Vasküler Yaralar: Venöz Ülserler
Özet
Venöz ülserler, venöz hipertansiyon zemininde gelişen ve diz ile ayak bileği arasında, özellikle medial yüzde görülen açık yaralardır. Tüm bacak ülserlerinin yaklaşık %80'ini oluşturarak gelişmiş ülkelerde ciddi halk sağlığı problemi ve iş gücü kaybı yaratırlar. Patofizyolojisinde venöz reflü, obstrüksiyon, kapak yetmezliği ve azalmış kas pompa fonksiyonu rol oynar. İleri yaş, obezite, derin ven trombozu (DVT) ve gebelik başlıca risk faktörleridir. Cerrahi veya endovenöz girişimler sonrası varis rekürens oranları yüksektir ve bu durum REVAS veya PREVAIT olarak tanımlanır; nedenleri arasında taktiksel/teknik hatalar, neovaskülarizasyon ve hastalık progresyonu yer alır. Akut DVT sonrası olguların %20-50'sinde yaşam kalitesini düşüren Post-Trombotik Sendrom (PTS) gelişebilir. PTS ciddiyeti Villalta-Prandoni skorlaması ile değerlendirilir; venöz hipertansiyonun yol açtığı kapiller basınç artışı ödem, hiperpigmentasyon ve ülserlere neden olur. Asemptomatik iliofemoral obstrüksiyonlarda konservatif tedaviler (kompresyon çorapları/cihazları) tercih edilirken, semptomatik hastalarda görüntüleme (USG, BT/MR venografi) sonrası girişimsel tedaviler uygulanır. Endovenöz anjiyoplasti ve metalik stentleme, düşük morbidite ve yüksek uzun dönem açık kalım oranlarıyla cerrahiye tercih edilen, güvenli ve minimal invaziv yöntemlerdir. Ayrıca dıştan bası, Klippel-Trenaunay, Parkes-Weber ve May-Thurner sendromları da kronik venöz obstrüksiyona yol açan diğer önemli nedenler ve anatomik varyasyonlar arasında yer almaktadır.
Venous ulcers are open sores that develop on the basis of venous hypertension, typically localized on the medial aspect between the knee and ankle joints. Accounting for approximately 80% of all leg ulcers, they present a serious public health problem and cause significant labor loss in developed countries. Venous reflux, obstruction, valvular incompetence, and decreased muscle pump function play roles in their pathophysiology. Advanced age, obesity, deep vein thrombosis (DVT), and pregnancy are the primary risk factors. Varicose vein recurrence rates after surgery or endovenous interventions are high, defined as REVAS or PREVAIT, and are caused by tactical/technical errors, neovascularization, and disease progression. Post-Thrombotic Syndrome (PTS), which lowers quality of life, can develop in 20-50% of cases within 1-2 years after acute DVT, and its severity is evaluated using the Villalta-Prandoni scoring system. Increased capillary pressure caused by venous hypertension leads to edema, hyperpigmentation, and ulcers. Conservative treatments (compression stockings/devices) are preferred in asymptomatic iliofemoral obstructions, whereas symptomatic patients undergo interventional treatments following detailed imaging (USG, CT/MR venography). Endovenous angioplasty and metallic stenting are safe, minimally invasive methods preferred over surgery due to low morbidity and high long-term patency rates. Additionally, extrinsic compression, Klippel-Trenaunay, Parkes-Weber, and May-Thurner syndromes constitute other important causes and anatomical variants leading to chronic venous obstruction.
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