Author/Editor		Šikovec, Andrej
Title		Endovenska laserska obliteracija velike vene safene: nova minimalno invazivna metoda zdravljenja krčnih žil - preliminarno poročilo
Translated title		Endovenous obliteration of long saphenous vein. A new minimal invasive method of treatment for varicose veins - preliminary report
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 73, št. 12
Publication year		2004
Volume		str. 921-4
Language		slo
Abstract		Background. Minimally invasive treatment of varicose veins is becoming more and more important as it represents less burden to the patient and health system. The success of the different methods depends on their capability to eliminate the reflux at the sapheno femoral junction (SFJ) and the incompetent greater saphenous vein (GSV). In achieving these only three methods are successful: ultrasound (US) guided catheter sclerosation, radiofrequency or laser endovenous obliteration of GSV Aims. To demonstrate a novel way to use a laser energy through an endoluminal laser fiber for the minimally invasive treatment of truncal varicosities and the elimination of SFJ reflux. Methods. The patients with US detected reflux in the SFJand GSV were treated on the outpatient basis under local anaesthesia with laser mediated heat energy in the GSV 2-3 cm from SFJ with the laser of wave leugth of 980 nm with the power 15 W and the impulse duration of 1 sek. We used 20-40 impulses along the treated segment of GSV. The exact position of the laser fiber was determined by the US. The smaller branch varices were removed by mini phlebectomies. Patients tolerated well the procedure and they were dismissed from the hospital with applied compression stockings (CCL II) immediately after the completion of the procedure. The control US was done one week, four weeks and three months later. At one week one out of 16 patients presented with no occlusion of the GSV. At four weeks another patient had recanalisation of GSV but without the reflux. All other patients had the short GSV stump in which the patient epigastric vein was draining while the remaning part of the GSV was obliterated by the thrombus. Except for some skin ecchymosis and mild induration in the but patients did not have any other problems. The unsuccessful treatment in two patients is probably due to insufficient applied energy.
Summary		Izhodišča. Minimalno invazivno zdravljernje krčnih žil pridobiva na pomenu zaradi manjše obremenitve za bolnika in zdravstveni sistem. Uspešnost različnih metod je odvisna od zmožnosti metode, da odpravi obratni tok v področju safeno femoralnega ustja (SFU) in odstrani iz obtoka oboleli del velike vene safene (VSM). Pri tem so uspešne le tri metode: ultrazvočno (UZ) vodena kateterska sklerozacijo radiofrekvenčna ali laserska endovenska obliteracija VSM. Cilj. Prikazati nov način uporabe laserske energije preko endovenoznega laserskega vlakna za minimalno invazivno zdravljenje debelnih varic in odstranitve obratnega toka v SFU. Metode. Bolnike z UZ ugotovljenim obratnim tokom krvi v SFU in VSM smo zdravili ambulantno v lokalni anesteziji z dovajanjem toplotne energije v VSM 2-3 cm pod SFU s pomočjo laserja valovne dolžine 980 nm in jakosti 15 W in trajanjem impulza 1 sek. Uporabili smo 20-40 impulzov vzdolž zdravljenega dela VSM. Natančno namestitev vlakna smo določili z UZ Pri vseh smo opravili še mini flebektomijo manjših varic. Bolniki so poseg dobro prenašali in so neposredno po posegu z nameščeno kompresijsko nogavico (Ccl ll) zapustili bolnišnico. Kontrolni UZ smo opravili teden dni, štiri tedne in tri mesece po posegu. Pri enem od 16 bolnikov smo že ob prvi kontroli ugotovili, da nismo dosegli trombotske zapore VSM. Po štirih tednih se je ponovno vzpostavil pretok v VSM, vendar brez obratnega toka še pri enem bolniku. Vsi ostali bolniki so imeli ob kontrolah kratek krn VSM, v katerega se je izlivala kri iz epigastrične vene, preostanek VSM je imel trombotsko zaporo. Bolniki po posegu razen nekaj podkožnih izlivov krvi in manjšega občutka boleče zatrdline na stegnu drugih težav niso imeli. Neuspeh pri dveh bolnikih pripisujemo prenizki uporabljeni energiji.
Descriptors		VARICOSE VEINS LASER SURGERY SAPHENOUS VEIN