Die Chirurgie der Vena saphena parva – endoluminal oder
                    operativ

Dietmar Stenger; Michael Hartmann

doi:10.1055/a-0806-8349

Phlebologie, Table of Contents

Phlebologie 2019; 48(01): 23-31
DOI: 10.1055/a-0806-8349

Review

Die Chirurgie der Vena saphena parva – endoluminal oder operativ

Article in several languages: deutsch | English

Authors

Dietmar Stenger

¹Venenzentrum Saarlouis
Michael Hartmann

²Venenzentrum Freiburg

Abstract

Zusammenfassung

Bislang existiert kein einheitlicher Standard in der operativen oder endovenösen Therapie der Parvainsuffizienz. Daher ist eine direkte Vergleichbarkeit operativer und endovenöser Verfahren bislang nur eingeschränkt möglich. Insbesondere erschweren unterschiedliche Definitionen eines Rezidivs die Vergleichbarkeit der unterschiedlichen Therapieoptionen. Prospektive randomisierte Studien zu den Langzeitergebnissen fehlen. Aufgrund der schwachen Datenlage sind grundsätzliche Empfehlungen für oder gegen die eine oder andere Therapieoption derzeit nicht möglich. Dennoch gibt es in der täglichen Praxis eindeutige Vorteile für die Operation oder für die endovenöse Therapie, auch wenn entsprechende Vergleichsstudien fehlen. Die Rezidivraten sind sowohl bei operativer- als auch bei endovenöser Behandlung hoch. Allerdings wird weder bei der Operation, noch bei der endovenösen Therapie eine komplette Ausschaltung der krankhaft veränderten Vene vorgenommen. Zukünftige Studien sollten klären, inwieweit die komplette Ausschaltung der Parvacrosse mit Umsetzung des Prinzips der Crossektomie zu einer Verbesserung der Ergebnisse beitragen kann.

