Klasik cerrahi tedavinin spinal anestezi altında varisli hastalarda venöz tromboembolizme etkisi

Öz

Amaç: Varis tedavisinde minimal invaziv yöntemler özellikle son yıllarda hızla gelişme göstermesine rağmen klasik cerrahi tedavi olan yüksek ligasyon+stripping (S/L) halen altın standart kabul edilir. Varis hastalığına bağlı bazı tromboembolik olaylar meydana gelebilmektedir. Amacımız, spinal anestezi ve S/L uygulaması olan hastalarda işlem sonrası ortalama trombosit parametrelerindeki değişiklikleri belirlemek ve bu işlemin tromboembolik olaylara etkisini araştırmaktır. Yöntemler: Bu çalışma retrospektif kohort çalışması olarak tasarlandı. Çalışmaya dahil edilen hastalar Adıyaman Üniversitesi Tıp Fakültesi Anestezi Reanimasyon polikliniğine başvuran ve spinal anestezi ile S/L yapılan hastalardan seçildi. Veriler elektronik ortamda dosya taraması şeklinde toplandı. Dosya taramasından operasyon öncesi ve 1 gün sonrası hemogram alınan hastalar çalışmaya dahil edildi. Laboratuar tetkiklerinden MPV, PLT, trombosit dağılım genişliği (PDW) ve plateletcrit (PCT) tespit edilerek kaydedildi. İstatistiksel analizler SPSS 22,0 kullanılarak yapıldı. Bulgular: Postoperatif MPV (P<0,001) ve PLT (P=0,01) değeri preoperatif döneme göre anlamlı düşüş gösterdi. PDW (P=0,194) ve PCT (P=0,863) değerlerinde postoperatif 1. gün, preoperatif döneme göre anlamlı bir değişim olmadığı görüldü. Sonuç: Spinal anestezi altında S/L uygulanan hastalarda postoperatif MPV değerinde anlamlı bir düşüş gözlenmesi, varis hastalığının ve MPV ün tromboembolik olaylarla ilişkili olduğu varsayılırsa uygulanan cerrahi tromboembolik olayları azaltır.

Anahtar Kelimeler

• Mean platelet volüm
• Tromboembolizm
• Stripping ve ligasyon
• Spinal anestezi

Effect of classical surgical treatment under spinal anesthesia on venous thromboembolism in varicose veins patients

Abstract

Aim: Although minimally invasive methods have developed rapidly in the treatment of varicose veins in recent years, high ligation + stripping (S/L), which is the classical surgical treatment, is still considered gold standard. Some thromboembolic events may occur due to varicose disease. Our aim is to determine the changes in mean platelet parameters after the procedure in patients who underwent S/L with spinal anesthesia and investigate the effect of this procedure on thromboembolic events. Methods: Patients who visited the Anesthesia Reanimation outpatient clinic of Adiyaman University Faculty of Medicine and underwent S/L with spinal anesthesia were evaluated in this retrospective cohort study. Data was collected electronically with file scanning. Patients whose hemograms were obtained before and 1 day after the operation were included. Among the laboratory tests, MPV, PLT, platelet distribution width (PDW) and plateletcrit (PCT) were noted. Results: Postoperative MPV (P<0,001) and PLT (P=0.01) values showed a significant decrease compared to the preoperative period, while PDW (P=0.194) and PCT (P=0.863) values remained similar. Conclusion: If it is assumed that varicose veins and MPV are associated with thromboembolic events, a significant decrease in postoperative MPV value in patients who underwent S / L with spinal anesthesia will reduce thromboembolic events.

Keywords

• Mean platelet volume
• Thromboembolism
• Stripping and ligation
• Spinal anesthesia

References

1. 1. Callam MJ. Epidemiology of varicose veins. Br J Surg. 1994 Feb;81(2):167-73. doi: 10.1002/bjs.1800810204. PMID: 8156326.
2. 2. Güven C, Haydar AB. Comparison of stripping/ligation and embolization with cyanoacrylate in venous insufficiency treatment. J Surg Med. 2020;4(5):400-5.
3. 3. Youn YJ, Lee J. Chronic venous insufficiency and varicose veins of the lower extremities. Korean J Intern Med. 2019 Mar;34(2):269-83. doi: 10.3904/kjim.2018.230. Epub 2018 Oct 26. PMID: 30360023; PMCID: PMC6406103.
4. 4. Güven C. Use of Cyanoacrylate in Venous Insufficiency and Varise Treatement and its Results. FÜ Sağ Bil Tıp Derg. 2020;34 (1):07-11.
5. 5. Cosmi B. Management of superficial vein thrombosis. J Thromb Haemost. 2015 Jul;13(7):1175-83. doi: 10.1111/jth.12986. Epub 2015 May 25. PMID: 25903684.
6. 6. Davì G, Patrono C. Platelet activation and atherothrombosis. N Engl J Med. 2007 Dec 13;357(24):2482-94. doi: 10.1056/NEJMra071014. PMID: 18077812.7.
7. 7. Koza K, Grzelązka P, Trofimiuk A, Suppan K, Wasielewski M, Wiśniewska J, et al. Clinical risk factors for loss of stent primary patency in patients with chronic legs ischemia. Adv Clin Exp Med. 2017 Mar-Apr;26(2):311-8. doi: 10.17219/acem/58997. PMID: 28791851.
8. 8. Rao AK, Goldberg RE, Walsh PN. Platelet coagulant activities in diabetes mellitus. Evidence for relationship between platelet coagulant hyperactivity and platelet volume. J Lab Clin Med. 1984 Jan;103(1):82-92. PMID: 6690642.9.

