Treatment of Chronic Venous Insufficiency

Öz

Chronic venous insufficiency (CVI), with its high prevalence, high cost of diagnosis and treatment, substantial loss in manpower and negative effects on quality of life, is an important health issue. A comprehensive knowledge of the anatomy and functions of venous system is a must to understand the pathophysiology of CVI. The diagnosis of CVI is made by history, physical examination and noninvasive tests. The traditional surgical strategy for CVI treatment is high ligation of saphenofemoral vein and saphenous vein stripping. In recent years, novel minimally invasive techniques such as ultrasound-guided foam sclerotherapy, endovenous laser and radiofrequency ablation have been more widely applied. Here, we have reviewed the various treatment strategies used in CVI.

Anahtar Kelimeler

• Chronic venous insufficiency, Sclerotherapy, Endovenous laser treatment, Radiofrequency ablation

Kronik Venöz Yetmezlik Tedavisi

Öz

Kronik venöz yetmezlik (KVY); yüksek prevalans›, tan› ve tedavi maliyetinin yüksek olmas›, belirgin iflgücü kayb› ve hastan›n yaflam kalitesi üzerinde yapt›¤› olumsuz etkilerle, epidemiyolojik ve sosyoekonomik sonuçlar›yla önemli bir sa¤l›k sorunudur. KVY patofizyolojisini tam anlayabilmek için normal venöz sistemin anatomisi ve fonksiyonlar› iyi bilinmelidir. KVY tan›s› anamnez,fizik muayene ve noninvaziv testlerle yap›l›r. Kronik venöz yetmezlikte klasik cerrahi tedavi stratejisi safenofemoral venin yüksek ligasyonu ve safen vene stripping olup,son y›llarda doppler ultrasonografi eflli¤inde köpük skleroterapi, endovenöz lazer ve radyofrekans ablasyon tedavisi gibi yeni minimal invaziv teknikler s›kl›kla kullan›l›r olmufltur. Bu yaz›m›zda toplumda s›k görülen kronik venöz yetmezli¤i tedavi seçenekleri incelenmifltir.

Anahtar Kelimeler

• Kronik venöz yetmezli¤i, Skleroterapi, Endovenöz lazer tedavisi, Radyofrekans ablasyon

Kaynakça

1. Nicolaides AN, Allegra C, Bergan J, Bradbury A, Cairols M, Carpantier P and et al. Management of chronic venous disor- ders of the lower limbs: Guidlines according to scientific evi- dence. International Angiology 2008;27:1–59
2. Scott TE, LaMorte WW, Gorin DR, Menzoian JO. Risk factors for chronic venous insufficiency: a dual case-control study. J Vasc Surg 1995; 22: 622–8
3. Jawien A. The influence of environmental factors in chronic venous insufficiency. Angiology. 2003; 54: S19–S31.
4. Fowkes FG, Evans CJ, Lee AJ. Prevalence and risk factors for chronic venous insufficiency. Angiology. 2001; 52: S5–S15 55.. Mózes G, Carmichael SW, Gloviczki P. Development and anatomy of the venous system.In Gloviczki P, Yao JS, eds. Handbook of Venous Disorders. 2nd ed. New York, NY: Ar- nold; 2001: 11–24.
5. Caggiati A, Bergan JJ, Gloviczki P, Jantet G, Wendell-Smith CP, Partsch H; International Interdisciplinary Consensus Com- mittee on Venous Anatomical Terminology. Nomenclature of the veins of the lower limbs: an international interdisciplinary consensus statement. J Vasc Surg 2002; 36: 416–22.
6. Padberg F. The physiology and hemodynamics of the normal venous circulation.In Gloviczki P, Yao JS, eds. Handbook of Ve- nous Disorders. 2nd ed. New York, NY: Arnold; 2001: 25–35.
7. Burnand KG. The physiology and hemodynamics of chronic venous insufficiency of the lower limb.In Gloviczki P, Yao JS, eds. Handbook of Venous Disorders. 2nd ed. New York, NY: Arnold; 2001: 49–57.
8. Pappas PJ, Durán WN, Hobson RW. Pathology and cellular physiology of chronic venous insufficiency.In Gloviczki P, Yao JS, eds. Handbook of Venous Disorders. 2nd ed. New York, NY: Arnold; 2001: 58–67.

