Skleroterapi, Ekzojen İşlemler ve Cihazlar
Özet
Skleroterapi; retiküler venler ve telenjiektazilerin tedavisinde yaygın şekilde kullanılan ve kalp ve damar cerrahları tarafından uygulanan bir tedavi yöntemidir. Günümüzde varis hastalığının tedavisinde önemli bir yer tutmaktadır. Skleroterapiye ek olarak kimi zaman tek başına kimi zaman skleroterapi ile kombine şekilde kullanılan bir diğer yöntem ise lazer uygulamalarıdır. Teknolojinin de gelişmesi sayesinde bu konuda yıllar içerisinde önemli yenilikler ve ilerlemeler kaydedilmiştir. Hem skleroterapi hem de lazer uygulamaları doğru eller tarafından uygulandığında oldukça yüz güldürücü sonuçlar alınmasını sağladığı gibi; yanlış veya yetersiz kullanımlarda ise ciddi komplikasyonlar doğurabilmekte olan hassas ve uzmanlık gerektiren işlemlerdir. Bu bölümde varis hastalığının tedavisinde skleroterapi ve kutanöz lazer uygulamalarının yerinden bahsedilecek, tedavi ve komplikasyonları anlatılacaktır.
Referanslar
Saddick N, Li C. Small-vessel sclerotherapy. Dermatologic Clinics. 2001; 19(3):475-481.
Schneider W. In: Tournay R et al., eds. Terapia sclerosante delle varici. Milan, Italy: Cortina; 1984. p. 79-90.
Mancini S, Mariani F, De Sando D, et al. La sclérose de la grande saphéne: Histologie et microscopie électronique des altérations chez l'homme. In: Davy A, Stemmer R, eds. Phlebologie '89. 10éme Congres Mondial Union Internationale des Phlebologie; Strasbourg, Sep 25-29, 1989. London: John Libbey Eurotext; 1989. p. 769-771.
Wittens C, Davies AH, Bækgaard N, Broholm R, Cavezzi A, Chastanet S, et al. Editor’s choice - management of chronic venous disease: clinical practice guidelines of the european society for vascular surgery (ESVS). European Journal of Vascular and Endovascular Surgery. 2015;49:678-737.
Kreussler: Fachinformationen Aethoxysklerol 0,25%/0,5%/1%/2%/3% Stand Oktober 2009, Chemische Fabrik Kreussler & Co GmbH.
Weiss RA, Weiss MA. Doppler ultrasound findings in reticular veins of the thigh subdermic lateral venous system and implications for sclerotherapy. Dermatologic Surgery and Oncology. 1993; 19(10): 947-951.
Somjen GM, Ziegenbein R, Johnston AH, Royle JP. Anatomical examination of leg telangiectases with duplex scanning [see comments]. Dermatologic Surgery and Oncology. 1993; 19(10): 940-945.
Bozkurt AK. Kronik Venöz Hastalık. Bozkurt AK (ed.) Periferik Arter ve Ven Hastalıkları Ulusal Tedavi Kılavuzu 2021 içinde. İstanbul: Bayçınar Tıbbi Yayıncılık; 2021. p. 251-297.
Weiss RA, Weiss MA. Sclerotherapy Treatment of Telangiectasias. In: Bergan JJ, Bunke-Paquette N, editors. The Vein Book. Second Edition. New York: Oxford University Press; 2014. p. 109-114.
Tessari L, Cavezzi A, Frullini A. Preliminary experience with a new sclerosing foam in the treatment of varicose veins. Dermatologic Surgery. 2001;27:58-60.
Lurie F, Lal BK, Antignani PL, Blebea J, Bush R, Caprini J, et al. Compression therapy after invasive treatment of superficial veins of the lower extremities: Clinical practice guidelines of the American Venous Forum, Society for Vascular Surgery, American College of Phlebology, Society for Vascular Medicine, and International Union of Phlebology. Journal of Vascular Surgery: Venous and Lymphatic Disorders. 2019;7:17-28.
Nicolaides A, Kakkos S, Baekgaard N, Comerota A, de Maeseneer M, Eklof B, et al. Management of chronic venous disorders of the lower limbs. Guidelines According to Scientific Evidence. Part I. International Angiology. 2018;37:181-254.
Rabe E, Breu FX, Cavezzi A, Coleridge Smith P, Frullini A, Gillet JL, et al. European guidelines for sclerotherapy in chronic venous disorders. Phlebology. 2014;29:338-354.
