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Please use this identifier to cite or link to this item: http://hdl.handle.net/20.500.12710/13960
Title: Tratamentul refluxului safenian prin scleroterapie cu spumă transcateter: indicaţii, aspecte tehnice şi rezultate clinice
Other Titles: Treatment of saphenous reflux through transcatheter foam sclerotherapy: indications, technical issues and clinical results
Authors: Culiuc, V.
Casian, D.
Guţu, E.
Issue Date: 2015
Publisher: Asociaţia chirurgilor “Nicolae Anestiadi” din Republica Moldova
Citation: CULIUC, V., CASIAN, D., GUŢU, E. Tratamentul refluxului safenian prin scleroterapie cu spumă transcateter:indicaţii, aspecte tehnice şi rezultate clinice = Treatment of saphenous reflux through transcatheter foam sclerotherapy: indications, technical issues and clinical results. In: Arta Medica. 2015, nr. 3(56), p. 141-142. ISSN 1810-1852.
Abstract: Introducere: Actualmente tehnicile endovenoase de suprimare a refluxului patologic se bucură de o mare popularitate. Scopul studiului: Analiza experienţei utilizării scleroterapiei cu spumă transcateter (STST) în tratamentul refluxului safenian. Material și metode: Lotul evaluat a inclus 59 bolnavi (64 extremităţi inferioare afectate) cu insuficienţă venoasă cronică, condiţionată de reflux prin vena safenă (>0,5 sec) determinat prin duplex scanare. Vârsta medie a pacienţilor – 56 ani (24-83); M/F=1/1,56. În funcţie de clasa clinică a clasificării CEAP cazurile s-au repartizat în felul următor: C2=10,93%; C3=10,93%; C4=28,12%; C5=9,37%; C6=40,62%. Etiologia primară a patologiei venoase a fost constatată în 78,12% cazuri. Drept indicaţii pentru STST au servit: refluxul venos total prin safenă la pacienţii cu lipodermatoscleroză extinsă sau ulcere trofice; dezvoltarea incompetenţei trunchiului safenian restant postoperator pe gambă; riscul/traumatismul considerat elevat al stripping-ului;cerinţele cosmetice (minimalizarea numărului de incizii). Spuma a fost creată prin mixajul polidocanolului sau a tetradecil sulfatului de sodiu cu aer (1:4). Rezultate: Majoritatea intervenţiilor au fost efectuate cu anestezie locală infiltrativă (55,93%) sau spinală (28,81%). În 62,5% cazuri injectarea s-a realizat prin cateter scurt plasat retrograd. Vena safena magna a fost tratată în 76,56% cazuri; parva – 9,37%; magna și parva – 14,06%. Valoarea medie a diametrului safenei a constituit 9,38±1,1 mm, iar cea a spumei administrate per caz – 6,42 ml. În 32,81% cazuri STST a fost asociată cu miniflebectomie, iar în 17,18% cazuri – cu ablaţia endovenoasă cu laser. Complicaţii majore post-procedurale nu au fost înregistrate. În 3 cazuri s-a dezvoltat flebita ramurilor safenei (toate au fost tratate conservator). La un an postoperator cazuri de recurenţă clinică a bolii venoase nu au fost, iar rata de ocluzie a safenei a constituit 92,18%. Concluzii: Prin STST poate fi realizată eradicarea sigură, eficientă și într-o manieră minim invazivă a refluxului safenian.
Introduction: Nowadays endovenous techniques for suppression of pathologic venous reflux gained a great popularity. The aim of study: Assessment of our clinical experience in treatment of saphenous reflux through transcatheter foam sclerotherapy (TCFS). Material and methods: A total of 59 patients (64 affected lower limbs) with chronic venous insufficiency, conditioned by the saphenous vein reflux determined during duplex scanning (>0.5 sec) were evaluated. Median age – 56 years (24-83); male/female ratio = 1/1.56. Depending on the clinical (C) class of CEAP classification cases were distributed as follows: C2=10.93%; C3=10.93%; C4=28.12%; C5=9.37%; C6=40.62%. Primary etiology of chronic venous disease was found in 78.12% cases. As indications for TCFS served: total saphenous vein reflux in patients with extended lipodermatosclerosis or venous leg ulcer; incompetence of below-knee saphenous remnant; considered high risk of saphenous stripping; cosmetic requirements (minimizing the number of incisions). The foam was created by mixing polidocanol or sodium tetradecyl sulphate with air (ratio – 1:4). Results: Most of the interventions were performed with local tumescent (55.93%) or spinal (28.81%) anaesthesia. In 62.5% of cases injecting was achieved by short, retrograde placed catheter. Great saphenous vein was treated in 76.56% of cases; short saphenous vein – in 9.37%; both – in 14.06% of cases. Mean value of saphenous vein diameter and amount of foam administrated per case was 9.38±1.1 mm, and 6.42 ml, respectively. In 32.81% of cases TCFS has been associated with miniphlebectomy, and in 17.18% of cases – with endovenous laser ablation. There were not major post-procedural complications. Thrombophlebitis of superficial vein tributaries occurs in 3 cases (all were treated conservatively). At one year post-TCFS there were no clinical signs of recurrence, while saphenous vein occlusion rate was 92.18%. Conclusions: By transcatheter foam sclerotherapy can be achieved safe, efficient and minimally invasive eradication of saphenous reflux.
URI: http://repository.usmf.md/handle/20.500.12710/13960
ISSN: 1810-1852
Appears in Collections:Arta Medica Vol. 56 No 3, 2015 ediție specială

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