.: ORİJİNAL ARAŞTIRMA
Radyofrekans Ablasyon, Endovenöz Lazer Ablasyon ve N-Butil Siyanoakrilat Embolizasyonu Yapılan Venöz Yetmezlik Hastalarının Doppler Ultrasonografi ile Açıklık Oranlarının Uzun Dönem Karşılaştırılması: Retrospektif Araştırma
Venous Insufficiency with Radiofrequency Ablation, Endovenous Laser Ablation and N-Butil Cyanoacrylate Embolization Long-Term Analysis of Patency Rates with Doppler Ultrasonography of Patients Comparison: Retrospective Research
Turkiye Klinikleri J Cardiovasc Sci. 2021;33(2):54-60
doi: 10.5336/cardiosci.2021-83611
Makale Dili: TR
Tam Metin
ÖZET
Amaç: Alt ekstremite venöz sistem yetersizlikleri, toplumda oldukça yaygın görülen, hayat kalitesinde ve iş gücünde ciddi kayıplara neden olan önemli bir hastalıktır. Bu çalışmamızda, kliniğimizde kronik venöz yetmezlik nedeniyle vena safena magnaya (VSM) radyofrekans ablasyon (RFA), endovenöz lazer ablasyon (EVLA) ve N-butil siyanoakrilat embolizasyonu tedavisi uygulanan hastaların sonuçlarının değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Çalışmaya, Bakırköy Dr. Sadi Konuk Eğitim ve Araştırma Hastanesi Kalp ve Damar Cerrahisi Kliniğine Şubat 2015 ve Şubat 2020 tarihleri arasında başvuran, venöz yetmezliği olan semptomatik 150 hasta dâhil edildi. Seksen (%53,3) hasta kadın, 70 (%46,6) hasta erkek idi. Renkli Doppler ultrasonografi (RDUS) ile VSM çapı kadın hastalarda 5 mm, erkek hastalarda ise 5,5 mm üzerinde olan, reflü süresi 4 sn veya daha uzun olan, VSM'si ciddi derecede tortüyöz olmayan bu hastalara, tek taraflı olmak üzere 50 hastaya RFA (Grup 1) (%33,3), 50 hastaya EVLA (Grup 2) (%33,3) ve 50 hastaya siyanoakrilat ile embolizasyon (Grup 3) (%33,3) uygulandı. Bulgular: Operasyon sonrası 1. sene yapılan RDUS incelemede, 143 (%95,3) hastada VSM tam oklüde iken; 7 (%4,66) hastada %40-60 oranında rekanalizasyon tespit edildi. Grup 1'in 5 yıllık takiplerinde, Grup 2 ve Grup 3'e göre VSM oklüzyon oranları daha yüksek bulunmuştur (%94). Grup 3'ün ise 5 yıllık takiplerinde, Grup 1 ve Grup 2'ye göre %45-65 rekanalizasyon tespit edildi. Sonuç: Retrospektif çalışmamızda, endovenöz tedavi seçenekleri arasında RFA uygulanan hastalarda, uzun dönem sonuçlarında yüksek oklüzyon ve yüksek hasta konforu sağlaması nedeniyle safen ven yetmezliklerinin tedavisinde, diğer tedavi seçeneklerine göre güvenle kullanılabileceği kanaatindeyiz.
Anahtar Kelimeler: Endovenöz lazer ablasyon; N-butil siyanoakrilat embolizasyon; radyofrekans ablasyon; vena safena magna; venöz yetmezlik
Amaç: Alt ekstremite venöz sistem yetersizlikleri, toplumda oldukça yaygın görülen, hayat kalitesinde ve iş gücünde ciddi kayıplara neden olan önemli bir hastalıktır. Bu çalışmamızda, kliniğimizde kronik venöz yetmezlik nedeniyle vena safena magnaya (VSM) radyofrekans ablasyon (RFA), endovenöz lazer ablasyon (EVLA) ve N-butil siyanoakrilat embolizasyonu tedavisi uygulanan hastaların sonuçlarının değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Çalışmaya, Bakırköy Dr. Sadi Konuk Eğitim ve Araştırma Hastanesi Kalp ve Damar Cerrahisi Kliniğine Şubat 2015 ve Şubat 2020 tarihleri arasında başvuran, venöz yetmezliği olan semptomatik 150 hasta dâhil edildi. Seksen (%53,3) hasta kadın, 70 (%46,6) hasta erkek idi. Renkli Doppler ultrasonografi (RDUS) ile VSM çapı kadın hastalarda 5 mm, erkek hastalarda ise 5,5 mm üzerinde olan, reflü süresi 4 sn veya daha uzun olan, VSM'si ciddi derecede tortüyöz olmayan bu hastalara, tek taraflı olmak üzere 50 hastaya RFA (Grup 1) (%33,3), 50 hastaya EVLA (Grup 2) (%33,3) ve 50 hastaya siyanoakrilat ile embolizasyon (Grup 3) (%33,3) uygulandı. Bulgular: Operasyon sonrası 1. sene yapılan RDUS incelemede, 143 (%95,3) hastada VSM tam oklüde iken; 7 (%4,66) hastada %40-60 oranında rekanalizasyon tespit edildi. Grup 1'in 5 yıllık takiplerinde, Grup 2 ve Grup 3'e göre VSM oklüzyon oranları daha yüksek bulunmuştur (%94). Grup 3'ün ise 5 yıllık takiplerinde, Grup 1 ve Grup 2'ye göre %45-65 rekanalizasyon tespit edildi. Sonuç: Retrospektif çalışmamızda, endovenöz tedavi seçenekleri arasında RFA uygulanan hastalarda, uzun dönem sonuçlarında yüksek oklüzyon ve yüksek hasta konforu sağlaması nedeniyle safen ven yetmezliklerinin tedavisinde, diğer tedavi seçeneklerine göre güvenle kullanılabileceği kanaatindeyiz.
