Comparison of stripping/ligation and embolization with cyanoacrylate in venous insufficiency treatment

Abstract

Aim: Stripping/ligation (S/L) is the gold standard method used in the treatment of varicose veins. Saphenous vein ablation with cyanoacrylate (CA) is a new minimally invasive treatment method that forces this throne. Our aim is to compare these two methods in terms of patient satisfaction.
Methods: In this cross-sectional study, voluntary patients who had superficial venous insufficiency and varicose vein were divided into two groups as S/L and CA. CEAP (Clinical-Etiologic-Anatomic-Pathophysiologic-clinical score) and VAS (Visual Analogue Scale ) were evaluated on the 1st, 3rd, 7th, 14th, 30th postoperative days and at the outpatient follow-up visits 1 year later. SF-36 (Short Form-36) questionnaire was applied at the first month. VCSS (Venous Clinical Severity Score) of patients were compared at 6 months after surgery. Control, color doppler ultrasonography was performed on patients with recurrent varicose veins or those who were symptomatic. SPSS 22.0 program was used for data analysis.
Results: The preoperative and postoperative VCSS scores were lower in the CA group than in the S/L group (P<0.001). In both groups, postoperative VCSS score was lower compared to preoperative conditions (P<0.001). The VAS score of S/L group was higher than the CA group, during anesthesia, on the 1st, and 3rd postoperative days (P<0.001). However, during the procedure, on the 7th (P<0.001) and 14th days (P=0.033), VAS scores were lower in the S/L group than the CA group. In short form -36, viability score was better in the S/L group (P<0.001). CA group scored higher in the other parameters (such as physical functioning, role limitations, bodily pain, general mental health, social functioning, role limitations due to emotional problems and general health perceptions) (P˂0.001 for all).
Conclusion: Although the S/L method is the gold standard for varicose vein treatment, saphenous vein ablation with CA scored higher in terms of patient satisfaction.

Keywords

• Venous insufficiency,Stripping and ligation,Endovenous ablation with Cyanoacrylate,Short Form-36 quality of life questionnaire

Venöz yetmezlik ve varis tedavisinde stripping/ligasyon ve siyanoakrilat ile embolizasyon yöntemlerinin karşılaştırılması

Öz

Amaç: Sıyırma/ligasyon (S/L), varisli damarların tedavisinde kullanılan altın standart yöntemdir. Siyanoakrilat (CA) ile safen ven ablasyonu, bu tahtı zorlayan yeni minimal invaziv bir tedavi yöntemidir. Amacımız bu iki yöntemi hasta memnuniyeti noktasında karşılaştırmaktır.
Yöntemler: Bu makale kesitsel bir çalışma olarak tasarlandı. Gönüllü yüzeysel venöz yetmezliği ve varisi olan hastalar, S/L ve CA grubu şeklinde ikiye ayrıldı. CEAP (Klinik-Etiyolojik-Anatomik-Patofizyolojik-klinik skor) ve VAS (vizüel ağrı skalası) 1. gün, 3. gün, 7. gün, 14. gün, 30. gün ve poliklinik takip ziyaretlerinde 1 yıl sonra değerlendirildi. Bir ay sonra SF-36 (Kısa Form-36) anketi uygulandı. Hastaların ameliyat sonrasi 6. ayda VCSS (Venöz Klinik Şiddet Skor) karşılaştırıldı. Tekrarlayan varisli veya semptomatik hastalarda kontrol renkli doppler ultrasonografi yapıldı. Veri analizi için SPSS 22.0 programı kullanıldı.
Bulgular: CA grubunda ameliyat öncesi ve ameliyat sonrası VCSS, S/L grubuna göre anlamlı olarak düşüktü (P<0,001). S/L grubunun VAS skoru anestezi sırasında, 1. ve 3. günlerde CA grubundan daha yüksekti (P<0,001). Ancak işlem sırasında, 7. günde (P<0,001) ve 14. günde (P=0,033) VAS skoru S/L grubunda CA grubuna göre daha düşüktü. S/L grubunda Kısa Form-36 canlılık skoru anlamlı olarak daha iyi bulundu (P<0,001). Diğer parametrelerde (fiziksel işlevsellik, rol kısıtlamaları, bedensel ağrı, genel ruh sağlığı, sosyal işlevsellik, duygusal sorunlara bağlı rol kısıtlamaları ve genel sağlık algıları gibi) CA grubu üstündü (tümü için P<0,001).
Sonuç: Varis tedavisinde S/L yöntemi altın standart olmasına rağmen, CA ile safen ven ablasyonu hasta memnuniyeti açısından daha üstün bulunmuştur.

