YÜZEYEL VARİSLERDE N-BUTİL SİYANOAKRİLAT İLE SKLEROTERAPİ SONUÇLARIMIZ

Year 2021, Volume: 23 Issue: 3, 627 - 634, 31.12.2021

Ali Bolat Yıldırım Gültekin Hüseyin Gemalmaz

https://doi.org/10.24938/kutfd.1006506

Abstract

Amaç: Varis, kronik venöz yetmezlik sonrası daha çok alt eksremitede ortaya çıkan ve toplumda yaygın olarak görülen; tromboflebit ve derin ven trombozu gibi ciddi komplikasyonlara neden olabildiği gibi, kozmetik sorunlara da neden olan bir patolojidir. Bu çalışmanın amacı küçük çaplı varikoz venlerin (1-3 mm) n-butil-siyanoakrilatla yapılan skleroterapi sonuçlarını paylaşmaktır.

Gereç ve Yöntemler: Ocak 2017 ve Ağustos 2019 yılları arasında varis nedeniyle n-butil-siyanoakrilat kullanılarak skleroterapi yapılan 90 hastanın dosyaları geriye dönük incelendi. Hastaların demografik özellikleri, şikayetleri, venöz renkli Doppler ultrasonografi raporları, işlem sonrası komplikasyonlar ve hasta memnuniyet sonuçları retrospektif olarak incelendi.

Bulgular: Hastaların yaş aralığı 20 ile 60 yıl arasında değişmekteydi. Bunlardan 70’i kadın, 20’si erkekti. İşlem yapılan 90 hastanın 85’inde tam oklüzyon sağlandı. 5 hastada geriye kalan telenjektazik varisler ekzovenöz lazer uygulamasıyla tedavi edildi. Hiçbir hastada cilt nekrozu görülmedi. Üç hastada tromboflebit ve 4 hastada hiperpigmentasyon geliştiği görüldü. Derin ven trombozu ve anafilaktik reaksiyon gelişmedi. Takipte uygulama yerinde nüks görülmedi. Hasta memnuniyeti %94.4 olarak yüksek düzeyde saptandı. Varislerin kapatılması için ortalama 1-3 seans tedavi uygulandı.

Sonuç: N-butil-siyanoakrilat, varis lümenini hızlı bir şekilde kapatması, nüks ve komplikasyonların az olması ve hasta memnuniyetinin yüksek olması nedeniyle varis tedavisinde skleroterapi uygulamasında iyi bir alternatif ajan olarak kullanılabilir.

Keywords

Skleroterapi, varis, n-butil-siyanoakrilat

Supporting Institution

YOK

Project Number

YOK

Our Sclerotherapy Results with N-Butyl-Cyanoacrylate in Superficial Varices

Abstract

Objective: Varicose veins occur mostly in the lower extremities after chronic venous insufficiency and are common in the society. It is a pathology that can cause serious complications such as thrombophlebitis and deep vein thrombosis, as well as cosmetic problems. The aim of this study is to share the results of sclerotherapy of small varicose veins with n-butyl-cyanoacrylate.

Material and Methods: The files of 90 patients who underwent sclerotherapy using n-butyl-cyanoacrylate for varicose veins between January 2017 and August 2019 were reviewed retrospectively. Demographic characteristics of the patients, complaints, venous color Doppler ultrasonography reports, postoperative complications and patient satisfaction results were retrospectively analyzed.

Results: The age of the patients ranged from 20 to 60 years. Of these, 70 were women and 20 were men. Complete occlusion was achieved in 85 of 90 patients who underwent the procedure. The remaining telangiectatic varices in 5 patients were treated with exovenous laser application. Skin necrosis was not observed in any patient. Thrombophlebitis was observed in 3 patients and hyperpigmentation was observed in 4 patients. Deep vein thrombosis and anaphylactic reaction did not develop. No recurrence was observed at the application site during follow-up. Patient satisfaction was found to be high at 94.4%. An average of 1-3 sessions of treatment was applied to occlude the varicose veins.

Conclusion: N-butyl-cyanoacrylate can be used as a good alternative agent in sclerotherapy because it closes the varicose lumen quickly, recurrence and complications are low, and patient satisfaction is high.

