Research Article
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Derin Venöz Reflü Tedavisinde Hyaluran-Siyanoakrilat Kompleks Jelin Perivasküler Uygulaması

Year 2023, Volume: 14 Issue: 1, 23 - 29, 23.03.2023
https://doi.org/10.18663/tjcl.1245389

Abstract

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.

References

  • 1. Meissner MH, Eklof B, Smith PC, Dalsing MC, DePalma RG, Gloviczki P, et al. Secondary chronic venous disorders. J Vasc Surg 2007;46(Suppl S):68S-83S.
  • 2. Partsch H, Rabe E, Stemmer R. Compression therapy of the extremities. Paris: Editions Phlébologiques Francaises, 1999.
  • 3. Yavuz T, Acar AN, Yavuz K, Ekingen E. A retrospective study of deep vein insufficiency treatment device: ICT. Ann Vasc Dis 2020;13:255-260.
  • 4. Perrin M, Gillet JL, Guex JJ. Syndrome postthrombotique. Angéiologie 2003;19:12. EMC (Elsevier Masson SAS, Paris).
  • 5. Danielsson G, Eklof B, Grandinetti A, Kistner RL, Masuda EM, Sato DT. Reflux from thigh to calf, the major pathology in chronic venous ulcer disease: surgery indicated in the majority of patients. Vasc Endovasc Surg 2004;38:209e19.
  • 6. Maleti O. Venous valvular reconstruction in postthrombotic syndrome. A new technique. J Mal Vasc 2002;27:218e21.
  • 7. Hardy SC, Riding G, Abidia A. Surgery for deep venous incompetence. Cochrane Database Syst Rev. 2004;(3):CD001097.
  • 8. Wang SM, Hu ZJ, Li SQ, Huang XL, Ye CS. Effect of external valvuloplasty of the deep vein in the treatment of chronic venous insufficiency of the lower extremity. J Vasc Surg. 2006 Dec;44(6):1296-300.
  • 9. https://vascularnews.com/a-new-modality-in-vein-treatment-percutaneous-valvuloplasty-by-interventional-injection-of-hyaluronic-acid-gel TJCL Volume 14 Number 1 p: 23-39
  • 10. Christopoulos D, Nicolaides AN, Cook A, Irvine A, Galloway JM, Wilkinson A. Pathogenesis of venous ulceration in relation to the calf muscle pump function. Surgery 1989;106:829-835.
  • 11. Kistner RL, Sparkuhl MD. Surgery in acute and chronic venous disease. Surgery 1979;85:31-43.
  • 12. Taheri SA, Lazar L, Elias S, Marchand P, Heffner R. Surgical treatment of postphlebitic syndrome with vein valve transplant. Am J Surg 1982;144:221-224.
  • 13. Bry JD, Muto PA, O'Donnell TF, Isaacson LA. The clinical and hemodynamic results after axillary to popliteal vein valve transplantation. J Vasc Surg 1995;21:110-119.
  • 14. Linfante I, Wakhloo AK. Brain aneurysms and arteriovenous malformations: advancements and emerging treatments in endovascular embolization. Stroke 2007; 38:1411–1417.
  • 15. Labenz J, Borsch G. Bleeding gastric and duodenal varicose veins: endoscopic embolisation using tissue adhesives. Dtsch Med Wochenschr 1992;117:1274–1277.
