CARDIOVASCULAR JOURNAL OF AFRICA • Volume 35, No 3, September – October 2024 166 AFRICA Evaluation of clinical results of esmarch bandage application in giant saphenous vein closure during endovenous glue ablation Oğuz Karahan, Ozgur Akkaya, Eyup Aydogan Abstract Background: In recent years, the endovenous technique has been presented as a good alternative to surgery in the treatment of patients with lower extremity varicose veins. However, its effectiveness in very advanced saphenous vein diameters is controversial. In this study, we investigated the results of an endovenous glue ablation closure system applied with an esmarch bandage in saphenous veins with very large diameters. Methods: Eighty-nine patients who were operated on for varicose veins were divided into three groups according to their saphenous vein diameters: less than 10 mm (group 1), between 10 and 15 mm (group 2), and larger than 15 mm (group 3). Endovenous closure was performed with n-butyl cyanoacrylate in all patients. An esmarch bandage was applied during the procedure to all patients, except for the group with a diameter of less than 10 mm. This group underwent the standard procedure. All patients were followed up for six months after the procedure and postoperative symptoms, complications and closure rates were recorded. Results: There was complete closure of all veins in the first month postoperatively. While no thrombophlebitis was observed in group 3, thrombophlebitis was detected in two patients in groups 1 and 2. In the third month, minimal saphenofemoral reflux was observed in two (4.2%) patients in group 1 and in one (4.3%) in group 2. In the sixth month, minimal saphenofemoral reflux was detected in three (6.3%) patients in group 1 and in one (4.3%) in group 2. No residual leakage was observed in group 3 (p = 0.001). In all groups, the severity score regressed significantly in the postoperative sixth month. However, the most significant symptomatic regression was observed in group 3, which had the largest saphenous diameters and we used an esmarch bandage during closure (p = 0.000). Conclusion: Our findings support the idea that the application of an esmarch bandage during endovenous closure improves clinical outcomes, especially in saphenous veins with larger diameters. Keywords: varicose veins, endovenous closure, esmarch bandage, large diameter, postoperative outcomes Submitted 25/1/23; accepted 3/5/23 Published online 3/6/23 Cardiovasc J Afr 2024; 35: 166–171 www.cvja.co.za DOI: 10.5830/CVJA-2023-026 Although the incidence of chronic venous insufficiency increases with age, it is an important pathology affecting all age groups.1 In addition to having certain risk factors, such as gender, family history, obesity, pregnancy, sedentary lifestyle, and being constantly exposed to smoke and smoking, it also occurs in the postphlebitic process after deep venous thrombosis.1,2 This pathology, which impairs an individual’s quality of life, also causes active future workforce losses.2,3 Increased venous blood pressure affects deep and superficial veins. Venous insufficiency causes pain in the legs, restlessness, night cramps, and later in life, varicose veins and oedema develop under the skin, with poor cosmetic results. In more advanced stages, it results in ulcers due to stasis dermatitis. Therefore, it should be diagnosed and treated with the appropriate treatment methods.2,3 In the early period of disease, medical treatment and compression are usually sufficient. However, additional interventional treatment methods are needed in the future.4 Surgical treatment has been developed for the great and small saphenous veins, which are usually superficial veins. If there is no venous leakage in the deep veins, prevention of leakage in the superficial veins relieves the symptoms to a great extent. For removal of the saphenous vein, surgical treatment was previously performed as open surgery and/or its ligation in the saphenofemoral region. However, due to poor cosmetic results, the need for general or spinal anaesthesia, and a long postoperative recovery period, over time, surgery has been replaced by endovenous closure systems.5,6 The most commonly used endovenous techniques are endovenous laser ablation (EVLA), radiofrequency ablation (RFA) and chemical ablation. Although successful operations have been reported with all methods, preferences vary in different clinics due to usage differences and accessibility.6,7 EVLA and RFA, which have been used in the past, have been presented as a useful alternative to surgery, as they have good cosmetic results and successful mid- and long-term results.6,7 However, studies show that these systems are based on heat energy and require tumescent anaesthesia during the procedure, and that heatrelated tissue damage occurs during ablation. This has led to the search for alternative methods.8,9 N-butyl cyanoacrylate (NBCA) ablation methods, which are offered as a good solution to this issue and are gaining popularity, are easy to apply under local anaesthesia and do not cause surrounding tissue damage.9 Studies have reported Medical School of Alaaddin Keykubat University, Alanya, Turkey Oğuz Karahan, MD, oguzk2002@gmail.com Eyup Aydogan, MD Alanya Research and Training Hospital, Alanya, Turkey Ozgur Akkaya, MD
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