Varis Tedavisinde Güncel Yaklaşımlar: Girişimsel Radyolojinin Rolü
Özet
Kronik venöz yetmezlik ve variköz venler, dünya genelinde erişkin popülasyonu etkileyen yaygın damar hastalıklarıdır ve yaşam kalitesini önemli ölçüde azaltabilmektedir. Son yıllarda cerrahi tedavilere alternatif olarak minimal invaziv endovenöz teknikler hızla gelişmiş ve klinik pratiğin önemli bir parçası haline gelmiştir. Bu bölümde kronik venöz hastalığın patofizyolojisi, klinik spektrumu ve tanısal görüntüleme yöntemleri girişimsel radyoloji perspektifinden ele alınmaktadır. Özellikle Doppler ultrasonografi başta olmak üzere BT venografi ve MR venografi gibi görüntüleme yöntemlerinin tanı ve tedavi planlamasındaki rolü vurgulanmaktadır. Bunun yanı sıra endovenöz lazer ablasyon, radyofrekans ablasyon, mekanik-kimyasal ablasyon, siyanoakrilat kapama ve ultrason eşliğinde köpük skleroterapi gibi güncel minimal invaziv tedavi yöntemleri ayrıntılı biçimde tartışılmaktadır. Bölüm ayrıca yapay zekâ destekli görüntü analizi, robotik kateter sistemleri ve yeni biyomalzeme tabanlı sklerozan ajanlar gibi gelecekte varis tedavisini şekillendirebilecek teknolojik gelişmelere de değinmektedir. Güncel literatür ışığında girişimsel radyolojinin kronik venöz hastalıkların tanı ve tedavisindeki artan rolü ve kişiselleştirilmiş tedavi yaklaşımlarının önemi ortaya konulmaktadır.
Chronic venous insufficiency and varicose veins are common vascular disorders affecting a significant proportion of the adult population worldwide and are associated with substantial impairment in quality of life. In recent years, minimally invasive endovenous therapies have largely replaced conventional surgical approaches and have become central to modern management strategies. This chapter reviews the pathophysiology and clinical spectrum of chronic venous disease from an interventional radiology perspective. The role of diagnostic imaging modalities, particularly Doppler ultrasonography, computed tomography venography, and magnetic resonance venography, in the evaluation and treatment planning of venous disorders is discussed. Current minimally invasive treatment options including endovenous laser ablation, radiofrequency ablation, mechanochemical ablation, cyanoacrylate closure, and ultrasound-guided foam sclerotherapy are presented with emphasis on their mechanisms, clinical outcomes, and advantages. In addition, emerging technologies such as artificial intelligence-assisted imaging analysis, robotic catheter systems, and novel biomaterial-based sclerosants are highlighted as potential future directions in varicose vein treatment. Overall, this chapter emphasizes the expanding role of interventional radiology in the diagnosis and management of chronic venous disease and highlights the transition toward personalized, image-guided therapeutic strategies.
Referanslar
Eberhardt RT, Raffetto JD. Chronic venous insufficiency. Circulation. 2014;130(4):333-46.
Evans CJ, Fowkes FGR, Ruckley CV, Lee AJ. Prevalence of varicose veins and chronic venous insufficiency in men and women in the general population: Edinburgh Vein Study. Journal of Epidemiology & Community Health. 1999;53(3):149-53.
Davies AH. The seriousness of chronic venous disease: a review of real-world evidence. Advances in therapy. 2019;36:5-12.
Youn YJ, Lee J. Chronic venous insufficiency and varicose veins of the lower extremities. The Korean journal of internal medicine. 2018;34(2):269.
Rochon PJ, Reghunathan A, Kapoor BS, Kalva SP, Fidelman N, Majdalany BS, Hohenwalter EJ. ACR appropriateness Criteria® lower extremity chronic venous disease. Journal of the American College of Radiology. 2023;20(11):481-500.
Ortega MA, Fraile-Martínez O, García-Montero C, Álvarez-Mon MA, Chaowen C, Ruiz-Grande F, Bujan J. Understanding chronic venous disease: a critical overview of its pathophysiology and medical management. Journal of clinical medicine. 2021;10(15):32-9.