  • 16. Brothers MF, Kaufmann JC, Fox AJ, Deveikis JP. N-butyl 2- cyanoacrylate substitute for IBCA in interventional neuroradiology: histopathologic and polymerization time studies. Am J Neuroradiol 1989;10:777–786.
  • 17. Ragg JC, Despa OR, Brüggemann U, El-Chamali S, Stoyanova K. Foam sclerotherapy of segments of the saphenous vein with adjuvant hyaluronan compression. Phlebologie 2017;46:81-86
  • 18. Perrin M. La chirurgie des reflux veineux profonds des members in-férieurs. J Mal Vasc 2004;29:73-87.
  • 19. Raju S, Fredericks R. Valve reconstruction procedures for nonobstructive venous insufficiency: rationale, techniques, and results in 107 procedures with two-to eight-year follow-up. J Vasc Surg 1988;7:301-310. 20. Perrin M. Reconstructive surgery for deep venous reflux: a report on 144 cases. Cardiovasc Surg 2000;8:246-255.
  • 21. Proebstle TM, Alm J, Dimitri S, Rasmussen L, Whiteley M, Lawson J et al. Twelve-month follow-up of the European multicenter study on cyanoacrylate embolization of incompetent great saphenous veins. J Vasc Surg 2014;2:105–106.
  • 22. Morrison N, Gibson K, McEnroe S, Goldman M, King T, Weiss R et al. Randomized trial comparing cyanoacrylate embolization and radiofrequency ablation for incompetent great saphenous veins (VeClose). J Vasc Surg 2015;61:985–994. 23. Yasim A, Eroglu E, Bozoglan O, Mese B, Acipayam M, Kara H. A new non-tumescent endovenous ablation method for varicose vein treatment: Early results of Nbutyl cyanoacrylate (VariClose®). Phlebology 2017;32:194-199.
  • 24. Tok M, Tüydeş O, Yüksel A, Şenol S, Akarsu S. EarlyTerm Outcomes for Treatment of Saphenous Vein Insufficiency with N-Butyl Cyanoacrylate: A Novel, NonThermal, and Non-Tumescent Percutaneous Embolization Technique. Heart Surg Forum 2016;19:118-122.
  • 25. Çalık ES, Arslan Ü, Ayaz F, Tort M, Yıldız Z, Aksu V et al. N-butyl cyanoacrylate in the treatment of venous insufficiency--the effect of embolisation with ablative polymerisation. Vasa 2016;45:241-246.
  • 26. Perrin M. Place de la chirurgie dans le traitement de l’ulcère veineux de jambe. Encycl Méd Chir. Paris: Elsevier SAS; 2004. 43-169-H; p. 1-10.
  • 27. Plagnol P, Ciostek P, Grimaud JP, Prokopowicz SC. Autogenous valve reconstruction technique for postthrombotic reflux. Ann Vasc Surg 1999;13:339-342.
  • 28. Karagoz HY, Dogan N, Kocailik M, Sungun M, Duran E. Treatment of congenital venous avalvulosis using a surgically created autogenous vein valve. Cardiovasc Surg 1993;1:131-133.
  • 29. Jessup G, Lane RJ. Repair of incompetent venous valve: a new technique. J Vasc Surg 1988;8:569-575.
  • 30. Wilson NM, Rutt DL, Browse NL. In situ venous valve construction. Br J Surg 1991;78:595-600.
  • 31. Puggioni A, Kistner RL, Eklof B, Lurie F. Surgical disobliteration of postthrombotic deep veins – endophlebectomy – is feasible. J Vasc Surg 2004;39:1048-1051.

