Endovenous procedures in varicose veins

Summary

Over the past ten years endoveous treatment options for varicose veins have evovled considerably, offering clinicians a multitude of options to meet the needs of their patients. The endothermal ablation procedures have moved to the forefront as the choice modality for treating truncal reflux. Both radiofrequency ablation and endovenous laser ablation are widely accepted and interchangeable, showing comparable efficacy and safety. Although numerous endovenous laser wavelengths exist, the data indicates that the differences do not affect the efficacy or postoperative recovery of the procedure. The endovenous laser innovation that has shown early evidence of improved patient outcome is the jacket-tip fiber. The versatility of sclerotherapy makes it a critical component in the endovenous treatment of varicosities. Although not approved by the Food and Drug Administration (USA), the use of a foamed sclerosing agent is the fastest growing segment of sclerotherapy and an important treatment modality in the future of varicose vein treatment. Cutaneous lasers and intense pulse light devices contribute a crucial element, enabling clinicians to treat minute veins that may be impossible to treat with other therapies.

Zusammenfassung

In den vergangenen zehn Jahren haben sich die Behandlungsmethoden für variköse Venen erheblich entwickelt. Dadurch wird Ärzten eine Vielzahl von Optionen geboten, den Patientenbedürfnissen zu entsprechen. Bei der Behandlung der Stammveneninsuffizienz sind endotherme Ablationsverfahren zur Behandlungsmethode der ersten Wahl geworden. Sowohl Radiofrequenzablation als auch endovenöse Lasertherapie sind allgemein anerkannt und gegeneinander austauschbar. Beide weisen eine vergleichbare Wirksamkeit und Sicherheit auf. Zwar existieren zahlreiche endovenöse Laserwellenlängen, aber die Daten weisen darauf hin, dass unterschiedliche Wellenlängen keinen Einfluss auf die Wirksamkeit des Verfahrens bzw. die postoperative Rekonvaleszenz haben. Das Jacket-tip-fiber-Verfahren stellt eine innovative Form der endovenösen Lasertherapie dar und konnte bereits sehr früh nachweislich bessere Ergebnisse für den Patienten erzielen. Auf Grund ihrer Vielseitigkeit ist die Sklerotherapie eine entscheidende Komponente der endovenösen Varizenbehandlung. Dabei stellt die Schaumsklerotherapie, obwohl von der Food and Drug Administration (USA) nicht zugelassen, das am schnellsten wachsende Segment in der Sklerotherapie dar und wird in Zukunft eine wichtige Option für die Therapie variköser Venen bilden. Haut-Laser und hochenergetische Blitzlampen sind weitere entscheidende Elemente der Therapie und ermöglichen Ärzten, kleinste Venen zu behandeln, die anderen Therapieformen nicht zugänglich sind.

Résumé

Depuis 10 ans les possibilités thérapeutiques pour les veines variqueuses ont considérablement évolué, offrant plusieurs options. Les méthodes de traitement endoveineux ont tendance à devenir peut-être le premier choix pour le traitement de reflux tronculaire. L’ablation par radiofréquence et le traitement par laser endoveineux sont largement répandus et donnent des résultats comparables en efficacité et en sécurité. Bien que de nombreuses variations de longueurs d’ondes existent pour le laser endoveineux, ces différences ne semblent pas influer sur l’efficacité de la guérison. L’innovation du laser endoveineux qui a montré les meilleurs effets provient de fibres enrobées (jacket-typ). Les résultats variables de la sclérothérapie en font une méthode discutable pour le traitement endoveineux de varicosités. Bien qu’elle ne soit pas reconnue par la FDA aux Etats-Unis, l’utilisation d’une mousse sclérosante reste le domaine prometteur de la sclérothérapie et une variante thérapeutique importante dans l’avenir du traitement des varices. Les lasers cutanés et les appareils à pulsation lumineuse intense restent utilisables pour le traitement de microvaricosités que l’on peut traiter par d’autres méthodes.

Keywords

Varicose veins - radiofrequency ablation - endovenous laser ablation - sclerotherapy

Schlüsselwörter

Variköse Venen - Radiofrequenzablation - endovenöse Lasertherapie - Sklerotherapie

Mots clés

Varices des membres inférieurs - ablation par radiofréquence - traitement par laser endoveineux - sclérothérapie

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