Anahtar Kelimeler: Endovenöz lazer ablasyon; N-butil siyanoakrilat embolizasyon; radyofrekans ablasyon; vena safena magna; venöz yetmezlik
ABSTRACT
Objective: Lower extremity venous system insufficiency is an important disease that is quite common in the society and causes serious losses in quality of life and workforce. In this study, we aimed to evaluate the results of patients who received radiofrequency ablation (RFA), endovenous laser ablation (EVLA) and N-butyl cyanoacrylate embolization for chronic venous insufficiency (CVI) to vena saphena magna (VSM) in our clinic. Material and Methods: For the study, 150 symptomatic patients with venous insufficiency who applied to the Cardiovascular Surgery Clinic of Bakırköy Dr. Sadi Konuk Training and Research Hospital between February 2015 and February 2020 were included in the study. 80 (53.3%) patients were female, 70 (46.6%) patients were male. With color Doppler ultrasound, the VSM diameter is 5 mm in female patients and 5.5 mm in male patients, and the reflux duration is 4 seconds or longer, in these patients whose VSM is not severely tortuous, 50 patients were unilateral RFA (Group 1) (33.3%), 50 patients EVLA (Group 2) (33.3%) and 50 patients were embolized with cyanoacrylate (Group 3) (33.3%) was applied. Results: RDUS examination conducted in the 1st year after the operation, while the VSM was completely occluded in 143 (95.3%) patients, recanalization was detected at a rate of 40-60% in 7 (4.66%) patients. In the 5-year follow-up of Group 1, VSM occlusion rates were found to be higher than Group 2 and Group 3 (94%). In the 5-year followup of Group 3, 45-65% recanalization was detected compared to Group 1 and Group 2. Conclusion: In our retrospective study, we believe that it can be used safely in the treatment of saphenous vein insufficiency compared to other treatment options, since it provides high occlusion, and high patient comfort in patients who undergo RFA among the endovenous treatment options.
Keywords: Endovenous laser ablation; N-butyl cyanoacrylate embolization; radiofrequency ablation; vena saphena magna; venous insufficiency
Objective: Lower extremity venous system insufficiency is an important disease that is quite common in the society and causes serious losses in quality of life and workforce. In this study, we aimed to evaluate the results of patients who received radiofrequency ablation (RFA), endovenous laser ablation (EVLA) and N-butyl cyanoacrylate embolization for chronic venous insufficiency (CVI) to vena saphena magna (VSM) in our clinic. Material and Methods: For the study, 150 symptomatic patients with venous insufficiency who applied to the Cardiovascular Surgery Clinic of Bakırköy Dr. Sadi Konuk Training and Research Hospital between February 2015 and February 2020 were included in the study. 80 (53.3%) patients were female, 70 (46.6%) patients were male. With color Doppler ultrasound, the VSM diameter is 5 mm in female patients and 5.5 mm in male patients, and the reflux duration is 4 seconds or longer, in these patients whose VSM is not severely tortuous, 50 patients were unilateral RFA (Group 1) (33.3%), 50 patients EVLA (Group 2) (33.3%) and 50 patients were embolized with cyanoacrylate (Group 3) (33.3%) was applied. Results: RDUS examination conducted in the 1st year after the operation, while the VSM was completely occluded in 143 (95.3%) patients, recanalization was detected at a rate of 40-60% in 7 (4.66%) patients. In the 5-year follow-up of Group 1, VSM occlusion rates were found to be higher than Group 2 and Group 3 (94%). In the 5-year followup of Group 3, 45-65% recanalization was detected compared to Group 1 and Group 2. Conclusion: In our retrospective study, we believe that it can be used safely in the treatment of saphenous vein insufficiency compared to other treatment options, since it provides high occlusion, and high patient comfort in patients who undergo RFA among the endovenous treatment options.
Keywords: Endovenous laser ablation; N-butyl cyanoacrylate embolization; radiofrequency ablation; vena saphena magna; venous insufficiency
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