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

Year 2023, Volume: 14 Issue: 1, 23 - 29, 23.03.2023
https://doi.org/10.18663/tjcl.1245389

Abstract

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.

References

  • 1. Meissner MH, Eklof B, Smith PC, Dalsing MC, DePalma RG, Gloviczki P, et al. Secondary chronic venous disorders. J Vasc Surg 2007;46(Suppl S):68S-83S.
  • 2. Partsch H, Rabe E, Stemmer R. Compression therapy of the extremities. Paris: Editions Phlébologiques Francaises, 1999.
  • 3. Yavuz T, Acar AN, Yavuz K, Ekingen E. A retrospective study of deep vein insufficiency treatment device: ICT. Ann Vasc Dis 2020;13:255-260.
  • 4. Perrin M, Gillet JL, Guex JJ. Syndrome postthrombotique. Angéiologie 2003;19:12. EMC (Elsevier Masson SAS, Paris).
  • 5. Danielsson G, Eklof B, Grandinetti A, Kistner RL, Masuda EM, Sato DT. Reflux from thigh to calf, the major pathology in chronic venous ulcer disease: surgery indicated in the majority of patients. Vasc Endovasc Surg 2004;38:209e19.
  • 6. Maleti O. Venous valvular reconstruction in postthrombotic syndrome. A new technique. J Mal Vasc 2002;27:218e21.
  • 7. Hardy SC, Riding G, Abidia A. Surgery for deep venous incompetence. Cochrane Database Syst Rev. 2004;(3):CD001097.
  • 8. Wang SM, Hu ZJ, Li SQ, Huang XL, Ye CS. Effect of external valvuloplasty of the deep vein in the treatment of chronic venous insufficiency of the lower extremity. J Vasc Surg. 2006 Dec;44(6):1296-300.
  • 9. https://vascularnews.com/a-new-modality-in-vein-treatment-percutaneous-valvuloplasty-by-interventional-injection-of-hyaluronic-acid-gel TJCL Volume 14 Number 1 p: 23-39
  • 10. Christopoulos D, Nicolaides AN, Cook A, Irvine A, Galloway JM, Wilkinson A. Pathogenesis of venous ulceration in relation to the calf muscle pump function. Surgery 1989;106:829-835.
  • 11. Kistner RL, Sparkuhl MD. Surgery in acute and chronic venous disease. Surgery 1979;85:31-43.
  • 12. Taheri SA, Lazar L, Elias S, Marchand P, Heffner R. Surgical treatment of postphlebitic syndrome with vein valve transplant. Am J Surg 1982;144:221-224.
  • 13. Bry JD, Muto PA, O'Donnell TF, Isaacson LA. The clinical and hemodynamic results after axillary to popliteal vein valve transplantation. J Vasc Surg 1995;21:110-119.
  • 14. Linfante I, Wakhloo AK. Brain aneurysms and arteriovenous malformations: advancements and emerging treatments in endovascular embolization. Stroke 2007; 38:1411–1417.
  • 15. Labenz J, Borsch G. Bleeding gastric and duodenal varicose veins: endoscopic embolisation using tissue adhesives. Dtsch Med Wochenschr 1992;117:1274–1277.
  • 16. Brothers MF, Kaufmann JC, Fox AJ, Deveikis JP. N-butyl 2- cyanoacrylate substitute for IBCA in interventional neuroradiology: histopathologic and polymerization time studies. Am J Neuroradiol 1989;10:777–786.
  • 17. Ragg JC, Despa OR, Brüggemann U, El-Chamali S, Stoyanova K. Foam sclerotherapy of segments of the saphenous vein with adjuvant hyaluronan compression. Phlebologie 2017;46:81-86
  • 18. Perrin M. La chirurgie des reflux veineux profonds des members in-férieurs. J Mal Vasc 2004;29:73-87.
  • 19. Raju S, Fredericks R. Valve reconstruction procedures for nonobstructive venous insufficiency: rationale, techniques, and results in 107 procedures with two-to eight-year follow-up. J Vasc Surg 1988;7:301-310. 20. Perrin M. Reconstructive surgery for deep venous reflux: a report on 144 cases. Cardiovasc Surg 2000;8:246-255.
  • 21. Proebstle TM, Alm J, Dimitri S, Rasmussen L, Whiteley M, Lawson J et al. Twelve-month follow-up of the European multicenter study on cyanoacrylate embolization of incompetent great saphenous veins. J Vasc Surg 2014;2:105–106.
  • 22. Morrison N, Gibson K, McEnroe S, Goldman M, King T, Weiss R et al. Randomized trial comparing cyanoacrylate embolization and radiofrequency ablation for incompetent great saphenous veins (VeClose). J Vasc Surg 2015;61:985–994. 23. Yasim A, Eroglu E, Bozoglan O, Mese B, Acipayam M, Kara H. A new non-tumescent endovenous ablation method for varicose vein treatment: Early results of Nbutyl cyanoacrylate (VariClose®). Phlebology 2017;32:194-199.
  • 24. Tok M, Tüydeş O, Yüksel A, Şenol S, Akarsu S. EarlyTerm Outcomes for Treatment of Saphenous Vein Insufficiency with N-Butyl Cyanoacrylate: A Novel, NonThermal, and Non-Tumescent Percutaneous Embolization Technique. Heart Surg Forum 2016;19:118-122.
  • 25. Çalık ES, Arslan Ü, Ayaz F, Tort M, Yıldız Z, Aksu V et al. N-butyl cyanoacrylate in the treatment of venous insufficiency--the effect of embolisation with ablative polymerisation. Vasa 2016;45:241-246.
  • 26. Perrin M. Place de la chirurgie dans le traitement de l’ulcère veineux de jambe. Encycl Méd Chir. Paris: Elsevier SAS; 2004. 43-169-H; p. 1-10.
  • 27. Plagnol P, Ciostek P, Grimaud JP, Prokopowicz SC. Autogenous valve reconstruction technique for postthrombotic reflux. Ann Vasc Surg 1999;13:339-342.
  • 28. Karagoz HY, Dogan N, Kocailik M, Sungun M, Duran E. Treatment of congenital venous avalvulosis using a surgically created autogenous vein valve. Cardiovasc Surg 1993;1:131-133.
  • 29. Jessup G, Lane RJ. Repair of incompetent venous valve: a new technique. J Vasc Surg 1988;8:569-575.
  • 30. Wilson NM, Rutt DL, Browse NL. In situ venous valve construction. Br J Surg 1991;78:595-600.
  • 31. Puggioni A, Kistner RL, Eklof B, Lurie F. Surgical disobliteration of postthrombotic deep veins – endophlebectomy – is feasible. J Vasc Surg 2004;39:1048-1051.
There are 29 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Research Article
Authors