Rabe E, Breu FX, Flessenkämper I, Gerlach H, Guggenbichler S, Kahle B, et al. Sclerotherapy in the treatment of varicose veins : S2k guideline of the Deutsche Gesellschaft für Phlebologie (DGP) in cooperation with the following societies: DDG, DGA, DGG, BVP. Hautarzt 2020. [Online ahead of print]
Kabnick L, Sadeck M. Varicose veins: Endovenous ablation and sclerotherapy. In: Sidawy AN, Perler BA, editors. Rutherford’s Vascular Surgery. Philadelphia: Elsevier; 2019. p. 2036-2048.
Goldman MP, Sadick NS, Weiss RA. Cutaneous necrosis, telangiectatic matting, and hyperpigmentation following sclerotherapy. Etiology, prevention, and treatment. Dermatologic Surgery. 1995;21:19-29.
Munavalli GS, Weiss RA. Complications of sclerotherapy. Seminars in Cutaneous Medicine and Surgery. 2007; 26: 22-28.
Rabe E, Pannier F. Sclerotherapy of varicose veins with polidocanol based on the guidelines of the German Society of Phlebology. Dermatologic Surgery. 2010; 36(Suppl 2): 968-975.
Sylvoz N, Villier C, Blaise S, Seinturier C, Mallaret M. Polidocanol induced cardiotoxicity: A case report and review of the literature. Journal des Maladies Vasculaires. 2008; 33(4-5): 234-238.
Guex JJ, Allaert FA, Gillet JL, Chlier F. Immediate and midterm complications of sclerotherapy report of a prospective multi-center registry of 12,173 sclerotherapy sessions. Dermatologic Surgery. 2005; 31: 123-128.
Norris MJ, Carlin MC, Ratz JL. Treatment of essential telangiectasia: Effects of increasing concentrations of polidocanol. Journal of the American Academy of Dermatology. 1989; 20(4): 643-649.
Mlosek RK, Wozniak W, Malinowska S, Migda B, Serafin-Kroi M, Milek T. The removal of post-sclerotherapy pigmentation following sclerotherapy alone or in combination with crossectomy. European Journal of Vascular and Endovascular Surgery. 2012; 43(1): 100-105.
Goldman MP, Sadick NS, Weiss RA. Cutaneous necrosis, telangiectatic matting, and hyperpigmentation following sclerotherapy: Etiology, prevention and treatment. Dermatologic Surgery. 1995; 21(1): 19-29.
Weiss RA, Weiss MA. Incidence of side effects in the treatment of telangiectasias by compression sclerotherapy: Hypertonic saline vs. polidocanol. Dermatologic Surgery and Oncology. 1990; 16(9): 800–804.
Goldman, M. Complications and adverse sequelae of sclerotherapy. In: Bergan J, ed. The Vein Book. Massachusetts: Elsevier Academic Press; 2007. p. 139-155.
Sadick N. A dual wavelength approach for laser/intense pulsed light source treatment of lower extremity veins. Journal of the American Academy of Dermatology. 2002; 46: 66-72.
Sadick N, Sorhaindo L. Laser Treatment of Telangiectasias and Reticular Veins. In: Bergan JJ, Bunke-Paquette N, editors. The Vein Book. Second Edition. New York: Oxford University Press; 2014. p. 127-135.
Goldman M. Treatment of leg veins with lasers and intense pulse light. Dermatologic Clinics. 2001; 19: 467-473.
Sadick N. A dual wavelength approach for laser/intense pulsed light source treatment of lower extremity veins. Journal of the American Academy of Dermatology. 2002; 46: 66-72.
Eremias L, Umars H. A side by side comparative study of 1064 nm Nd: YAG, 310 nm diode and 755 nm alexandrite lasers for treatment of 0.3-3.0 mm leg veins. Dermatologic Surgery. 2002; 28: 224-230.
Goldman M, Fitzpatrick R. Pulsed dye laser treatment of leg telangiectasia: With and without simultaneous sclerotherapy. Dermatologic Surgery. 1990; 16: 338-344.
Sadick N. Long-term results with a multiple synchronized pulse 1064 nm Nd:YAG laser for the treatment of leg venulectasias and reticular veins. Dermatologic Surgery. 2001; 27: 365-369.
Schroeter C, Wilder D, Reineke T, et al. Clinical significance of an intense, pulsed light source on leg telangiectasias of up to 1 mm diameter. European Journal of Dermatology. 1997; 7: 38-42.
