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Termal ablasyon, nontermal ablasyon ve cerrahi striping uygulamaları: 1 yıllık tek merkezde erken sonuçlar

Year 2022, Volume: 13 Issue: 47, 417 - 424, 15.12.2022
https://doi.org/10.17944/mkutfd.1121446

Abstract

Amaç: 1990’lı yıllardan başlayarak endovenöz lazer ablasyon (EVLA), radyofrekans ablasyon (RFA) ve ultrason eşliğinde köpük skleroterapi (UGFS) gibi minimal invaziv yöntemler geliştirildi.

Yöntem: Bu çalışma toplam 136 hastayı içermektedir (81 kadın/55 erkek) 22’ (10 kadın/12 erkek) klasik cerrahi stripping, 54’ (32 kadın/22 erkek) termal ablasyon ve 60’ (39 kadın/21 erkek) termal olmayan ablasyon ile tedavi edildi.

Bulgular: Yirmi iki hasta (10 kadın/12 erkek) cerrahi stripping ile tedavi edildi. Bir kadın hastada operasyon sonrasında kruris medialinde hematom meydana geldi. 54 hastada (32 kadın/22 erkek) termal ablasyon işlemlerinde radyofrekans kateter (ThermoBLOCK TM) kullanıldı. Bir kadın hastada işlem sonrası kalıcı parestezi gelişti. 3 erkek hastada ameliyat sonrası geçici parestezi gelişti. 60 hastaya (39 kadın/21 erkek) termal olmayan ablasyon uygulandı. 6 hastada (5 kadın/1 erkek) işlem sırasında şiddetli yanma olmasına rağmen bu semptom geçiciydi. Bir hastada postoperatif altıncı günde popliteal ven düzeyinde derin ven trombozu (DVT) gelişti.

Sonuç: Termal ve termal olmayan ablasyon ve cerrahi işlemler aynı ağrı azaltma oranlarına sahip olsa da cerrahi işlemlerde hematomlar ve hastanede daha uzun süre kalış daha sık görülür.

