Dtsch Med Wochenschr 2019; 144(09): 606-623
DOI: 10.1055/a-0855-2401
CME-Fortbildung
© Georg Thieme Verlag KG Stuttgart · New York

Moderne Behandlungsverfahren der Varikose der unteren Extremität

Modern treatment of varicose veins
Andreas Bayer*
,
Birgit Kahle*
,
Marco Horn
,
Anna Lena Recke
,
Tobias Keck
,
Markus Kleemann
Further Information

Publication History

Publication Date:
26 April 2019 (online)

Abstract

Varicosis of the lower limb is a common disease that can lead to edema, trophic disturbances and skin ulcerations. In addition to the classic surgical procedure of crossectomy with stripping of the saphenous vein, a growing number of minimally invasive endoluminal treatment methods has been established over the past 15 years, offering a colorful array of procedures to the modern phlebologist. It is important to choose the optimal treatment option for each individual patient.

Die Varikosis der unteren Extremität stellt eine häufige Erkrankung dar, die zu Ödemen, trophischen Störungen und Ulzerationen der Haut führen kann. In den letzten 15 Jahren haben sich neben dem klassischen operativen Verfahren der Krossektomie mit Stripping der Stammvene zunehmend minimalinvasive endoluminale Behandlungsverfahren etabliert, sodass dem modernen Phlebologen nun ein bunter Strauß an Prozeduren zur Verfügung steht. Es gilt, daraus für jeden Patienten die individuell optimale Behandlungsoption zu wählen.

* Diese Autoren haben zu gleichen Teilen zur Arbeit beigetragen.