Chwała M, Szczeklik W, Szczeklik M, Aleksiejew-Kleszczyński T, Jagielska-Chwała M. Varicose veins of lower extremities, hemodynamics and treatment methods. Adv Clin Exp Med. 2015;24(1):5-14.
Gwozdzinski L, Pieniazek A, Gwozdzinski K. Factors influencing venous remodeling in the development of varicose veins of the lower limbs. International Journal of Molecular Sciences. 2024;25(3):1560.
Raffetto JD, Khalil RA. Mechanisms of lower extremity vein dysfunction in chronic venous disease and implications in management of varicose veins. Vessel plus. 2021;5:36.
Jaworucka-Kaczorowska A, Roustazadeh R, Simka M, Jalaie H. Management of extra-pelvic varicose veins of pelvic origin in female patients. Journal of Clinical Medicine. 2025;14(8):2707.
De Maeseneer MG, Kakkos SK, Aherne T, Baekgaard N, Black S, Blomgren L, ESVS Guidelines Committee. Editor's choice–European Society for Vascular Surgery (ESVS) 2022 clinical practice guidelines on the management of chronic venous disease of the lower limbs. European Journal of Vascular and Endovascular Surgery. 2022;63(2):184-267.
Eberhardt RT, Raffetto JD. Chronic venous insufficiency. Circulation. 2014; 130(4): 333-46.
Shahzad G, Kumar K, Kumar M, Hassan A, Rafiq N. Diagnostic accuracy of color Doppler ultrasonography among patients having deep vein thrombosis by taking venography as gold standard. J Pharm Res Int. 2020;32(18):1-5.
Srisuwan T, Inmutto N, Kattipathanapong T, Rerkasem A, Rerkasem K. Ultrasound use in diagnosis and management of venous leg ulcer. The International Journal of Lower Extremity Wounds. 2020;19(4):305-14.
Attia NM, Sayed MA, Galal Mohamed HE, AbdelAleem MA. The role of MR venography with time-resolved imaging in diagnosis of pelvic congestion syndrome. Egyptian Journal of Radiology and Nuclear Medicine. 2020;53(1):19.
Awad AS, Taha MMM, Manaf MHA, Gad MMM, Mashhour SN. Role of multi-detector CT venography in evaluation of pelvic congestion syndrome. Egyptian Journal of Radiology and Nuclear Medicine. 2020;51(1):159.
Markl M, Frydrychowicz A, Kozerke S, Hope M, Wieben O. 4D flow MRI. Journal of Magnetic Resonance Imaging. 2012;36(5):1015-36.
Gao RD, Qian SY, Wang HH, Liu YS, Ren SY. Strategies and challenges in treatment of varicose veins and venous insufficiency. World journal of clinical cases. 2022;10(18):5946.
Wittens C, Davies AH, Bækgaard N, Broholm R, Cavezzi A, Chastanet S, Rosales A. European society for vascular surgery. editor's choice-management of chronic venous disease: clinical practice guidelines of the european society for vascular surgery (ESVS). Eur J Vasc Endovasc Surg. 2015;49(6):678-737.
Gloviczki P. The best vascular care for every patient, every day. Journal of Vascular Surgery. 2014;59(3):843-56.
Van den Bos R, Arends L, Kockaert M, Neumann M, Nijsten T. Endovenous therapies of lower extremity varicosities: a meta-analysis. Journal of vascular Surgery. 2009,49(1):230-9.
Nesbitt C, Eifell RK, Coyne P, Badri H, Bhattacharya V, Stansby G. Endovenous ablation (radiofrequency and laser) and foam sclerotherapy versus conventional surgery for great saphenous vein varices. Sao Paulo Medical Journal. 2014;132:69.
Toz H, Kuserli Y. Comparison of long-term outcomes and quality of life following radiofrequency ablation, endovenous laser ablation, and N-butyl cyanoacrylate treatment of greater saphenous vein insufficiency. J Vasc Surg Venous Lymphat Disord. 2026;14(1):102316.