References

  • Youn YJ, Lee J. Chronic venous insufficiency and varicose veins of the lower extremities. Korean J Intern Med. 2019;34(2):269-283. https://doi.org/10.3904/kjim.2018.230.
  • Callam MJ. Epidemiology of varicose veins. Br J Surg. 1994 Feb;81(2):167-73. https://doi.org/10.1002/bjs.1800810204.
  • Baliyan V, Tajmir S, Hedgire SS, Ganguli S, Prabhakar AM. Lower extremity venous reflux. Cardiovasc Diagn Ther. 2016;6(6):533-543. https://doi.org/10.21037/cdt.2016.11.14.
  • Evans CJ, Fowkes FG, Ruckley CV, Lee AJ. Prevalence of varicose veins and chronic venous insufficiency in men and women in the general population: Edinburgh Vein Study. J Epidemiol Community Health. 1999 Mar;53(3):149-53. https://doi. org/10.1136/jech.53.3.149.
  • Patel SK, Surowiec SM. Venous Insufficiency. [Updated 2021 Dec 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www. ncbi.nlm.nih.gov/books/NBK430975/
  • Beyaz MO, Bozkurt E, Onalan MA, et al. Evaluation of chronic inflammation in the aetiology of venous insufficiency by investigating cytomegalovirus DNA. Arch Med Sci. 2019;18(1):129-132. Published 2019 May 17. https://doi. org/10.5114/aoms.2019.85232.
  • Rosales A, Slagsvold CE, Jørgensen JJ, Sandbaek G. Kirurgi ved kronisk venøs insuffisiens [Surgical treatment of chronic venous insufficiency]. Tidsskr Nor Laegeforen. 2009 Nov 19;129(22):2378-80. Norwegian. https://doi.org/10.4045/tidsskr.09.0204.
  • Sam RC, Silverman SH, Bradbury AW. Nerve injuries and varicose vein surgery. Eur J Vasc Endovasc Surg. 2004 Feb;27(2):113-20. https://doi.org/10.1016/j.ejvs.2003.11.007.
  • Alavi A, Sibbald RG, Phillips TJ, Miller OF, Margolis DJ, Marston W, Woo K, Romanelli M, Kirsner RS. What’s new: Management of venous leg ulcers: Treating venous leg ulcers. J Am Acad Dermatol. 2016 Apr;74(4):643-64; quiz 665-6. https://doi. org/10.1016/j.jaad.2015.03.059.
  • Amshar M, Nugraha RA, Batubara EAD, Siddiq T, Indriani S, Adiarto S. Cyanoacrylate Embolization versus Endovenous Laser Ablation in Treating Saphenous Vein Insufficiency: A Systematic Review and Meta-Analysis. Ann Vasc Surg. 2021 Nov 12:S0890-5096(21)00820-7. https://doi.org/10.1016/j. avsg.2021.09.041. Epub ahead of print.
  • Almeida JI, Javier JJ, Mackay E, et. al.: First human use of cyanoacrylate adhesive for treatment of saphenous vein incompetence. J Vasc Surg Venous Lymphat Disord [Internet] 2013; 1: pp. 174-180.
  • Beyaz MO, Oztas DM, Ulukan MO, Arslan HM, Unal O, Ugurlucan M. Preliminary Results of a New Illuminated Radiofrequency Ablation Catheter for the Treatment of Great Saphenous Vein Reflux Disease. Surg Innov. 2021 May 27:15533506211021806. https://doi.org/10.1177/15533506211021806. Epub ahead of print.
  • Medical Advisory Secretariat. Endovascular radiofrequency ablation for varicose veins: an evidence-based analysis. Ont Health Technol Assess Ser. 2011;11(1):1-93.
  • Bozkurt AK, Lawaetz M, Danielsson G, Lazaris AM, Pavlovic M, Olariu S, Rasmussen L. European College of Phlebology guideline for truncal ablation. Phlebology. 2020 Mar;35(2):73-83. https://doi.org/10.1177/0268355519857362. Epub 2019 Jun 27.
  • Beebe-Dimmer JL, Pfeifer JR, Engle JS, Schottenfeld D. The epidemiology of chronic venous insufficiency and varicose veins. Ann Epidemiol. 2005 Mar;15(3):175-84. https://doi. org/10.1016/j.annepidem.2004.05.015.
  • Beyaz, M. O. ve Ata, E. C. (2021). Effects of diosmin-hesperidin and low pressure compression stocking combination in superficial venous insufficiency. Annals of Medical Research, 28(1), 132-135. https://dx.doi.org/10.5455/annalsmedres.2020.06.624
  • Ontario Health (Quality) . Nonthermal Endovenous Procedures for Varicose Veins: A Health Technology Assessment. Ont Health Technol Assess Ser. 2021;21(8):1-188. Published 2021 Jun 4.
  • Rosales A, Slagsvold CE, Jørgensen JJ, Sandbaek G. Kirurgi ved kronisk venøs insuffisiens [Surgical treatment of chronic venous insufficiency]. Tidsskr Nor Laegeforen. 2009 Nov 19;129(22):2378-80. Norwegian. https://doi.org/10.4045/tidsskr.09.0204.
  • Woo HY, Kim SM, Kim D, Chung JK, Jung IM. Outcome of ClosureFAST radiofrequency ablation for large-diameter incompetent great saphenous vein. Ann Surg Treat Res. 2019 Jun;96(6):313-318. https://doi.org/10.4174/astr.2019.96.6.313. Epub 2019 May 29.
  • Gloviczki P, Comerota AJ, Dalsing MC, Eklof BG, Gillespie DL, Gloviczki ML, Lohr JM, McLafferty RB, Meissner MH, Murad MH, Padberg FT, Pappas PJ, Passman MA, Raffetto JD, Vasquez MA, Wakefield TW; Society for Vascular Surgery; American Venous Forum. The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 2011 May;53(5 Suppl):2S-48S. https://doi. org/10.1016/j.jvs.2011.01.079.
  • Mendes CA, Martins AA, Fukuda JM, et al. Randomized trial of radiofrequency ablation versus conventional surgery for superficial venous insufficiency: if you don’t tell, they won’t know. Clinics. 2016;71(11):650-656.
  • Tamura K, Maruyama T, Sakurai S. Effectiveness of endovenous radiofrequency ablation for elderly patients with varicose veins of lower extremities. Ann Vasc Dis. 2019; 12(2):200-204.
  • Hamann SAS, Timmer-de Mik L, Fritschy WM, Kuiters GRR, Nijsten TEC, van den Bos RR. Randomized clinical trial of endovenous laser ablation versus direct and indirect radiofrequency ablation for the treatment of great saphenous varicose veins. Br J Surg. 2019;106(8):998-1004.
  • Jones WS, Vemulapalli S, Parikh KS, et al. Treatment Strategies for Patients with Lower Extremity Chronic Venous Disease (LECVD). Rockville (MD): Agency for Healthcare Research and Quality (US); April 6, 2017.
  • Chokkalingam Mani B, Delgado GA. Varicose Veins Radiofrequency Ablation Therapy. In: StatPearls. Treasure Island (FL): StatPearls Publishing; September 28, 2021.