Anahtar Kelimeler

• Venöz yetmezlik,Sıyırma ve ligasyon,Siyanoakrilat ile endovenöz ablasyon,Kısa Form-36 yaşam kalitesi ölçeği

Kaynakça

1. 1. Kahraman N, Demir D. Efficacy of foam sclerotherapy accompanied by near infrared light and duplex ultrasonography in treatment of symptomatic recurrent varicose veins: A retrospective cohort study. J Surg Med. 2019;3(1):82-7. doi: 10.28982/josam.517231.
2. 2. Callam MJ. Epidemiology of varicose veins. Br J Surg. 1994;81(2):167e73.
3. 3. Brand FN, Dannenberg AL, Abbott RD, Kannel WB. The epidemiology of varicose veins: the Framingham Study. Am J Prev Med. 1988;4(2):96-101.
4. 4. Lim CS, Davies AH. Pathogenesis of primary varicose veins. Br J Surg. 2009;96(11):1231-42.
5. 5. Lee AJ, Evans CJ, Allan PL, Ruckley CV, Fowkes FG. Lifestyle factors and the risk of varicose veins: Edinburgh vein study. J Clin Epidemiol. 2003;56(2):171-9.
6. 6. Comerota AJ, Ramelet AA, Jawien A, Nicolaides A. Treatment of chronic venous disease of the lower extremities: what’s new in guidelines? Phlebolymphology. 2009;16(4):313-20.
7. 7. 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;101:1040-52.
8. 8. Ostler AE, Holdstock JM, Harrison CC, Whiteley MS. Arteriyal false Aneurism in the groin folloving endovenouslaser ablation. Phlebology. 2015;30:220-2.

9. 9. Hashimato O, Miyazaki T, Hosokava J, Shimura Y, Okuyama H, Endo Masahiro. A case of hight-output heard failure caused by afemoral arteriovenous fistula after endovenous laser ablation treatment of the saphenous vein. Phlebology. 2015;30:290-2.
10. 10. Bozkurt AK, Yılmaz MF. A prospective comparison of a new cyanoacrylate glue and laser ablation for the treatment of venous insufficiency. Phlebology. 2016 Mar;31(1 Suppl):106-13. doi: 10.1177/0268355516632652.
11. 11. Tekin Aİ, Tuncer ON, Memetoglu ME, Araslan Ü, Öztekin A, Yağmur B, et al. Nonthermal, Nontumescent endovenous treatment of varicose veins. Ann Vasc Surg. 2016;36:231–5.
12. 12. Koramaz I, El Kılıc¸ H, Gökalp F, et al. Ablation of the great saphenous vein with nontumescent nbutyl cyanoacrylate versus endovenous laser therapy. J Vasc Surg Venous Lymphat Disord. 2017;5:210–5.
13. 13. Tok M, Tuydes O, Yuksel A, Şenol S, Akarsu S. Early-term outcomes for treatment of saphenous vein insufficiency with N-Butyl Cyanoacrylate: a novel, nonthermal,and non-tumescent Percutaneous Embolization Technique. Heart Surg Forum. 2016;19:118–22.
14. 14. Bademci MS, Tayfur K, Ocakoglu G, Yazman S, Akyüz M, Yasa H. A new percutaneous technique: N-butyl cyanoacrylate adhesive for the treatment of giant saphenous vein insufficiency. Vascular. 2018;26:194-197.
15. 15. Morrison C, Dolsing MC. Signs and symptoms of Saphenous Nevre Injury After Greater Saphenous Vein stripping Prevalance ,Severity and Relevance for Modern Pratice J. Vascular Surgery. 2003;38:886- 90.
16. 16. Holme JB, Skajaa K, Holme K. Incidence of lesions of the saphenous nerve after partial or complete stripping of the long saphenous vein. Acta Chirurgica Scandinavica. 1990;156(2):145-8.
17. 17. Kara Y. Comparative study of totally extra-peritoneal hernia repair versus open Lichtenstein hernioplasty for the treatment of primary inguinal hernia. J Surg Med. 2019;3(5):348-52. DOI: 10.28982/josam.551595
18. 18. Downie WW, Leatham PA, Rhind VM, Branco JA, Anderson JA. Studies with pain rating scales. Annals Rheumatic Diseases. 1978;37: 378-81.
19. 19. Ran F, Shi Y, Qiao T, Shang T, Liu Z, Liu CJ. Comparison of foam sclerotherapy alone or combined with stripping of the great saphenous vein for treating varicose veins. Dermatologic Surgery. 2017;43(4):541-7.
20. 20. Chan YC, Law Y, Cheung GC, Ting AC, Cheng SW. Cyanoacrylate glue used to treat great saphenous reflux: measures of outcome. Phlebology. 2017;32(2):99-106.
21. 21. Almeida JI, Javier JJ, Mackay EG, Bautista C, Cher DJ, Proebstle TM. Two-year follow-up of first human use of cyanoacrylate adhesive for treatment of saphenous vein incompetence. Phlebology. 2015; 30(6):397-404.
22. 22. Lurie F, Creton D, Eklof B, Kistner RL, Pichot O, Petrovic SS. Prospective Randomised Study of Endovenous Radiofrequency Obliteration (Closure) Versus Ligation and Vein Stripping (EVOLVeS): Two-year Follow-up. Eur J Vasc Endovasc Surg. January. 2005;29(1):67-73
23. 23. Jones L, Braithwaite BD, Selwyn D, Cooke S, Earnshaw JJ. Neovascularisation is the principal cause of varicose vein recurrence: results of a randomised trial of stripping the long saphenous vein. Eur J Vasc Endovasc Surg. 1996;12:442-5.
24. 24. Creton D. Hypotheses etiologiques des re´cidives variqueuses saphene interne: etude anatomique sur 211 cas. In: Negus D, Jantet G, Colleridge-Smith PD, editors. Phlebology London: Springer-Verlag; 1995. p. 164-8.