Schlüsselwörter

Parvainsuffizienz - Parvacrosse - Crossektomie

Full Text

References

Literatur / References
1 Allegra C, Antignani PL, Carilizza A. Recurrent Varicose Veins Following Surgical Treatment: Our Experience with Five Years Follow-up. Eur J Vasc Endovasc Surg 2007; 33: 751-756
2 Boersma D, Kornmann Verena NN, Van Eekeren RRJP. et al. Treatment Modalities for Small Saphenous Vein Insufficiency: Systematic Review and Meta-analysis. Journal of Endovascular Therapy 2016; 23: 199-211
3 Brittenden J, Cotton SC, Elders A. et al. Clinical effectiveness and cost-effectiveness of foam sclerotherapy, endovenous laser ablation and surgery for varicose veins: results from the Comparison of Laser, Surgery and foam Sclerotherapy (CLASS) randomised controlled trial. Health Technol Assess 2015; 19: 142-342
4 Creton D. 125 reinterventions for recurrent popliteal varicose veins after excision of the short saphenous vein. Anatomical and physiological hypotheses of the mechanism of recurrence. J Mal Vasc 1999; 24: 30-37
5 Desmyttere J, Grard C, Stalnikiewicz G. et al. Endovenous laser ablation (980 mm) of the small saphenous vein in a series of 147 limbs with a 3-year follow-up. Eur J Vasc Enovasc Surg 2010; 41: 400-405
6 Dogancy S, Yildirim V, Demikilic U. Does puncture site affect the rate of nerve injuries following endovenous laser ablation of the small saphenous veins?. Eur J Vasc Endovasc Surg 2011; 41: 400-405
7 Engel AF, Davies G, Keeman JN. Preoperative Localisation of the Sapheopopliteal Junction with Duplex Scanning. Eur J Vasc Surg 1991; 5: 507-509
8 Feuerstein W. Zur Behandlung der Vena saphena parva Varizen. Phlebol 1993; 22: 230-235
9 Fischer R. Die chirurgische Behandlung der Varizen – Grundlagen und heutiger Stand, Schweiz. Rundschau Med. PRAXIS. 1990 79. Nr. 7
10 Fischer R, Vogel P. Die Resultate der Strippingoperation bei der Vena saphena parva. VASA 1987; 16: 349-351
11 Flessenkämper I, Hartmann M, Hartmann K. et al. Endovenous laser ablation with and without high ligation compared to high ligation and stripping for treatment of great saphenous varicose veins. Br J Surg 2014; 95: 1232-1238
12 lessenkämper I, Hartmann M, Stenger D. et al. Endovenous laser ablation with an without high ligation compared with high ligation and stripping in the treatment of great saphenous varicose veins: intial results of a multicentre radomized controlles trial. Phlebology 2013; 28: 16-23
13 Flessenkämper I, Hartmann M, Hartmann K. et al. Endovenous laser ablation with and without high ligation compared to high ligation and stripping for treatmant of great saphenous varicose veins: Results of a multicentre randomised controlled trial with up to 6 years follow-up. Phlebologie 2016; 31: 23-33
14 Frings N, Glowacki P, Kohajda J. Major-Komplikationen am Gefäß- und Nervensystem in der Varicenchirurgie. Chirurg 2001; 72: 1032-1035
15 Geier B, Stücker M, Hummel T. et al. Residual Stumpfs associated with inguinal varicose vein recurrences: a multicenter study. Eur J Vasc Endovasc Surg 2008; 36: 207-210
16 Gloviczki P, Comerota AJ, Dalsing MC. et al. The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg 2011; 53: 2-48
17 Hach W, Mumme A. et al. Venenchirurgie. 3. Aufl.. Schattauer; Stuttgart: 2012
18 Hamann St AS, Giang J, De Maeseneer MGR. et al. Five Year Results of Great Saphenous Vein Treatment: A Meta-Analysis. Eur J Vasc Endovasc Surg 2017; 1-11
19 Hanzlick J. Recurrent varicosity of the lesser saphenous vein. A 5-year-follow-up. Zentralbl Chir 1999; 1241: 42-47
20 Hartmann M. Krossektomie heilt Krampfadern schnell. Ärztl Prax 1980; 73: 2349-2350
21 Hartmann M, Waldermann F, Weingard IEt al. Ist die Ischiadicusvarikosis eine Variante der Parvavarikosis. Phlebologie. 05/2001
22 Hartmann K, Klode J, Pfister R. et al. Recurrent varicose veins: Sonography-based re-examination of 210 patients 14 years after ligation and saphenous vein stripping. VASA 2006; 35: 21-26
23 Hartmann K, Stenger D, Hartmann M. et al. Endochirurgie versus offene Chirurgie der Varikose. Der Hautarzt 2017; 8: 603-613
24 Helmig L, Stelzer G. Häufigkeit der operative Behandlung der insuffizienten Vena saphena parva. VASA 1983; 12: 159-164
25 Huisman LC, Bruins RM, vn den Berg M. et al. Endovenous laser ablation oft he small saphenous vein: prospective analysis of 150 patients, a cohort study. Eur J Vasc Endovasc Surg 2009; 38: 199-202
26 Mildner A, Hilbe G. Parvarezidive nach subfascialer Ligatur – 5 Jahres Ergebnisse. Phlebologie 1997; 26: 35-39
27 Monahan TS, Belek K, Sarkar R. Results of radiofrequency ablation oft he small saphenous vein in the supine position. Vasc Endovascular Surg 2012; 46: 40-44
28 Mouton WG, Naef M, Mouton KT. et al. Nerve Injury and Small Saphenous Vein Surgery. Eur J Vasc Surg 2005; 30: 108