Thermal ablation, nonthermal ablation and surgical striping applications: 1-year single center early results

Year 2022, Volume: 13 Issue: 47, 417 - 424, 15.12.2022
https://doi.org/10.17944/mkutfd.1121446

Abstract

Objective: Starting from the 1990’s minimally invasive methods such as endovenous laser ablation (EVLA), radiofrequency ablation (RFA), and ultrasound-guided foam sclerotherapy (UGFS) developed.

Method: This study includes a total of 136 patients (81 women/55 men), of whom 22 (10 women/12 men) were treated with classic surgical stripping, 54 (32 women/22 men) with thermal ablation and 60 (39 women/21 men) with non-thermal ablation.

Results: Twenty-two patients (10 women/12 men) were treated with surgical stripping. In one female patient a hematoma arose in the medial crural region postoperatively. A radiofrequency catheter (ThermoBLOCK TM) was used in the thermal ablation procedures in 54 patients (32 female/22 male). While permanent paresthesia occurred in one female patient after the procedure, temporary paresthesia occurred in 3 male patients postoperatively. Non-thermal ablation was performed in 60 patients (39 female/21 male). Even through a severe burning sensation was present in 6 patients (5 female/1 male) during the procedure, this symptom was only transient. In one of the patients, deep venous thrombosis (DVT) occurred at the level of the popliteal vein postoperatively at the sixth day.

Conclusion: Even if thermal and non-thermal ablation and surgical procedures have the same pain decreasing rates, hematomas and a longer hospital stay are more frequent in surgical procedures.