Jiang W, Liang Y, Long Z, Hu M, Yang H, Qin X. Endovenous radiofrequency ablation vs laser ablation in patients with lower extremity varicose veins: A meta-analysis. Journal of Vascular Surgery: Venous and Lymphatic Disorders. 2024;12(5):101842.
De Maeseneer MG, Kakkos SK, Aherne T, Baekgaard N, Black S, Blomgren L, ESVS Guidelines Committee. Editor's choice–European Society for Vascular Surgery (ESVS) 2022 clinical practice guidelines on the management of chronic venous disease of the lower limbs. European Journal of Vascular and Endovascular Surgery. 2022;63(2):184-267.
Blebea J, Fukaya E, Moore KS, Lurie, F. Mechanochemical chemically assisted ablation of varicose veins for venous insufficiency: American vein and lymphatic society position statement. Phlebology. 2025;40(2):104-9.
Nugroho J, Wardhana A, Ghea, C. Mechanical Occlusion Chemically Assisted Ablation (MOCA) for Saphenous Vein Insufficiency: A Meta‐Analysis of a Randomized Trial. Int J Vasc Med. 2020;2020:8758905.
Srinath SR, Sharma G. Review of non-thermal non-tumescent endovenous ablation using cyanoacrylate. Journal of Surgery. 2018;14(2):91-5.
Imai T, Mo M, Hirokawa M, Kurihara N, Shokoku S, Sugiyama S, Ogawa T. Mid-term results of cyanoacrylate closure for the treatment of incompetent great and small saphenous veins: Findings from a Japanese prospective consecutive multi-center registry: Mid-term results of cyanoacrylate closure. Phlebology. 2025;40(1):21-8.
Park I. Initial outcomes of cyanoacrylate closure, VenaSeal system, for the treatment of the incompetent great and small saphenous veins. Vascular and endovascular surgery. 2017;51(8):545-9.
Bhavsar A, Bochiya GP, Modi JV, Trivedi M. An observational study to evaluate efficacy and safety of ultrasound guided foam sclerotherapy for treatment of varicose veins. 2023;10(2):261-7.
Pugalenthi LS, Garapati C, Maddukuri S, Kanwal F, Kumar J, Asadimanesh N, Arunachalam SP. From data to decisions: AI in varicose veins—Predicting, diagnosing, and guiding effective management. J Vasc Dis. 2025;4(2):19.
Wilkinson MC, Ayad A, Kiang SC, Grewal ML. A review on the current applications of artificial intelligence in chronic venous insufficiency. JVS-Vascular Insights. 2025;100261.
Song HS, Yi BJ, Won JY, Woo J. Learning-based catheter and guidewire-driven autonomous vascular intervention robotic system for reduced repulsive force. Journal of Computational Design and Engineering. 2022;9(5):1549-64.
Ma J, Zhang K, Li W, Ding Y, Chen Y, Huang X, Ding P. Tranexamic acid-fatty alcohol polyoxyethylene ether conjugation/PVA foam for venous sclerotherapy via vascular damage and inhibiting plasmin system. Acta Pharmaceutica Sinica B. 2025;15(6):3291-3304.
Rivard A, Soulez G, Lerouge S, Fortin MA. Novel Sclerosing and Embolizing Gel for Varicose Vein Treatment: Feasibility Study in a Porcine Model. Journal of Vascular and Interventional Radiology. 2025;34(3):S126.
Referanslar
Eberhardt RT, Raffetto JD. Chronic venous insufficiency. Circulation. 2014;130(4):333-46.
Evans CJ, Fowkes FGR, Ruckley CV, Lee AJ. Prevalence of varicose veins and chronic venous insufficiency in men and women in the general population: Edinburgh Vein Study. Journal of Epidemiology & Community Health. 1999;53(3):149-53.
Davies AH. The seriousness of chronic venous disease: a review of real-world evidence. Advances in therapy. 2019;36:5-12.