Keywords

Sclerotherapy, Varicose veins, N-butyl-cyanoacrylate

Project Number

YOK

References

• 1. Beebe-Dimmer JL, Pfeifer JR, Engle JS, Schottenfeld D. The epidemiology of chronic venous insufficiency and varicose veins. Ann Epidemiol. 2005;15(3):175-84.
• 2. Allan PL, Bradbury AW, Evans CJ, Vaughan Rucley C, Fowkes FVR. Patterns of reflux and severity of varicose veins in the general population-Edinburgh Vein Study. Eur J Vasc Endovasc Surg. 2000;20(5):470-7.
• 3. Chiesa R, Marone EM, Limoni C, Volonte M, Schaefer E, Petrini O. Chronic venous insufficiency in Italy: the 24-cities cohort study. Eur J Vasc Endovasc Surg. 2005;30(4):422-9.
• 4. Nicolaides AN, Allegra C, Bergan J, Bradbury A, Cairols M, Carpantier P et al. Management of chronic venous disorders of the lower limbs: Guidelines according to scientific evidence. International Angiology. 2008;27(1):1–59
• 5. 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. Arnold, 2001:49–57.
• 6. Pappas PJ, Duran 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. Arnold, 2001:58–67.
• 7. Gschwandtner ME, Ehringer H. Microcirculation in chronic venous insufficiency. Vasc Med. 2001:6(1):169-79.
• 8. Mattos MA, Sumner DS. Direct noninvasive tests (duplex scan) for the evaluation of chronic venous obstruction and valvular incompetence. In: Gloviczki P, Yao JS, eds. Handbook of Venous Disorders. 2nd ed. New York. Arnold, 2001;120–31.
• 9. 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(1):13–20.
• 10. Puggioni A, Kalra M, Carmo M, Mozes G, Gloviczki P. Endovenous laser therapy and radiofrequency ablation of the great saphenous vein: analysis of early efficacy and complications. J Vasc Surg. 2005;42(3):488-93.
• 11. Santler B, Goerge T. Chronic venous insufficiency - a review of pathophysiology, diagnosis, and treatment. J Dtsch Dermatol Ges. 2017;15(5):538-56.
• 12. Çalık ES, Arslan Ü, Ayaz F, Tort M, Yıldız Z, Aksu V et al. N-butyl cyanoacrylate in the treatment of venous insufficiency--the effect of embolisation with ablative polymerisation. Vasa. 2016;45(3):241-6.
• 13. Premnath KPB, Joy B, Raghavendra VA, Toms A, Sleeba T. Cyanoacrylate adhesive embolization and sclerotherapy for primary varicose veins. Phlebology. 2018;33(8):547-57.
• 14. Rabe E, Pannier -Fisher F, Gerlach H, Breu FX, Guggenbıchler S, Zabel M. Guidelines for sclerotherapy of varicose veins (ICD 10: I83.0, I83.1, I83.2, and I83.9) Dermatol Surg. 2004;30(5):687-93.
• 15. Carlin MC, Ratz JL. Treatment of Telangiectasia: Comparison of Sclerosing Agents. J. Dermatol. Surg Oncol. 1987:13(11);1181-86.
• 16. Alos J, Carreno P, Jopez JA, Estadella B, Serra-Prat M, Marinel-jo L. Efficacy and safety of sclerotherapy using polidocanol foam: A controlled clinical trial. European Journal of Vascular and Endovascular Surgery. Vasc Endovasc Surg. 2006;31(1):101-7.
• 17. Morrison N. Laser 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. Edward Arnold, 2009;37:418-28.
• 18. Pujari-Palmer M, Guo H, Wenner D, Autefage H, Spicer CD, Stevens MM et al. A Novel Class of Injectable Bioceramics that Glue Tissues and Biomaterials. Materials (Basel). 2018;11(12):2492-507.
• 19. Balcıoğlu S. Alifatik yapıdaki izosiyanatlarla şeker temelli yapıştırıcı poliüretan sentezi ve in-vitro biyouyumluluk özelliklerinin incelenmesi (Tez). Malatya. İnönü Üniversitesi Fen Bilimleri Enstitüsü, 2015.
• 20. Çelik D. Tavşanlarda septal kartilajın anterior nazal spina’ya tespiti için kullanılan n-butil-2 siyanoakrilat (histoacryl) etkinliği ve histopatolojik değerlendirilmesi (Tez). İstanbul. Şişli Etfal Eğitim ve Araştırma Hastanesi II. Kulak Burun Boğaz ve Baş Boyun Cerrahisi Kliniği, 2006.
• 21. Bhalla RK, Lesser THC. Simple, painless, cosmetic closure of endaural incisions. The J Laryngol Otol. 2003;117(1):67-8.
• 22. Matras H. Fibrin seal: The state of the art. Joral Maxillofacial Surg.1985:43(8):605-11.
• 23. Toriumi DM, Raslan WF, Friedman M, Tardy E. Histotoxicity of cyanoacrylate tissue adhesives. Arch Otolaryngol Head Neck Surg. 1990;116(5):546-50.
• 24. Ovalı C. Safen ven yetmezliklerinin n-butil siyanoakrilat embolizasyonu ile tedavisi: tek merkez bulguları. Cukurova Med J. 2018;43(4):886-91.
• 25. Guex JJ, Allaert FA, Gillet JL, Chleir F. Immediate and midterm complications of sclerotherapy: report of a prospective multicenter registry of 12,173 sclerotherapy sessions. Dermatol Surg. 2005;31(2):123-8.
• 26. Rabe E, Pannier F. Sclerotherapy of varicose veins with polidocanol based on the guidelines of the German Society of Phlebology. Dermatol Surg. 2010;36(2):968-75.
• 27. Chan YC, Law Y, Cheung GC, Cheng SW. Predictors of recanalization for incompetent great saphenous veins treated with cyanoacrylate glue. J Vasc Interv Radiol. 2017;28(5):665-71.
• 28. Kavala AA, Türkyılmaz S. Telenjiektazik venlerde skleroterapi ve komplikasyonları. Bakırköy Tıp Dergisi. 2018;14(1):222-5.
• 29. Watson JJ, Mansour MA. Cosmetic sclerotherapy. J Vasc Surg Venous Lymphat Disord. 2017;5(3):437-45.
• 30. Rabe E, Breu EF, Cavezzi A, Coleridge Smith P, Frullini A, Gillet JL et al. European guidelines for sclerotherapy in chronic venous disorders. Phlebology. 2014; 29(6):338-54.