Efficacy of foam sclerotherapy accompanied by near infrared light and duplex ultrasonography in treatment of symptomatic recurrent varicose veins: A retrospective cohort study
Öz
Aim: The recurrence of Great Saphenous Vein (GSV) and that of Small Saphenous Vein (SSV) is a common, costly and complex challenge which is related with technically insufficient surgery or insufficient endovenous ablation and neovascularization. The purpose of this study is to assess the efficacy and the reliability of the foam sclerotherapy with Near Infrared (NIR) Light and/or Duplex Ultrasonography (DUS) in the treatment of the symptomatic Recurrent Varicose Veins (RVV).
Methods: One hundred sixty four patients (181 legs) who had been treated between April 2014 and May 2017 have been studied retrospectively. The demographic data of the patients, DUS findings, Clinical, Etiologic, Anatomic and Pathophysiologic (CEAP) classification, peri-operative data and follow-up examinations were recorded.
Results: The mean age our patients were 44.79±12.57 and 76 of them were females. It was detected that RVV in 145 extremities were developed after the open surgery (GSV ligation, GSVstripping, SSV ligation and phlebectomy) and that RVV in 36 extremities were developed after endovenous ablation (Radiofrequency ablation, Laser ablation). The reflux pathologies which led to RVV were evaluated in four groups such as incompetent saphenofemoral junction (SFJ) ±neovascularization in 114 patients, reflux from incompetent perforator / reflux from pelvic vein in 17 patients, incompetent SFJ ±neovascularization in 15 patients and combined causes in 35 patients. The stages of the patients were detected as C2 for 24 patients, as C3 for 91 patients, as C4 for 45 patients, as C5 for 16 patients and C6 for five extremities. Total occlusion was developed occurred in 172 extremities in the sixth-month control following the treatment. No major complication was seen during the follow-up.
Conclusions: Tactical and technical errors, the progression of the diseases, neovascularization may lead to RVV. The redo open surgery is more difficult compared to primary surgery. Besides, the neurovascular injury and the infection incidence of the redo surgery may be higher compared to primary surgery. Nowadays, open surgery, endovenous ablation, sclerotherapy, mechanochemical ablation (N-butyl-cyanoacrylate) may be performed in the treatment of the RVV. According to our experiences, we suggest that when foam sclerotherapy is applied in companion with NIR light and/or DUS it is a reliable, effective and cheaper treatment option that may be considered an alternative to other treatments in the convenient patients for the treatment of RVV.
Anahtar Kelimeler
Recurrent varicose vein Near infrared light Foam sclerotherapy Duplex ultrasonography
Kaynakça
- 1. Brake M, Lim CS, Shepherd AC, Shalhoub J, Davies AH. Pathogenesis and etiology of recurrent varicose veins. Journal of Vascular Surgery. 2013;57(3):860-8.
- 2. Kostas T, Ioannou CV, Touloupakis E, Daskalaki E, Giannoukas AD, Tsetis D, Katsamouris AN. Recurrent varicose veins after surgery: a new appraisal of a common and complex problem in vascular surgery. European Journal of Vascular and Endovascular Surgery. 2004;27(3):275-82.
- 3. Carradice D, Mekako AI, Mazari FAK, Samuel N, Hatfield J, Chetter IC. Clinical and technical outcomes from a randomized clinical trial of endovenous laser ablation compared with conventional surgery for great saphenous varicose veins. British Journal of Surgery. 2011;98(8):1117-23.
- 4. Theivacumar NS, Darwood R, Gough MJ. Neovascularisation and recurrence 2 years after varicose vein treatment for sapheno-femoral and great saphenous vein reflux: a comparison of surgery and endovenous laser ablation. European Journal of Vascular and Endovascular Surgery. 2009;38(2):203-7.
- 5. Negus D. Recurrent varicose veins: a national problem. British Journal of Surgery. 1993;80(7):823-4.
- 6. Brown KR, Rossi PJ. Superficial venous disease. Surgical Clinics. 2013;93(4): 963-982.
- 7. Gloviczki P, Gloviczki ML. Guidelines for the management of varicose veins. Phlebology. 2012;27(1):2-9.
- 8. Belardi P, Lucertini G. Advantages of the lateral approach for re-exploration of the sapheno-femoral junction for recurrent varicose veins. Cardiovascular Surgery. 1994;2(6):772-4.
- 9. Egan B, Donnelly M, Bresnihan M, Tierney S, Feeley M. Neovascularization: an “innocent bystander” in recurrent varicose veins. Journal of Vascular Surgery. 2006;44(6):1279-84.