References

  • Youn YJ, Lee J. Chronic venous insufficiency and varicose veins of the lower extremities. Korean J Intern Med. 2019;34(2):269-283. https://doi.org/10.3904/kjim.2018.230.
  • Callam MJ. Epidemiology of varicose veins. Br J Surg. 1994 Feb;81(2):167-73. https://doi.org/10.1002/bjs.1800810204.
  • Baliyan V, Tajmir S, Hedgire SS, Ganguli S, Prabhakar AM. Lower extremity venous reflux. Cardiovasc Diagn Ther. 2016;6(6):533-543. https://doi.org/10.21037/cdt.2016.11.14.
  • Evans CJ, Fowkes FG, Ruckley CV, Lee AJ. Prevalence of varicose veins and chronic venous insufficiency in men and women in the general population: Edinburgh Vein Study. J Epidemiol Community Health. 1999 Mar;53(3):149-53. https://doi. org/10.1136/jech.53.3.149.
  • Patel SK, Surowiec SM. Venous Insufficiency. [Updated 2021 Dec 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www. ncbi.nlm.nih.gov/books/NBK430975/
  • Beyaz MO, Bozkurt E, Onalan MA, et al. Evaluation of chronic inflammation in the aetiology of venous insufficiency by investigating cytomegalovirus DNA. Arch Med Sci. 2019;18(1):129-132. Published 2019 May 17. https://doi. org/10.5114/aoms.2019.85232.
  • Rosales A, Slagsvold CE, Jørgensen JJ, Sandbaek G. Kirurgi ved kronisk venøs insuffisiens [Surgical treatment of chronic venous insufficiency]. Tidsskr Nor Laegeforen. 2009 Nov 19;129(22):2378-80. Norwegian. https://doi.org/10.4045/tidsskr.09.0204.
  • Sam RC, Silverman SH, Bradbury AW. Nerve injuries and varicose vein surgery. Eur J Vasc Endovasc Surg. 2004 Feb;27(2):113-20. https://doi.org/10.1016/j.ejvs.2003.11.007.
  • Alavi A, Sibbald RG, Phillips TJ, Miller OF, Margolis DJ, Marston W, Woo K, Romanelli M, Kirsner RS. What’s new: Management of venous leg ulcers: Treating venous leg ulcers. J Am Acad Dermatol. 2016 Apr;74(4):643-64; quiz 665-6. https://doi. org/10.1016/j.jaad.2015.03.059.
  • Amshar M, Nugraha RA, Batubara EAD, Siddiq T, Indriani S, Adiarto S. Cyanoacrylate Embolization versus Endovenous Laser Ablation in Treating Saphenous Vein Insufficiency: A Systematic Review and Meta-Analysis. Ann Vasc Surg. 2021 Nov 12:S0890-5096(21)00820-7. https://doi.org/10.1016/j. avsg.2021.09.041. Epub ahead of print.
  • Almeida JI, Javier JJ, Mackay E, et. al.: First human use of cyanoacrylate adhesive for treatment of saphenous vein incompetence. J Vasc Surg Venous Lymphat Disord [Internet] 2013; 1: pp. 174-180.
  • Beyaz MO, Oztas DM, Ulukan MO, Arslan HM, Unal O, Ugurlucan M. Preliminary Results of a New Illuminated Radiofrequency Ablation Catheter for the Treatment of Great Saphenous Vein Reflux Disease. Surg Innov. 2021 May 27:15533506211021806. https://doi.org/10.1177/15533506211021806. Epub ahead of print.
  • Medical Advisory Secretariat. Endovascular radiofrequency ablation for varicose veins: an evidence-based analysis. Ont Health Technol Assess Ser. 2011;11(1):1-93.
  • Bozkurt AK, Lawaetz M, Danielsson G, Lazaris AM, Pavlovic M, Olariu S, Rasmussen L. European College of Phlebology guideline for truncal ablation. Phlebology. 2020 Mar;35(2):73-83. https://doi.org/10.1177/0268355519857362. Epub 2019 Jun 27.
  • Beebe-Dimmer JL, Pfeifer JR, Engle JS, Schottenfeld D. The epidemiology of chronic venous insufficiency and varicose veins. Ann Epidemiol. 2005 Mar;15(3):175-84. https://doi. org/10.1016/j.annepidem.2004.05.015.
  • Beyaz, M. O. ve Ata, E. C. (2021). Effects of diosmin-hesperidin and low pressure compression stocking combination in superficial venous insufficiency. Annals of Medical Research, 28(1), 132-135. https://dx.doi.org/10.5455/annalsmedres.2020.06.624
  • Ontario Health (Quality) . Nonthermal Endovenous Procedures for Varicose Veins: A Health Technology Assessment. Ont Health Technol Assess Ser. 2021;21(8):1-188. Published 2021 Jun 4.
  • Rosales A, Slagsvold CE, Jørgensen JJ, Sandbaek G. Kirurgi ved kronisk venøs insuffisiens [Surgical treatment of chronic venous insufficiency]. Tidsskr Nor Laegeforen. 2009 Nov 19;129(22):2378-80. Norwegian. https://doi.org/10.4045/tidsskr.09.0204.
  • Woo HY, Kim SM, Kim D, Chung JK, Jung IM. Outcome of ClosureFAST radiofrequency ablation for large-diameter incompetent great saphenous vein. Ann Surg Treat Res. 2019 Jun;96(6):313-318. https://doi.org/10.4174/astr.2019.96.6.313. Epub 2019 May 29.
  • Gloviczki P, Comerota AJ, Dalsing MC, Eklof BG, Gillespie DL, Gloviczki ML, Lohr JM, McLafferty RB, Meissner MH, Murad MH, Padberg FT, Pappas PJ, Passman MA, Raffetto JD, Vasquez MA, Wakefield TW; Society for Vascular Surgery; American Venous Forum. The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 2011 May;53(5 Suppl):2S-48S. https://doi. org/10.1016/j.jvs.2011.01.079.
  • Mendes CA, Martins AA, Fukuda JM, et al. Randomized trial of radiofrequency ablation versus conventional surgery for superficial venous insufficiency: if you don’t tell, they won’t know. Clinics. 2016;71(11):650-656.
  • Tamura K, Maruyama T, Sakurai S. Effectiveness of endovenous radiofrequency ablation for elderly patients with varicose veins of lower extremities. Ann Vasc Dis. 2019; 12(2):200-204.
  • Hamann SAS, Timmer-de Mik L, Fritschy WM, Kuiters GRR, Nijsten TEC, van den Bos RR. Randomized clinical trial of endovenous laser ablation versus direct and indirect radiofrequency ablation for the treatment of great saphenous varicose veins. Br J Surg. 2019;106(8):998-1004.
  • Jones WS, Vemulapalli S, Parikh KS, et al. Treatment Strategies for Patients with Lower Extremity Chronic Venous Disease (LECVD). Rockville (MD): Agency for Healthcare Research and Quality (US); April 6, 2017.
  • Chokkalingam Mani B, Delgado GA. Varicose Veins Radiofrequency Ablation Therapy. In: StatPearls. Treasure Island (FL): StatPearls Publishing; September 28, 2021.
There are 25 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Original Articles
Authors

Metin Onur Beyaz 0000-0001-9338-8152

Senem Urfalı 0000-0003-4500-2408

Onur Koyuncu 0000-0002-0282-181X

İyad Fansa 0000-0002-5390-5511

Publication Date December 15, 2022
Submission Date June 1, 2022
Acceptance Date October 28, 2022
Published in Issue Year 2022 Volume: 13 Issue: 47

Cite

Vancouver Beyaz MO, Urfalı S, Koyuncu O, Fansa İ. Thermal ablation, nonthermal ablation and surgical striping applications: 1-year single center early results. mkutfd. 2022;13(47):417-24.