Efficacy of foam sclerotherapy accompanied by near infrared light and duplex ultrasonography in treatment of symptomatic recurrent varicose veins: A retrospective cohort study

J Surg Med. 2019;3(1):82-87. DOI: 10.28982/josam.517231 Research article Araştırma makalesi Efficacy of foam sclerotherapy accompanied by near infrared light and duplex ultrasonography in treatment of symptomatic recurrent varicose veins: A retrospective cohort study Semptomatik rekürren variköz venlerin tedavisinde near infrared ışık ve dubleks ultrasonografi eşliğinde köpük skleroterapinin etkinliği: Retrospektif kohort çalışma Nail Kahraman 1, Deniz Demir 1 1 Bursa Yüksek Ihtisas Training and Research Hospital, Department of Cardiovasculary Surgery, Bursa, Turkey ORCID ID of the author(s) NK: 0000-0001-9343-0947 DD: 0000-0003-2169-7647 Corresponding author / Sorumlu yazar: Nail Kahraman Address / Adres: Bursa Yüksek Ihtisas Eğitim ve Araştırma Hastanesi, Kalp Damar Cerrahisi Kliniği, Bursa, Türkiye E-mail: ⸺ Ethics Committee Approval: This study approved by Uludag University Medical Faculty Clinical Research Ethics Committee (24 October 2017/2017-15/17). Etik Kurul Onayı: Bu çalışma Uludağ Üniversitesi Tıp Fakültesi Klinik Araştırmalar Etik Kurulu tarafından onaylandı (24 Ekim 2017/2017-15/17). ⸺ Informed Consent: The authors stated that the written consent was obtained from the patients presented with images in the study. Hasta Onamı: Yazar çalışmada görüntüleri sunulan hastalardan yazılı onam alındığını ifade etmiştir. ⸺ Conflict of Interest: No conflict of interest was declared by the authors. Çıkar Çatışması: Yazarlar çıkar çatışması bildirmemişlerdir. ⸺ Financial Disclosure: The authors declared that this study has received no financial support. Finansal Destek: Yazarlar bu çalışma için finansal destek almadıklarını beyan etmişlerdir. ⸺ Received / Geliş Tarihi: 24.01.2019 Accepted / Kabul Tarihi: 25.01.2019 Published / Yayın Tarihi: 25.01.2019 Copyright © 2019 The Author(s) Published by JOSAM This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND 4.0) where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. Abstract 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. Keywords: Recurrent varicose vein, Near infrared light, Foam sclerotherapy, Duplex ultrasonography 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 uygu (...truncated)