- 10. Van Rij AM, Jones GT, Hill GB, Jiang P. Neovascularization and recurrent varicose veins: more histologic and ultrasound evidence. Journal of Vascular Surgery. 2004;40(2):296-302.
- 11. Fischer R, Linde N, Duff C, Jeanneret C, Chandler JG, Seeber P. Late recurrent saphenofemoral junction reflux after ligation and stripping of the greater saphenous vein. Journal of Vascular Surgery. 2001;34(2):236-40.
- 12. Blomgren L, Johansson G, Emanuelsson L, Dahlberg ÅA, Thermaenius P, Bergqvist D. Late follow up of a randomized trial of routine duplex imaging before varicose vein surgery. British Journal of Surgery. 2011;98(8):1112-6.
- 13. Van Rij AM, Jian, P, Solomon C, Christie RA, Hill GB. Recurrence after varicose vein surgery: a prospective long-term clinical study with duplex ultrasound scanning and air plethysmography. Journal of Vascular Surgery. 2003;38(5):935-43.
- 14. Nelzén O, Fransson I. Varicose vein recurrence and patient satisfaction 10–14 years following combined superficial and perforator vein surgery: a prospective case study. European Journal of Vascular and Endovascular Surgery. 2013;46(3):372-7.
- 15. Boné Salat C. Tratamiento endoluminal de las varices con laser de diodo: estudio preliminar. Rev Patol Vasc. 1999;5:35-46.
- 16. Van den Bos R, Arends L, Kockaert M, Neumann M, Nijsten T. Endovenous therapies of lower extremity varicosities: a meta-analysis. Journal of Vascular Surgery. 2009;49(1):230-9.
- 17. Min RJ, Khilnani N, Zimmet SE. Endovenous laser treatment of saphenous vein reflux: long-term results. Journal of Vascular and Interventional Radiology. 2003;14(8):991-6.
- 18. Disselhoff BCVM, Der Kinderen DJ, Kelder JC, Moll FL. Five-year results of a randomised clinical trial of endovenous laser ablation of the great saphenous vein with and without ligation of the saphenofemoral junction. European Journal of Vascular and Endovascular Surgery. 2011;41(5):685-90.
- 19. Proebstle TM, Gül D, Lehr HA, Kargl A, Knop J. Infrequent early recanalization of greater saphenous vein after endovenous laser treatment. Journal of Vascular Surgery. 2003;38(3):511-6.
- 20. Schanzer H. Endovenous ablation plus microphlebectomy/sclerotherapy for the treatment of varicose veins: single or two-stage procedure?. Vascular and Endovascular Surgery. 2010;44(7):545-9.
- 21. Myers KA, Jolle, D, Clough A, Kirwan J. Outcome of ultrasound-guided sclerotherapy for varicose veins: medium-term results assessed by ultrasound surveillance. European Journal of Vascular and Endovascular Surgery. 2007;33(1):116-21.
- 22. Chapman-Smith P, Browne A. Prospective five-year study of ultrasound-guided foam sclerotherapy in the treatment of great saphenous vein reflux. Phlebology. 2009;24(4):183-8.
- 23. Frullini A, Cavezzi A. Sclerosing foam in the treatment of varicose veins and telangiectases: history and analysis of safety and complications. Dermatologic Surgery. 2002;28(1):11-5.
- 24. Smith PC. Chronic venous disease treated by ultrasound guided foam sclerotherapy. European Journal of Vascular and Endovascular Surgery. 2006;32(5):577-83.
- 25. Kalodiki E, Lattimer CR, Azzam M, Shawish E, Bountouroglou D, Geroulakos G. Long-term results of a randomized controlled trial on ultrasound-guided foam sclerotherapy combined with saphenofemoral ligation vs standard surgery for varicose veins. Journal of Vascular Surgery. 2012;55(2):451-7.
Semptomatik rekürren variköz venlerin tedavisinde near infrared ışık ve dubleks ultrasonografi eşliğinde köpük skleroterapinin etkinliği: Retrospektif kohort çalışma
Öz
Amaç: Büyük safen ven (GSV) ve Small Safen ven (SSV) rekürrensi teknik olarak yetersiz cerrahi ya da yetersiz endovenöz ablasyon ve neovaskülarizasyona bağlı olarak yaygın, maliyetli ve karmaşık bir sorundur. Bu çalışmanın amacı semptomatik rekürren variköz venlerin (RVV) tedavisinde Near Infrared light (NIR) ve/veya Dublex Ultrasonografi (DUS) eşliğinde köpük skleroterapinin etkinliğini ve güvenliğini değerlendirmektir.
