.001). Recurrence was not found in the ligation group (p<0.001), endovenous laser group showed significantly higher re­currence than the cyanoacylate group (p<0.001). Cos­metic problems (hyperpigmentation or scar tissue) were significantly higher in the mini-incisional ligation group (p =0.003). Paresthesia was detected after endovenous la­ser (p=0.001). Conclusion: Although ligation has still lowest rate of recurrence after incompetent perforating vein surgery, it is being replaced by the endovascular procedure due to cosmetic problems. Cyanoacrylate embolization seems to be a promising alternative for incompetent perforating veins treatment due to higher recurrence and complica­tion rate after endovenous laser ablation.

Keywords

• venous insufficiency, laser ablation, therapeutic embolization, ligation

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