9. Gschwandtner ME, Ehringer H. Microcirculation in chronic venous insufficiency. Vasc Med. 2001; 6: 169–79.
10. Porter JM, Moneta GL. Reporting standards in venous di- sease: an update. International Consensus Committee on Chronic Venous Disease. J Vasc Surg 1995; 21: 635–45.
11. Mattos MA, Sumner DS. Direct noninvsive tests (duplex scan) for the evaluation of chronic venous obstruction and valvular in- competence.In Gloviczki P, Yao JS, eds. Handbook of Venous Di- sorders. 2nd ed. New York, NY: Arnold; 2001: 120–31.
12. Marston WA. PPG, APG, duplex: which noninvasive tests are most appropriate for the management of patients with chronic venous insufficiency? Semin Vasc Surg 2002; 15: 13–20
13. Motykie GD, Caprini JA, Arcelus JI, Reyna JJ, Overom E, Mokhtee D. Evaluation of therapeutic compression stockings in the treatment of chronic venous insufficiency. Dermatol Surg 1999; 25: 116–20.
14. Mayberry JC, Moneta GL, Taylor LM, Porter JM. Fifteen-ye- ar results of ambulatory compression therapy for chronic ve- nous ulcers. Surgery. 1991; 109: 575–81
15. Karlsmark T, Agerslev RH, Bendz SH, Larsen JR, Roed-Pe- tersen J, Andersen KE. Clinical performance of a new silver dressing, Contreet Foam, for chronic exuding venous leg ul- cers. J Wound Care. 2003; 12: 351–54
16. Veno-active drugs in the management of chronic venous disease. An international consensus statement: current medi- cal position, prospective views and final resolution.Clin He- morheol Microcirc. 2005;33(4):309-19
17. Padberg FT, Johnston MV, Sisto SA. Structured exercise improves calf muscle pump function in chronic venous insuffi- ciency: a randomized trial. J Vasc Surg 2004; 39: 79–87
18. Goldman MP. Sclerotherapy. st Louis. mosby-year book ,1991 2200.. Carlin MC, Ratz JL,Treatment of telengiectasias,comparison of sclerosing agents . J.Dermatol. Surg Oncol. 1987:13;1181
19. Bergan JJ. Varicose veins, treatment by surgery and
20. sclerotherapy. Rutherford. RB (ed). Vascular surgery 2000;2007-2020
21. Morrison N. Laser treatment of the incompetent sapheno- us vein. In: Gloviczki P, Dalsing MC, Eklöf B, Moneta GL, Wake- field TW (eds). Handbook of Venous Disorder. Third edition. American Venous Forum. London: Edward Arnold; 2009;37:418-28
22. Pannier F, Rabe E. Endovenous laser therapy and radiofre- quency ablation of saphenous varicose veins. J Cardiovasc Surg 2006;47:3–8
23. Van Den Boss RR, Kockaert MA, Neumann HAM and Nijs- ten T. Technical review of endovenous laser therapy for varico- se veins. Eur J Vasc Endovasc Surg 2008;35:88-95
24. Merchant RF and Kistner RL. Radiofrequency treatment of the incompetent saphenous vein. In: Gloviczki P, Dalsing MC, Eklöf B, Moneta GL, Wakefield TW (eds). Handbook of Venous Disorder. Third edition. American Venous Forum. London: Ed- ward Arnold; 2009;36:409-17
25. Garen G,Yellin AE, Primary varicose veins Topographic and hemodynamic correlations. J Cardiovasc Surg 1990:31;672-9
26. Lapropoulos N, Touloupulos E, GiannoulesAD et al. Recur- rent varicose veins; investigations of the pattern and extent of ref- lux with color-flow duplex scanning. Surgery 1996:119;406-10.
27. Bergan JJ. Varicose veins: treatment by intervention including sclerotherapy. In: Rutherford RB (ed). Vascular Surgery. Sixth edition, volume two. Philadelphia: WB Saunders Co; 2005; Section XXI (157): 2251-67
28. Howard A, Howard DPJ and Davies AH. Surgical treatment of the incompetent saphenous vein. In: Gloviczki P, Dalsing MC, Eklöf B, Moneta GL, Wakefield TW (eds). Handbook of Venous Disorder. Third edition. American Venous Forum.
29. London: Edward Arnold; 2009;35:400-8
30. Sarin S, Scurr JH, Coleridge Smith PD. Stripping of the long saphenous vein in the treatment of primary varicose
31. veins. Br J Surg 1994; 81: 1455–8.
32. Padberg FT Jr, Pappas PJ, Araki CT, Back TL, Hobson RW. Hemodynamic and clinical improvement after superficial vein ablation in primary combined insufficiency with ulceration. J Vasc Surg 1996; 24: 711–8.
33. MacKenzie RK, Allan PL, Ruckley CV, Bradbury AW. The effect of long saphenous vein stripping on deep venous reflux. Eur J Vasc Endovasc Surg 2004; 28: 104–7
34. Recek C . Saphenofemoral junction ligation supplemented by postoperative sclerotherapy: a review of long term clinical and hemodynamic results. Vasc Endovasc Surg 2004;38:533-40
35. MC Mullin GM, Coloridge Smith P, Scurr JH: Objective as- sesment of high ligation without stripping the long saphenous vein, Br J Surg 1991;78:1139-42