Yöntemler: Kliniğimizde nisan 2014- Mayıs 2017 yılları arasında semptomatik RVV nedeniyle köpük skleroterapi ile tedavi edilen 164 hasta (181 bacak) retrospektif olarak incelendi. Hastaların demografik verileri, DUS tarama bulguları, CEAP sınıflaması, perioperatif veriler ve takip muayeneleri kaydedildi.
Bulgular: Hastalarımızın yaş ortalaması 44.79±12.57 ve 76 (%46.3) ‘i kadındı. 145 ektremitedeki RVV’ler açık cerrahi (GSV ligasyon, GSV striping, SSV ligasyon ve flebektomi) sonrası, 36 ekstremiteki RVV’lerin endovenöz ablasyon (Radyofreakans ablasyon, Lazer ablasyon) sonrası geliştiği tespit edilmiştir. RVV sebeb olan reflü patolojilerini incompetent safenofemoral junction (SFJ) ± neovascularizasyon 114 hasta, reflux from incompetent perforator / reflux from pelvic vein 17 hasta, Incompetent safeno popliteal junction (SPJ) ± neovascularizasyon 15 hasta ve combine sebebler 35 hasta olmak üzere 4 grupta değerlendirildi. Hastaların CEAP evreleri C2: 24 ekstremite, C3: 91 ekstremite, C4: 45 ekstremite, C5: 16 ekstremite, C6: 5 ekstremite olarak tespit edildi. Tedavi sonrası 6. ay kontrolünde total oklüzyon 172 (95.02 %) ekstremitede gerçekleşti. Takip süresi boyunca majör komplikasyon görülmedi.
Sonuçlar: RVV’lere taktiksel ve tekniksel hatalar, hastalığın ilerlemesi, neovaskülarizasyon sebeb olabilir. Yeniden açık ameliyatı primer cerrahiye göre daha zordur. Ayrıca redo cerrahinin nörovasküler yaralanma ve enfeksiyon insidansı da primer cerrahiye göre daha yüksek olabilir. Günümüzde RVV tedavisinde açık cerrahi, endovenöz ablasyon, skleroterapi, mekanokimyasal ablasyon(N-Butil Siyanoakrilat) yapılabilir. Deneyimlerimize göre köpük skleroterapi NIR light ve/veya DUS eşliğinde uygulandığında RVV’lerin tedavisi için uygun hastalarda diğer tedavilere alternatif olarak düşünülebilecek güvenli, etkili ve ucuz bir tedavi seçeneneği olduğunu düşünüyoruz.
Anahtar Kelimeler
Recurrent varis Near infrared ışık Köpük skleroterapi Duplex ultrason
Kaynakça
- 1. Brake M, Lim CS, Shepherd AC, Shalhoub J, Davies AH. Pathogenesis and etiology of recurrent varicose veins. Journal of Vascular Surgery. 2013;57(3):860-8.
- 2. Kostas T, Ioannou CV, Touloupakis E, Daskalaki E, Giannoukas AD, Tsetis D, Katsamouris AN. Recurrent varicose veins after surgery: a new appraisal of a common and complex problem in vascular surgery. European Journal of Vascular and Endovascular Surgery. 2004;27(3):275-82.
- 3. Carradice D, Mekako AI, Mazari FAK, Samuel N, Hatfield J, Chetter IC. Clinical and technical outcomes from a randomized clinical trial of endovenous laser ablation compared with conventional surgery for great saphenous varicose veins. British Journal of Surgery. 2011;98(8):1117-23.
- 4. Theivacumar NS, Darwood R, Gough MJ. Neovascularisation and recurrence 2 years after varicose vein treatment for sapheno-femoral and great saphenous vein reflux: a comparison of surgery and endovenous laser ablation. European Journal of Vascular and Endovascular Surgery. 2009;38(2):203-7.
- 5. Negus D. Recurrent varicose veins: a national problem. British Journal of Surgery. 1993;80(7):823-4.
- 6. Brown KR, Rossi PJ. Superficial venous disease. Surgical Clinics. 2013;93(4): 963-982.
- 7. Gloviczki P, Gloviczki ML. Guidelines for the management of varicose veins. Phlebology. 2012;27(1):2-9.