Youn YJ, Lee J. Chronic venous insufficiency and varicose veins of the lower extremities. The Korean journal of internal medicine. 2018;34(2):269.
Rochon PJ, Reghunathan A, Kapoor BS, Kalva SP, Fidelman N, Majdalany BS, Hohenwalter EJ. ACR appropriateness Criteria® lower extremity chronic venous disease. Journal of the American College of Radiology. 2023;20(11):481-500.
Ortega MA, Fraile-Martínez O, García-Montero C, Álvarez-Mon MA, Chaowen C, Ruiz-Grande F, Bujan J. Understanding chronic venous disease: a critical overview of its pathophysiology and medical management. Journal of clinical medicine. 2021;10(15):32-9.
Chwała M, Szczeklik W, Szczeklik M, Aleksiejew-Kleszczyński T, Jagielska-Chwała M. Varicose veins of lower extremities, hemodynamics and treatment methods. Adv Clin Exp Med. 2015;24(1):5-14.
Gwozdzinski L, Pieniazek A, Gwozdzinski K. Factors influencing venous remodeling in the development of varicose veins of the lower limbs. International Journal of Molecular Sciences. 2024;25(3):1560.
Raffetto JD, Khalil RA. Mechanisms of lower extremity vein dysfunction in chronic venous disease and implications in management of varicose veins. Vessel plus. 2021;5:36.
Jaworucka-Kaczorowska A, Roustazadeh R, Simka M, Jalaie H. Management of extra-pelvic varicose veins of pelvic origin in female patients. Journal of Clinical Medicine. 2025;14(8):2707.
De Maeseneer MG, Kakkos SK, Aherne T, Baekgaard N, Black S, Blomgren L, ESVS Guidelines Committee. Editor's choice–European Society for Vascular Surgery (ESVS) 2022 clinical practice guidelines on the management of chronic venous disease of the lower limbs. European Journal of Vascular and Endovascular Surgery. 2022;63(2):184-267.
Eberhardt RT, Raffetto JD. Chronic venous insufficiency. Circulation. 2014; 130(4): 333-46.
Shahzad G, Kumar K, Kumar M, Hassan A, Rafiq N. Diagnostic accuracy of color Doppler ultrasonography among patients having deep vein thrombosis by taking venography as gold standard. J Pharm Res Int. 2020;32(18):1-5.
Srisuwan T, Inmutto N, Kattipathanapong T, Rerkasem A, Rerkasem K. Ultrasound use in diagnosis and management of venous leg ulcer. The International Journal of Lower Extremity Wounds. 2020;19(4):305-14.
Attia NM, Sayed MA, Galal Mohamed HE, AbdelAleem MA. The role of MR venography with time-resolved imaging in diagnosis of pelvic congestion syndrome. Egyptian Journal of Radiology and Nuclear Medicine. 2020;53(1):19.
Awad AS, Taha MMM, Manaf MHA, Gad MMM, Mashhour SN. Role of multi-detector CT venography in evaluation of pelvic congestion syndrome. Egyptian Journal of Radiology and Nuclear Medicine. 2020;51(1):159.
Markl M, Frydrychowicz A, Kozerke S, Hope M, Wieben O. 4D flow MRI. Journal of Magnetic Resonance Imaging. 2012;36(5):1015-36.
Gao RD, Qian SY, Wang HH, Liu YS, Ren SY. Strategies and challenges in treatment of varicose veins and venous insufficiency. World journal of clinical cases. 2022;10(18):5946.
Wittens C, Davies AH, Bækgaard N, Broholm R, Cavezzi A, Chastanet S, Rosales A. European society for vascular surgery. editor's choice-management of chronic venous disease: clinical practice guidelines of the european society for vascular surgery (ESVS). Eur J Vasc Endovasc Surg. 2015;49(6):678-737.
Gloviczki P. The best vascular care for every patient, every day. Journal of Vascular Surgery. 2014;59(3):843-56.
Van den Bos R, Arends L, Kockaert M, Neumann M, Nijsten T. Endovenous therapies of lower extremity varicosities: a meta-analysis. Journal of vascular Surgery. 2009,49(1):230-9.