Green D. Photothermal removal of telangiectases of the lower extremities with the Photoderm VL. Journal of the American Academy of Dermatology. 1998; 38: 61-68.
Sadick N, Weiss R, Goldman M. Advances in laser surgery for leg veins: Bimodal wavelength approach to lower extremity vessels, new cooling techniques, and longer pulse durations. Dermatologic Surgery. 2002; 28: 16-20.
Miyake RK, Chi YW, Franklin IJ, Gianesini S. State of the art on cryo-laser cryosclerotherapy in lower limb venous aesthetic treatment. Journal of Vascular Surgery: Venous and Lymphatic Disorders. 2020;8:893-895.
Referanslar
Saddick N, Li C. Small-vessel sclerotherapy. Dermatologic Clinics. 2001; 19(3):475-481.
Schneider W. In: Tournay R et al., eds. Terapia sclerosante delle varici. Milan, Italy: Cortina; 1984. p. 79-90.
Mancini S, Mariani F, De Sando D, et al. La sclérose de la grande saphéne: Histologie et microscopie électronique des altérations chez l'homme. In: Davy A, Stemmer R, eds. Phlebologie '89. 10éme Congres Mondial Union Internationale des Phlebologie; Strasbourg, Sep 25-29, 1989. London: John Libbey Eurotext; 1989. p. 769-771.
Wittens C, Davies AH, Bækgaard N, Broholm R, Cavezzi A, Chastanet S, et al. Editor’s choice - management of chronic venous disease: clinical practice guidelines of the european society for vascular surgery (ESVS). European Journal of Vascular and Endovascular Surgery. 2015;49:678-737.
Kreussler: Fachinformationen Aethoxysklerol 0,25%/0,5%/1%/2%/3% Stand Oktober 2009, Chemische Fabrik Kreussler & Co GmbH.
Weiss RA, Weiss MA. Doppler ultrasound findings in reticular veins of the thigh subdermic lateral venous system and implications for sclerotherapy. Dermatologic Surgery and Oncology. 1993; 19(10): 947-951.
Somjen GM, Ziegenbein R, Johnston AH, Royle JP. Anatomical examination of leg telangiectases with duplex scanning [see comments]. Dermatologic Surgery and Oncology. 1993; 19(10): 940-945.
Bozkurt AK. Kronik Venöz Hastalık. Bozkurt AK (ed.) Periferik Arter ve Ven Hastalıkları Ulusal Tedavi Kılavuzu 2021 içinde. İstanbul: Bayçınar Tıbbi Yayıncılık; 2021. p. 251-297.
Weiss RA, Weiss MA. Sclerotherapy Treatment of Telangiectasias. In: Bergan JJ, Bunke-Paquette N, editors. The Vein Book. Second Edition. New York: Oxford University Press; 2014. p. 109-114.
Tessari L, Cavezzi A, Frullini A. Preliminary experience with a new sclerosing foam in the treatment of varicose veins. Dermatologic Surgery. 2001;27:58-60.
Lurie F, Lal BK, Antignani PL, Blebea J, Bush R, Caprini J, et al. Compression therapy after invasive treatment of superficial veins of the lower extremities: Clinical practice guidelines of the American Venous Forum, Society for Vascular Surgery, American College of Phlebology, Society for Vascular Medicine, and International Union of Phlebology. Journal of Vascular Surgery: Venous and Lymphatic Disorders. 2019;7:17-28.
Nicolaides A, Kakkos S, Baekgaard N, Comerota A, de Maeseneer M, Eklof B, et al. Management of chronic venous disorders of the lower limbs. Guidelines According to Scientific Evidence. Part I. International Angiology. 2018;37:181-254.
Rabe E, Breu FX, Cavezzi A, Coleridge Smith P, Frullini A, Gillet JL, et al. European guidelines for sclerotherapy in chronic venous disorders. Phlebology. 2014;29:338-354.
Rabe E, Breu FX, Flessenkämper I, Gerlach H, Guggenbichler S, Kahle B, et al. Sclerotherapy in the treatment of varicose veins : S2k guideline of the Deutsche Gesellschaft für Phlebologie (DGP) in cooperation with the following societies: DDG, DGA, DGG, BVP. Hautarzt 2020. [Online ahead of print]
Kabnick L, Sadeck M. Varicose veins: Endovenous ablation and sclerotherapy. In: Sidawy AN, Perler BA, editors. Rutherford’s Vascular Surgery. Philadelphia: Elsevier; 2019. p. 2036-2048.