- 8. Belardi P, Lucertini G. Advantages of the lateral approach for re-exploration of the sapheno-femoral junction for recurrent varicose veins. Cardiovascular Surgery. 1994;2(6):772-4.
- 9. Egan B, Donnelly M, Bresnihan M, Tierney S, Feeley M. Neovascularization: an “innocent bystander” in recurrent varicose veins. Journal of Vascular Surgery. 2006;44(6):1279-84.
- 10. Van Rij AM, Jones GT, Hill GB, Jiang P. Neovascularization and recurrent varicose veins: more histologic and ultrasound evidence. Journal of Vascular Surgery. 2004;40(2):296-302.
- 11. Fischer R, Linde N, Duff C, Jeanneret C, Chandler JG, Seeber P. Late recurrent saphenofemoral junction reflux after ligation and stripping of the greater saphenous vein. Journal of Vascular Surgery. 2001;34(2):236-40.
- 12. Blomgren L, Johansson G, Emanuelsson L, Dahlberg ÅA, Thermaenius P, Bergqvist D. Late follow up of a randomized trial of routine duplex imaging before varicose vein surgery. British Journal of Surgery. 2011;98(8):1112-6.
- 13. Van Rij AM, Jian, P, Solomon C, Christie RA, Hill GB. Recurrence after varicose vein surgery: a prospective long-term clinical study with duplex ultrasound scanning and air plethysmography. Journal of Vascular Surgery. 2003;38(5):935-43.
- 14. Nelzén O, Fransson I. Varicose vein recurrence and patient satisfaction 10–14 years following combined superficial and perforator vein surgery: a prospective case study. European Journal of Vascular and Endovascular Surgery. 2013;46(3):372-7.
- 15. Boné Salat C. Tratamiento endoluminal de las varices con laser de diodo: estudio preliminar. Rev Patol Vasc. 1999;5:35-46.
- 16. Van den Bos R, Arends L, Kockaert M, Neumann M, Nijsten T. Endovenous therapies of lower extremity varicosities: a meta-analysis. Journal of Vascular Surgery. 2009;49(1):230-9.
- 17. Min RJ, Khilnani N, Zimmet SE. Endovenous laser treatment of saphenous vein reflux: long-term results. Journal of Vascular and Interventional Radiology. 2003;14(8):991-6.
- 18. Disselhoff BCVM, Der Kinderen DJ, Kelder JC, Moll FL. Five-year results of a randomised clinical trial of endovenous laser ablation of the great saphenous vein with and without ligation of the saphenofemoral junction. European Journal of Vascular and Endovascular Surgery. 2011;41(5):685-90.
- 19. Proebstle TM, Gül D, Lehr HA, Kargl A, Knop J. Infrequent early recanalization of greater saphenous vein after endovenous laser treatment. Journal of Vascular Surgery. 2003;38(3):511-6.
- 20. Schanzer H. Endovenous ablation plus microphlebectomy/sclerotherapy for the treatment of varicose veins: single or two-stage procedure?. Vascular and Endovascular Surgery. 2010;44(7):545-9.
- 21. Myers KA, Jolle, D, Clough A, Kirwan J. Outcome of ultrasound-guided sclerotherapy for varicose veins: medium-term results assessed by ultrasound surveillance. European Journal of Vascular and Endovascular Surgery. 2007;33(1):116-21.
- 22. Chapman-Smith P, Browne A. Prospective five-year study of ultrasound-guided foam sclerotherapy in the treatment of great saphenous vein reflux. Phlebology. 2009;24(4):183-8.
- 23. Frullini A, Cavezzi A. Sclerosing foam in the treatment of varicose veins and telangiectases: history and analysis of safety and complications. Dermatologic Surgery. 2002;28(1):11-5.
- 24. Smith PC. Chronic venous disease treated by ultrasound guided foam sclerotherapy. European Journal of Vascular and Endovascular Surgery. 2006;32(5):577-83.
- 25. Kalodiki E, Lattimer CR, Azzam M, Shawish E, Bountouroglou D, Geroulakos G. Long-term results of a randomized controlled trial on ultrasound-guided foam sclerotherapy combined with saphenofemoral ligation vs standard surgery for varicose veins. Journal of Vascular Surgery. 2012;55(2):451-7.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Cerrahi |
| Bölüm | Araştırma makalesi |
| Yazarlar | |
| Yayımlanma Tarihi | 27 Ocak 2019 |
| Yayımlandığı Sayı | Yıl 2019 Cilt: 3 Sayı: 1 |