Nesbitt C, Eifell RK, Coyne P, Badri H, Bhattacharya V, Stansby G. Endovenous ablation (radiofrequency and laser) and foam sclerotherapy versus conventional surgery for great saphenous vein varices. Sao Paulo Medical Journal. 2014;132:69.
Toz H, Kuserli Y. Comparison of long-term outcomes and quality of life following radiofrequency ablation, endovenous laser ablation, and N-butyl cyanoacrylate treatment of greater saphenous vein insufficiency. J Vasc Surg Venous Lymphat Disord. 2026;14(1):102316.
Jiang W, Liang Y, Long Z, Hu M, Yang H, Qin X. Endovenous radiofrequency ablation vs laser ablation in patients with lower extremity varicose veins: A meta-analysis. Journal of Vascular Surgery: Venous and Lymphatic Disorders. 2024;12(5):101842.
De Maeseneer MG, Kakkos SK, Aherne T, Baekgaard N, Black S, Blomgren L, ESVS Guidelines Committee. Editor's choice–European Society for Vascular Surgery (ESVS) 2022 clinical practice guidelines on the management of chronic venous disease of the lower limbs. European Journal of Vascular and Endovascular Surgery. 2022;63(2):184-267.
Blebea J, Fukaya E, Moore KS, Lurie, F. Mechanochemical chemically assisted ablation of varicose veins for venous insufficiency: American vein and lymphatic society position statement. Phlebology. 2025;40(2):104-9.
Nugroho J, Wardhana A, Ghea, C. Mechanical Occlusion Chemically Assisted Ablation (MOCA) for Saphenous Vein Insufficiency: A Meta‐Analysis of a Randomized Trial. Int J Vasc Med. 2020;2020:8758905.
Srinath SR, Sharma G. Review of non-thermal non-tumescent endovenous ablation using cyanoacrylate. Journal of Surgery. 2018;14(2):91-5.
Imai T, Mo M, Hirokawa M, Kurihara N, Shokoku S, Sugiyama S, Ogawa T. Mid-term results of cyanoacrylate closure for the treatment of incompetent great and small saphenous veins: Findings from a Japanese prospective consecutive multi-center registry: Mid-term results of cyanoacrylate closure. Phlebology. 2025;40(1):21-8.
Park I. Initial outcomes of cyanoacrylate closure, VenaSeal system, for the treatment of the incompetent great and small saphenous veins. Vascular and endovascular surgery. 2017;51(8):545-9.
Bhavsar A, Bochiya GP, Modi JV, Trivedi M. An observational study to evaluate efficacy and safety of ultrasound guided foam sclerotherapy for treatment of varicose veins. 2023;10(2):261-7.
Pugalenthi LS, Garapati C, Maddukuri S, Kanwal F, Kumar J, Asadimanesh N, Arunachalam SP. From data to decisions: AI in varicose veins—Predicting, diagnosing, and guiding effective management. J Vasc Dis. 2025;4(2):19.
Wilkinson MC, Ayad A, Kiang SC, Grewal ML. A review on the current applications of artificial intelligence in chronic venous insufficiency. JVS-Vascular Insights. 2025;100261.
Song HS, Yi BJ, Won JY, Woo J. Learning-based catheter and guidewire-driven autonomous vascular intervention robotic system for reduced repulsive force. Journal of Computational Design and Engineering. 2022;9(5):1549-64.
Ma J, Zhang K, Li W, Ding Y, Chen Y, Huang X, Ding P. Tranexamic acid-fatty alcohol polyoxyethylene ether conjugation/PVA foam for venous sclerotherapy via vascular damage and inhibiting plasmin system. Acta Pharmaceutica Sinica B. 2025;15(6):3291-3304.
Rivard A, Soulez G, Lerouge S, Fortin MA. Novel Sclerosing and Embolizing Gel for Varicose Vein Treatment: Feasibility Study in a Porcine Model. Journal of Vascular and Interventional Radiology. 2025;34(3):S126.