Orhan Rodoplu

Publication Date March 23, 2023
Published in Issue Year 2023 Volume: 14 Issue: 1

Cite

APA Rodoplu, O. (2023). Perivascular Administration of Hyaluran-Cyanoacrylate Complex Gel for Deep Venous Reflux. Turkish Journal of Clinics and Laboratory, 14(1), 23-29. https://doi.org/10.18663/tjcl.1245389
AMA Rodoplu O. Perivascular Administration of Hyaluran-Cyanoacrylate Complex Gel for Deep Venous Reflux. TJCL. March 2023;14(1):23-29. doi:10.18663/tjcl.1245389
Chicago Rodoplu, Orhan. “Perivascular Administration of Hyaluran-Cyanoacrylate Complex Gel for Deep Venous Reflux”. Turkish Journal of Clinics and Laboratory 14, no. 1 (March 2023): 23-29. https://doi.org/10.18663/tjcl.1245389.
EndNote Rodoplu O (March 1, 2023) Perivascular Administration of Hyaluran-Cyanoacrylate Complex Gel for Deep Venous Reflux. Turkish Journal of Clinics and Laboratory 14 1 23–29.
IEEE O. Rodoplu, “Perivascular Administration of Hyaluran-Cyanoacrylate Complex Gel for Deep Venous Reflux”, TJCL, vol. 14, no. 1, pp. 23–29, 2023, doi: 10.18663/tjcl.1245389.
ISNAD Rodoplu, Orhan. “Perivascular Administration of Hyaluran-Cyanoacrylate Complex Gel for Deep Venous Reflux”. Turkish Journal of Clinics and Laboratory 14/1 (March 2023), 23-29. https://doi.org/10.18663/tjcl.1245389.
JAMA Rodoplu O. Perivascular Administration of Hyaluran-Cyanoacrylate Complex Gel for Deep Venous Reflux. TJCL. 2023;14:23–29.
MLA Rodoplu, Orhan. “Perivascular Administration of Hyaluran-Cyanoacrylate Complex Gel for Deep Venous Reflux”. Turkish Journal of Clinics and Laboratory, vol. 14, no. 1, 2023, pp. 23-29, doi:10.18663/tjcl.1245389.
Vancouver Rodoplu O. Perivascular Administration of Hyaluran-Cyanoacrylate Complex Gel for Deep Venous Reflux. TJCL. 2023;14(1):23-9.


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