9. 9. Memetoglu ME, Kurtcan S, Kalkan A, Özel D. Combination technique of tumescent anesthesia during endovenous laser therapy of saphenous vein insufficiency. Interact Cardiovasc Thorac Surg. 2010 Dec;11(6):774-7. doi: 10.1510/icvts.2010.240762. Epub 2010 Sep 16. PMID: 20847066.
10. 10. Bar-Or D, Lau E, Winkler JV. A novel assay for cobalt-albumin binding and its potential as a marker for myocardial ischemia-a preliminary report. J Emerg Med. 2000 Nov;19(4):311-5. doi: 10.1016/s0736-4679(00)00255-9. PMID: 11074321.
11. 11. Demirel CB, Kalayci M, Ozkocak I, Altunkaya H, Ozer Y, Acikgoz B. A prospective randomized study comparing perioperative outcome variables after epidural or general anesthesia for lumbar disc surgery. J Neurosurg Anesthesiol. 2003 Jul;15(3):185-92. doi: 10.1097/00008506-200307000-00005. PMID: 12826965.
12. 12. Özyaprak B, Anarat K, Erkan G, Kahraman N, Retrospective evaluation of anesthesia methods applied in varicose surgery in our clinic. 6th Rize Thematic Anesthesia Symposium E-booklet. 2019:22-27.
13. 13. Demirel CB, Kalayci M, Ozkocak I, Altunkaya H, Ozer Y, Acikgoz B. A prospective randomized study comparing perioperative outcome variables after epidural or general anesthesia for lumbar disc surgery. J Neurosurg Anesthesiol. 2003 Jul;15(3):185-92. doi: 10.1097/00008506-200307000-00005. PMID: 12826965.
14. 14. Lee SH, Kim WH. Superficial Vein Thrombosis and Severe Varicose Veins Complicating Venous Thromboembolism. J Cardiovasc Imaging. 2019 Apr;27(2):154-5. doi: 10.4250/jcvi.2019.27.e14. PMID: 30993952; PMCID: PMC6470065..
15. 15. Wu NC, Chen ZC, Feng IJ, Ho CH, Chiang CY, Wang et al.,Severe varicose veins and the risk of mortality: a nationwide population-based cohort study. BMJ Open. 2020 Jun 21;10(6):e034245. doi: 10.1136/bmjopen-2019-034245. PMID: 32565451; PMCID: PMC7311034.
16. 16. Gasparyan AY, Ayvazyan L, Mikhailidis DP, Kitas GD. Mean platelet volume: a link between thrombosis and inflammation? Curr Pharm Des. 2011;17(1):47-58. doi: 10.2174/138161211795049804. PMID: 21247392.
17. 17. Altunisik N, Turkmen D, Sener S. Investigation of the relationship between inflammatory blood parameters and rosacea and demodex infestation. J Cosmet Dermatol. 2020 Aug;19(8):2105-8. doi: 10.1111/jocd.13254. Epub 2019 Dec 16. PMID: 31840349.
18. 18. Chang HY, Hsu LW, Lee CH, Lin CC, Huang CW, Chen PW, et al. Impact of Platelet Volume on the Clinical Outcomes of Patients with Acute Coronary Syndrome. Acta Cardiol Sin. 2019 Nov;35(6):563-70. doi: 10.6515/ACS.201911_35(6).20190423B. PMID: 31879507; PMCID: PMC6859097.
19. 19. Adam AM, Ali MA, Shah AA, Rizvi AH, Rehan A, Godil A, et al. Efficacy of Hematological and Coagulation Parameters in the Diagnosis and Prognosis of Patients with Acute Coronary Syndrome. J Tehran Heart Cent. 2018 Jul;13(3):115-25. PMID: 30745924; PMCID: PMC6368913.
20. 20. Sadeghi F, Kovács S, Zsóri KS, Csiki Z, Bereczky Z, Shemirani AH. Platelet count and mean volume in acute stroke: a systematic review and meta-analysis. Platelets. 2020 Aug 17;31(6):731-9. doi: 10.1080/09537104.2019.1680826. Epub 2019 Oct 26. PMID: 31657263.
21. 21. Farah R, Nseir W, Kagansky D, Khamisy-Farah R. The role of neutrophil-lymphocyte ratio, and mean platelet volume in detecting patients with acute venous thromboembolism. J Clin Lab Anal. 2020 Jan;34(1):e23010. doi: 10.1002/jcla.23010. Epub 2019 Sep 11. PMID: 31508844; PMCID: PMC6977138.
22. 22. Mayda-Domaç F, Misirli H, Yilmaz M. Prognostic role of mean platelet volume and platelet count in ischemic and hemorrhagic stroke. J Stroke Cerebrovasc Dis. 2010 Jan;19(1):66-72. doi: 10.1016/j.jstrokecerebrovasdis.2009.03.003. PMID: 20123229.
23. 23. Machin SJ, Briggs C. Mean platelet volume: a quick, easy determinant of thrombotic risk? J Thromb Haemost. 2010 Jan;8(1):146-7. doi: 10.1111/j.1538-7836.2009.03673.x. Epub 2009 Oct 30. PMID: 19874471.
24. 24. Beyan C, Beyan E. Were the measurements standardized sufficiently in published studies about mean platelet volume? Blood Coagul Fibrinolysis. 2017 Apr;28(3):234-6. doi: 10.1097/MBC.0000000000000586. PMID: 27388283.