29 Nandhra S, El-sheikha J, Carradice D. et al. A randomized clinical trial of endovenous laser ablation versus conventional surgery for small saphenous varicose veins. Journal of Vascular Surgery 03/2015; 741-746
30 Noppeney T, Eckstein HH, Niedermeier H. et al. Ergebnisse des Qualitätssicherungsprojektes Varizenchirurgie der Deutschen Gesellschaft für Gefäßchirurgie. Gefäßchirurgie 2005; 10: 121-128
31 Noppeney T, Nüllen H. Diagnostik und Therapie der Varikose. Springerverlag; 2010
32 Noppeney T, Storck M, Nüllen H. et al. Perioperative quality assesment of varicose vein surgery. Langenbecks Arch Surg 2016; 401: 375-380
33 O’Donnell Jr TFO, Iafrati MD. The small saphenous vein and other „neglected“ veins of the popliteal fossa: a review. Phlebology. 2007 22.
34 O’Hare JL, Vandenbroeck CP, Whitman B. et al. A prospective evaluatiom of the outcome after small saphenous varicose vein surgery with one-year follow-up. Journal of Vascular Surgery 09/2008; 669-673
35 Park JA, Park SW, Chang IS. et al. The 1470-nm bare-fiber diode laser ablation of the great saphenous vein and small saphenous vein at 1-year follow-up using 8–12 W and a mean linear endovenous energy density of 72 J/cm. J Vasc interv Radiol 2014; 25: 1795-1800
36 Peräla J, Autio R, Biancari F. et al. Radiofrequency endovenous oblitereation versus Stripping of the long saphenous vein in the management of primary varicose veins: 3-year-outcoume of randomized study. Ann Vasc Surg 2005; 19: 669-672
37 Pronk P, Gauw SA, Mooij MC. et al. Randomised controlled trail comparing saphenofemoral-ligation and stripping of the great saphenous vein with endovenous laser ablation (980 nm) using local tumescent anaestesia: one year results. Eur J Vasc Endovasc Surg 2010; 40: 649-656
38 Pukacki F, Zielinksi P, Checinski P. et al. Short saphenous vein incompetence as a cause of recurrent varicose veins. Wiad Lek 2003; 56: 28-33
39 Rabe E, Pannier F. Epidemiology of chronic venous disorders. In: Gloviciki P. (Hrsg) Handbook of venous disorders. Hodder Arnold, CRC Press; 2009: 105-110
40 Rashid HI, Ajeel A, Tyrrell MR. Persistent popliteal fossa reflux following saphenopopliteal disconnection. British Journal of Surgery 2002; 89: 748-751
41 Rass K, Frings N, Glowacki P. et al. Same Site recurrence is more frequent after endovenous laser ablation compared with High ligation and stripping of the great Saphenous vein: 5 Year results of a randomized clinical trial (RELACS Study). Eur J Vasc Endovasc Surg 2015; 50: 648-656
42 Roopram AD, Lind MY, Van Brussel JP. et al. Endovenous laser ablation versus conventional surgery in the treatment of small saphenous vein incompetence. J Vasc Surg: Venous Lym Dis 2013; 1: 357-363
43 Sam RC, Silverman SH, Bradbury AW. Nerve Injuries and Varicose Vein Surgery. Eur J Vasc Endovasc Surg 2004; 27: 113-120
44 Samuel N, Caradice D, Wallace T. et al. Saphenopopliteal ligation and stripping of small saphenous vein: does extended stripping provide better results?. Phlebology 2012; 27: 390-397
45 Samuel N, Carradice D, Wallace T. et al. Randomized Clinical Trial of Endovenous Laser Ablation Versus Conventional Surgery for Small Varicose Veins. Annals of Surgery 2013; 257: 419-426
46 Stenger D, Janthur E, Rafi L. Stripping-Operation heute. Vasomed 2011; 23: 06-13
47 Stenger D, Rafi L, Hauch T. et al. Chirurgie der Vena saphena parva-Varikose – Antworten bisher ungeklärter Fragen. Phlebologie. 05/2011
48 Stenger D, Hartmann M. Crossektomie und Stripping-OP der Klassiker. Hautarzt 2012; 63: 616-621
49 Subramonia S, Lees T. Radiofrequency ablation vs conventional surgery vor varicose veins a comparison of treatment costs in randomised trial. Eur J Vasc Endovasc Surg 2010; 39: 104-111
50 Tellings SS, Ceulen RPM, Sommer A. Surgery and endovenous techniques for the treatment of small saphenous varicose veins: a review of the literature. Phlebology 2011; 26: 179-184
51 Tong Y, Royle J. Recurrent varicose veins after short saphenous vein surgery: a duplex ultrasound study. Cardiovasc Surg 1996; 4: 364-367
52 Vin F, Chleir F. Ultrasonography of postoperatively recurrent varicose veins in the area of the short saphenous vein. Ann Chir 2001; 126: 320-324
53 Whiteley MS, Lewis G, Holdstock JM. et al. Minimally invasive technique for ligation and stripping of the small saphenous vein guided by intra-operaitve duplex ultrasound. Surgeon 2006; 4: 372-377
54 Winterborn RJ, Campbell WB, Heather BP. et al. The Management of Short Saphenous Varicose Veins: A Survey of the Members of the Vascular Surgical Society of Great Britain and Ireland. Eur J Vasc Endovasc Surg 2004; 28: 400-403
55 Winterborn RJ, Foy C, Heather BP. et al. Randomised trial of flush saphenofemoral ligation for primary great saphenous varicose veins. Eur J Vasc Endovasc Surg 2008; 36: 477-484