Variköz Venlerde Endovenöz N-Bütil Siyanoakrilat Tedavisi Sonuçlarımız

Öz

Amaç: Bu çalışmada kliniğimizde variköz venli hastalarda non-tümesan endovenöz ablasyon tekniği olan endovenöz N-Bütil Siyanoakrilat (NBSA) tekniğinin sonuçlarının değerlendirilmesi amaçlanmıştır.

Gereç ve Yöntemler: Nisan 2014 ve Ağustos 2016 tarihleri arasında merkezimize başvuran tek ya da iki taraflı safenofemoral venöz yetmezliği olan, semptomatik 542 hasta çalışmaya dahil edildi. Yüz on beşi bilateral olmak üzere 542 hastanın toplam 657 alt ekstremitesine NBSA uygulandı. Hastaların CEAP sınıflamasına göre C2, C3, C4, C5, C6 venöz yetmezliği mevcuttu. Vena safena magna (VSM) çapı diz seviyesinde en az 5,5 mm, safenofemoral bileşke (SFB) düzeyinde ise en az 6 mm ve reflü süresi 2 saniye veya daha uzundu.

Bulgular: Altı yüz elli yedi alt ektremitenin ortalama CEAP sınıflandırması 3,1±0,6, VSM çapı diz seviyesinde 6,7±1,1 mm, SFB’de 8,3±2,1 mm, işlem süresi 15,2±2,9 dakika ve hastanede kalış süresi 1,7±0,6 saat idi. Altı aylık takipte sadece 7 (%1.1) VSM’de parsiyel rekanalizasyon, 1 (%0.2) alt ekstremitede popliteal vende derin ven trombozu ve 9 (%1.4) VSM’de dizüstü 1/3 distal kesiminde medikal tedavi ile düzelen tromboflebit gözlendi. Yapılan işlemlerin tamamı herhangi bir komplikasyon oluşmadan tamamlandı.

Sonuç: Yeni gelişen teknikler hızla geleneksel yöntemlerin yerini alarak hasta konforunu arttırmaktadır. NBSA; tekniğe has avantajları, erken ve orta dönemdeki yüksek başarı oranları ile endovenöz ablasyon tedavileri arasında etkin bir yöntem olarak yerini almıştır.

Anahtar Kelimeler

• Siyanoakrilat,endovenöz ablasyon tedavi,venöz yetmezlik,lazer terapi

Our Results of Endovenous N-Butyl Cyanoacrylate Treatment in Varicose Veins

Abstract

Aim: In this study, we aimed to evaluate the results of endovenous N-Butyl Cyanoacrylate (NBCA) technique which is a non-tumescence endovenous ablation technique in patients with varicose veins.

Material and Methods: A total of symptomatic 542 patients with single or bilateral saphenofemoral failure who presented to our center between April 2014 and August 2016 were included in the study. NBCA was applied to 657 lower extremities of 542 patients, 115 of whom were bilateral. The patients had C2, C3, C4, C5, C6 venous insufficiency according to CEAP classification. Vena saphena magna (VSM) diameter was at least 5.5 mm at the knee level, at least 6 mm at the saphenofemoral junction (SFJ) level, and reflux time was 2 seconds or longer.

Results: The mean CEAP classification of 657 lower extremities was 3.1±0.6, the VSM diameter was 6.7±1.1 mm at the knee level, 8.3±2.1 mm at the SFJ, the procedure time was 15.2±2.9 minutes, and the hospital stay was 1.7±0.6 hours. At 6 months follow-up, only 7 (1.1%) partial recanalization of VSM, 1 (0.2%) deep vein thrombosis in the popliteal vein in the lower limb, and 9 (1.4%) thrombophlebitis in the distal 1/3 segment at over the knee of VSM healing with medical treatment. All of the procedures were completed without any complications.

Conclusion: Newly developing techniques rapidly replace traditional methods and increase patient comfort. NBCA; It has become an effective method among endovenous ablation therapies with its technical advantages, high success rates in early and midterm.