Goldman MP, Sadick NS, Weiss RA. Cutaneous necrosis, telangiectatic matting, and hyperpigmentation following sclerotherapy. Etiology, prevention, and treatment. Dermatologic Surgery. 1995;21:19-29.
Munavalli GS, Weiss RA. Complications of sclerotherapy. Seminars in Cutaneous Medicine and Surgery. 2007; 26: 22-28.
Rabe E, Pannier F. Sclerotherapy of varicose veins with polidocanol based on the guidelines of the German Society of Phlebology. Dermatologic Surgery. 2010; 36(Suppl 2): 968-975.
Sylvoz N, Villier C, Blaise S, Seinturier C, Mallaret M. Polidocanol induced cardiotoxicity: A case report and review of the literature. Journal des Maladies Vasculaires. 2008; 33(4-5): 234-238.
Guex JJ, Allaert FA, Gillet JL, Chlier F. Immediate and midterm complications of sclerotherapy report of a prospective multi-center registry of 12,173 sclerotherapy sessions. Dermatologic Surgery. 2005; 31: 123-128.
Norris MJ, Carlin MC, Ratz JL. Treatment of essential telangiectasia: Effects of increasing concentrations of polidocanol. Journal of the American Academy of Dermatology. 1989; 20(4): 643-649.
Mlosek RK, Wozniak W, Malinowska S, Migda B, Serafin-Kroi M, Milek T. The removal of post-sclerotherapy pigmentation following sclerotherapy alone or in combination with crossectomy. European Journal of Vascular and Endovascular Surgery. 2012; 43(1): 100-105.
Goldman MP, Sadick NS, Weiss RA. Cutaneous necrosis, telangiectatic matting, and hyperpigmentation following sclerotherapy: Etiology, prevention and treatment. Dermatologic Surgery. 1995; 21(1): 19-29.
Weiss RA, Weiss MA. Incidence of side effects in the treatment of telangiectasias by compression sclerotherapy: Hypertonic saline vs. polidocanol. Dermatologic Surgery and Oncology. 1990; 16(9): 800–804.
Goldman, M. Complications and adverse sequelae of sclerotherapy. In: Bergan J, ed. The Vein Book. Massachusetts: Elsevier Academic Press; 2007. p. 139-155.
Sadick N. A dual wavelength approach for laser/intense pulsed light source treatment of lower extremity veins. Journal of the American Academy of Dermatology. 2002; 46: 66-72.
Sadick N, Sorhaindo L. Laser Treatment of Telangiectasias and Reticular Veins. In: Bergan JJ, Bunke-Paquette N, editors. The Vein Book. Second Edition. New York: Oxford University Press; 2014. p. 127-135.
Goldman M. Treatment of leg veins with lasers and intense pulse light. Dermatologic Clinics. 2001; 19: 467-473.
Sadick N. A dual wavelength approach for laser/intense pulsed light source treatment of lower extremity veins. Journal of the American Academy of Dermatology. 2002; 46: 66-72.
Eremias L, Umars H. A side by side comparative study of 1064 nm Nd: YAG, 310 nm diode and 755 nm alexandrite lasers for treatment of 0.3-3.0 mm leg veins. Dermatologic Surgery. 2002; 28: 224-230.
Goldman M, Fitzpatrick R. Pulsed dye laser treatment of leg telangiectasia: With and without simultaneous sclerotherapy. Dermatologic Surgery. 1990; 16: 338-344.
Sadick N. Long-term results with a multiple synchronized pulse 1064 nm Nd:YAG laser for the treatment of leg venulectasias and reticular veins. Dermatologic Surgery. 2001; 27: 365-369.
Schroeter C, Wilder D, Reineke T, et al. Clinical significance of an intense, pulsed light source on leg telangiectasias of up to 1 mm diameter. European Journal of Dermatology. 1997; 7: 38-42.
Green D. Photothermal removal of telangiectases of the lower extremities with the Photoderm VL. Journal of the American Academy of Dermatology. 1998; 38: 61-68.
Sadick N, Weiss R, Goldman M. Advances in laser surgery for leg veins: Bimodal wavelength approach to lower extremity vessels, new cooling techniques, and longer pulse durations. Dermatologic Surgery. 2002; 28: 16-20.
Miyake RK, Chi YW, Franklin IJ, Gianesini S. State of the art on cryo-laser cryosclerotherapy in lower limb venous aesthetic treatment. Journal of Vascular Surgery: Venous and Lymphatic Disorders. 2020;8:893-895.
