Vasküler Yaralar: Venöz Yetmezlikte Cerrahi ve Girişimsel Radyolojik Yöntemler
Özet
Bu metinde, kronik venöz yetmezlik tedavisinde kullanılan cerrahi ve girişimsel radyolojik yöntemler detaylıca ele alınmaktadır. Tedavinin temel amaçları semptomları gidermek, hastalığın ilerlemesini ve uzun dönem komplikasyonları önlemek ile en iyi kozmetik sonuçları elde etmektir. Cerrahi yöntemler arasında tarihsel standart olan high ligasyon ve stripping'in yanı sıra perforan ven ligasyonu, flebektomi, TIPP, ASVAL ve CHIVA teknikleri yer almaktadır. Son yıllarda ise geleneksel cerrahiye alternatif olarak daha az invaziv olan girişimsel radyolojik yöntemler ön plana çıkmaktadır. Bu yöntemler skleroterapi (sıvı veya köpük), transkutanöz lazer ve perkutanöz endovenöz tedavileri (EVLA, RFA, mekanokimyasal ablasyon ve siyanoakrilat enjeksiyonu) kapsamaktadır. Özellikle endovenöz termal ablasyon yöntemleri (EVLA ve RFA), büyük safen ven yetmezliği tedavisinde cerrahi kadar yüksek uzun dönem etkinliğe sahip olup, daha az ağrı, daha kısa iyileşme süresi ve daha az komplikasyon riski sunduğu için kılavuzlarda ilk seçenek olarak önerilmektedir. İşlemler sırasında perivenöz dokuları ısıdan korumak ve konfor sağlamak amacıyla ultrason eşliğinde lokal tümesan anestezi uygulanmaktadır. Tedavi sonrasında DVT riskini azaltmak için hastaların hemen yürütülmesi ve varis çorabı kullanımı tavsiye edilirken, takip süreçleri Doppler ultrasonografi ile yürütülmektedir.
This text comprehensively examines the surgical and interventional radiological methods used in the treatment of chronic venous disease, aiming to alleviate symptoms, prevent disease progression and long-term complications, and achieve the best cosmetic outcomes. Surgical methods include traditional high ligation and stripping, perforator vein ligation, phlebectomy, TIPP, ASVAL, and CHIVA techniques, whereas interventional radiological methods encompass sclerotherapy (liquid or foam), transcutaneous laser, and percutaneous endovenous therapies such as endovenous laser ablation (EVLA), radiofrequency ablation (RFA), mechanochemical ablation, and cyanoacrylate injection. Endovenous thermal ablation techniques (EVLA and RFA) have become the preferred first-line treatment choices in guidelines for great saphenous vein insufficiency because they offer long-term efficacy equal to surgery but carry lower risks of complications, less postoperative pain, and shorter recovery periods. During these thermal procedures, ultrasound-guided local tumescent anesthesia is meticulously applied to protect perivenous tissues from heat damage, minimize pain, and empty the vein. Following the intervention, immediate ambulation and the use of compression stockings are recommended to mitigate the risk of deep vein thrombosis, while the recovery and ablation success are routinely monitored via periodic Doppler ultrasonography examinations.
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