Keywords

• Cyanoacrylates,endovenous ablation therapy,venous insufficiency,laser therapy

References

1. Jeanneret C, Karatolios K. Varicose veins: A critical review of the definition and the therapeutical options. Vasa. 2011;40(5):344-58.
2. Kelleher D, Lane TR, Franklin IJ, Davies AH. Treatment options, clinical outcome (quality of life) and cost benefit (quality-adjusted life year) in varicose vein treatment. Phlebology. 2012;27(Suppl 1):16-22.
3. Beebe-Dimmer JL, Pfeifer JR, Engle JS, Schottenfeld D. The epidemiology of chronic venous insufficiency and varicose veins. Ann Epidemiol. 2005;15(3):175-84.
4. Chiesa R, Marone EM, Limoni C, Volontè M, Petrini O. Chronic venous disorders: correlation between visible signs, symptoms and presence of functional disease. J Vasc Surg. 2007;46(2):322-30.
5. Van den Bos R, Arends L, Kockaert M, Neumann M, Nijsten T. Endovenous therapies of lower extremity varicosities: a meta-analysis. J Vasc Surg. 2009;49(1):230-9.
6. Bot GM, Bot KG, Ogunranti JO, Onah JA, Sule AZ, Hassan I, et al. The use of cyanoacrylate in surgical anastomosis: an alternative to microsurgery. J Surg Tech Case Rep. 2010;2(1):44-8.
7. Vaidya S, Tozer KR, Chen J. An overview of embolic agents. Semin Intervent Radiol. 2008;25(3):204-15.
8. Linfante I, Wakhloo AK. Brain aneurysms and arteriovenous malformations: advancements and emerging treatments in endovascular embolization. Stroke. 2007;38(4):1411-7.

9. Vanlangenhove P, Everaert K, Van Maele G, Defreyne L. Tolerance of glue embolization under local anesthesia in varicoceles: a comparative study of two different cyanoacrylates. Eur J Radiol. 2014;83(3):559-63.
10. Ikeda O, Nakasone Y, Yokoyama K, Inoue S, Takamori H, Baba H, et al. Successful treatment of mesentericvarices by retrograde transvenous obliteration by the delivery of N-butyl-2-cyanoacrylate via an abdominal wall vein. Cardiovasc Intervent Radiol. 2014;37(2):533-6.
11. Gohel MS, Epstein DM, Davies AH. Cost-effectiveness of traditional and endovenous treatments for varicose veins. Br J Surg. 2010;97(12):1815-23.
12. Carroll C, Hummel S, Leaviss J, Ren S, Stevens JW, Cantrell A, et al. Systematic review, network meta-analysis and exploratory cost-effectiveness model of randomized trials of minimally invasive techniques versus surgery for varicose veins. Br J Surg. 2014;101(9):1040-52.
13. Gloviczki P, Gloviczki ML. Guidelines for the management of varicose veins. Phlebology. 2012;27(Suppl 1):2-9.
14. Brown KR, Rossi PJ. Superficial venous disease. Surg Clin North Am. 2013;93(4):963-82.
15. Gale SS, Lee JN, Walsh ME, Wojnarowski DL, Comerota AJ. A randomized, controlled trial of endovenous thermal ablation using the 810-nm wavelength laser and the ClosurePLUS radiofrequency ablation methods for superficial venous insufficiency of the great saphenous vein. J Vasc Surg. 2010;52(3):645-50.
16. Rasmussen LH, Lawaetz M, Bjoern L, Vennits B, Blemings A, Eklof B. Randomized clinical trial comparing endovenous laser ablation, radiofrequency ablation, foam sclerotherapy and surgical stripping for great saphenous varicose veins. Br J Surg. 2011;98(8):1079-87.
17. Almeida JI, Kaufman J, Göckeritz O, Chopra P, Evans MT, Hoheim DF, et al. Radiofrequency endovenous ClosureFAST versus laser ablation for the treatment of great saphenous reflux: a multicenter, single-blinded, randomized study (RECOVERY study). J Vasc Interv Radiol. 2009;20(6):752-9.
18. Anwar MA, Lane TR, Davies AH, Franklin IJ. Complications of radiofrequency ablation of varicose veins. Phlebology. 2012;27(Suppl 1):34-9.
19. Kerver AL, van der Ham AC, Theeuwes HP, Eilers PH, Poublon AR, Kerver AJ, et al. The surgical anatomy of the small saphenous vein and adjacent nerves in relation to endovenous thermal ablation. J Vasc Surg. 2012;56(1):181-8.
20. Bozkurt AK, Yılmaz MF. A prospective comparison of a new cyanoacrylate glue and laser ablation for the treatment of venous insufficiency. Phlebology. 2016;31(Suppl 1):106-13.
21. Gürkan S, Gür Ö, Arar C, Donbaloğlu M O, Ege T. Comparison of manual pull back 980 nm wavelength bare tip fiber laser with automated pull back 1470 nm wavelength radial fiber laser in great saphenous vein insufficiency: analysis of early term efficacy and complications. Turk J Vasc Surg. 2013;22(2):211-6.