 
  • Literatur

  • 1 Rabe E, Berboth G, Pannier F. et al. Epidemiologie der chronischen Venenkrankheiten. Wiener Med Wochenschr 2016; 166, 9–10: 260-263
  • 2 Maurins U, Hoffmann BH, Lösch C. et al. Distribution and prevalence of reflux in the superficial and deep venous system in the general population-results from the Bonn Vein Study, Germany. J Vasc Surg 2008; 48: 680-687
  • 3 Vanhoutte PM, Corcaud S, de Montrion C. et al. Venous disease: from pathophysiology to quality of life. Angiology 1997; 48: 559-567
  • 4 Eklöf B, Rutherford RB, Bergan JJ. et al. American Venous Forum International Ad Hoc Committee for Revision of the CEAP Classification. Revision of the CEAP classification for chronic venous disorders: Consensus statement. J Vasc Surg 2004; 40: 1248-1252
  • 5 Vasquez MA, Rabe E, McLafferty RB. et al. Revision of the venous clinical severity score: Venous outcomes consensus statement: Special communication of the American Venous Forum Ad Hoc Outcomes Working Group. J Vasc Surg 2010; 52: 1387-1396
  • 6 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: 2S-48S
  • 7 Heyer K, Protz K, Glaeske G. et al. Epidemiology and use of compression treatment in venous leg ulcers: nationwide claims data analysis in Germany. Int Wound J 2017; 14: 338-343
  • 8 Reich-Schupke S, Protz K, Dissemond J. et al. Neue Entwicklungen in der Kompressionstherapie. Dtsch Med Wochenschr 2017; 142: 679-686
  • 9 Dissemond J, Assenheimer B, Bültemann A. et al. Kompressionstherapie bei Patienten mit Ulcus cruris venosum. J Dtsch Dermatol Ges 2016; 14: 1073-1089
  • 10 Renner R, Gebhardt C, Simon JC. Compliance hinsichtlich der Kompressionstherapie bei Patienten mit floridem Ulcus cruris venosum. Med Klin 2010; 105: 1-6
  • 11 Partsch H, Mosti G. Comparison of three portable instruments to measure compression pressure. Int Angiol 2010; 29: 426-430
  • 12 Heyer K, Augustin M, Protz K. et al. Effectiveness of advanced versus conventional wound dressings on healing of chronic wounds: systematic review and meta-analysis. Dermatology 2013; 226: 172-184
  • 13 van den Bremer J, Moll FL. Historical overview of varicose vein surgery. Ann Vasc Surg 2010; 24: 426-432
  • 14 Lill G, Hernández-Richter HJ, Golestan C. Operationstechnik bei Crossektomie und Varizenstripping nach Babcock. Med Welt 1977; 28: 331-333
  • 15 Noppeney T, Storck M, Nüllen H. et al. Perioperative quality assessment of varicose vein surgery: Commission for quality assessment of the German Society for Vascular Surgery. Langenbecks Arch Surg 2016; 401: 375-380
  • 16 Sperling M, Lacativa A. Die Invaginationsextraction? Eine Modifizierung der Babcock’schen Varicenoperation. Chirurg 1985; 56: 90-94
  • 17 Durkin M, Turton EP, Wijesinghe L. et al. Long saphenous vein stripping and quality of life – a randomised trial. Eur J Vasc Endovasc Surg 2001; 21: 545-549
  • 18 Joh JH, Lee KB, Yun WS. et al. External banding valvuloplasty for incompetence of the great saphenous vein: 10-year results. Int J Angiol 2009; 18: 25-28
  • 19 Proebstle T, van den Bos R. Endovenous ablation of refluxing saphenous and perforating veins. Vasa 2017; 46: 159-166
  • 20 Dermody M, OʼDonnell TF, Balk EM. Complications of endovenous ablation in randomized controlled trials. J Vasc Surg Venous Lymphat Disord 2013; 1: 427-436.e1
  • 21 Proebstle TM, Alm BJ, Göckeritz O. et al. Five-year results from the prospective European multicentre cohort study on radiofrequency segmental thermal ablation for incompetent great saphenous veins. Br J Surg 2015; 102: 212-218
  • 22 Shaidakov EV, Grigoryan AG, Ilyukhin EA. et al. Radiofrequency ablation or stripping of large-diameter incompetent great saphenous varicose veins with C2 or C3 disease. J Vasc Surg Venous Lymphat Disord 2016; 4: 45-50
  • 23 Proebstle TM, Alm J, Göckeritz O. et al. Three-year European follow-up of endovenous radiofrequency-powered segmental thermal ablation of the great saphenous vein with or without treatment of calf varicosities. J Vasc Surg 2011; 54: 146-152
  • 24 Lurie F, Creton D, Eklof B. et al. Prospective Randomised Study of Endovenous Radiofrequency Obliteration (Closure) Versus Ligation and Vein Stripping (EVOLVeS): two-year follow-up. Eur J Vasc Endovasc Surg 2005; 29: 67-73
  • 25 Gauw SA, Lawson JA, van Vlijmen-van Keulen CJ. et al. Five-year follow-up of a randomized, controlled trial comparing saphenofemoral ligation and stripping of the great saphenous vein with endovenous laser ablation (980 nm) using local tumescent anesthesia. J Vasc Surg 2016; 63: 420-428
  • 26 Lawaetz M, Serup J, Lawaetz B. et al. Comparison of endovenous ablation techniques, foam sclerotherapy and surgical stripping for great saphenous varicose veins. Extended 5-year follow-up of a RCT. Int Angiol 2017; 36: 281-288
  • 27 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: Results of a multicentre randomised controlled trial with up to 6 years follow-up. Phlebology 2016; 31: 23-33
  • 28 O’Donnell TF, Balk EM, Dermody M. et al. Recurrence of varicose veins after endovenous ablation of the great saphenous vein in randomized trials. J Vasc Surg Venous Lymphat Disord 2016; 4: 97-105
  • 29 Kalteis M, Adelsgruber P, Messie-Werndl S. et al. Five-year results of a randomized controlled trial comparing high ligation combined with endovenous laser ablation and stripping of the great saphenous vein. Dermatol Surg 2015; 41: 579-586
  • 30 Marston WA, Crowner J, Kouri A. et al. Incidence of venous leg ulcer healing and recurrence after treatment with endovenous laser ablation. J Vasc Surg Venous Lymphat Disord 2017; 5: 525-532
  • 31 Luebke T, Brunkwall J. Cost-effectiveness of endovenous laser ablation of the great saphenous vein in patients with uncomplicated primary varicosis. BMC Cardiovasc Disord 2015; 15: 138
  • 32 Carradice D, Mekako AI, Mazari FA. et al. Randomized clinical trial of endovenous laser ablation compared with conventional surgery for great saphenous varicose veins. Br J Surg 2011; 98: 501-510
  • 33 Rasmussen LH, Bjoern L, Lawaetz M. et al. Randomised clinical trial comparing endovenous laser ablation with stripping of the great saphenous vein: clinical outcome and recurrence after 2 years. Eur J Vasc Endovasc Surg 2010; 39: 630-635
  • 34 Whiteley MS. Glue, steam and Clarivein-Best practice techniques and evidence. Phlebology 2015; 30 (02) 24-28
  • 35 Milleret R, Huot L, Nicolini P. et al. Great saphenous vein ablation with steam injection: results of a multicentre study. Eur J Vasc Endovasc Surg 2013; 45: 391-396
  • 36 Rabe E, Otto J, Schliephake D. et al. Efficacy and safety of great saphenous vein sclerotherapy using standardised polidocanol foam (esaf): a randomised controlled multicentre clinical trial. Eur J Vasc Endovasc Surg 2008; 35: 238-245
  • 37 Uncu H. Sclerotherapy: a study comparing polidocanol in foam and liquid form. Phlebology 2010; 25: 44-49
  • 38 Rasmussen L, Lawaetz M, Serup J. et al. Randomized clinical trial comparing endovenous laser ablation, radiofrequency ablation, foam sclerotherapy, and surgical stripping for great saphenous varicose veins with 3-year follow-up. J Vasc Surg Venous Lymphat Disord 2013; 1: 349-356
  • 39 Rabe E, Pannier F. Sclerotherapy of varicose veins with polidocanol based on the guidelines of the German Society of Phlebology. Dermatol Surg 2010; 36 (02) 968-975
  • 40 Witte ME, Zeebregts CJ, de Borst GJ. et al. Mechanochemical endovenous ablation of saphenous veins using the ClariVein: A systematic review. Phlebology 2017; 32: 649-657
  • 41 Argyriou C, Papasideris C, Antoniou GA. et al. The effectiveness of various interventions versus standard stripping in patients with varicose veins in terms of quality of life. Phlebology 2017; DOI: 10.1177/0268355517720307.
  • 42 Bootun R, Lane TR, Davies AH. The advent of non-thermal, non-tumescent techniques for treatment of varicose veins. Phlebology 2016; 31: 5-14
  • 43 Eroglu E, Yasim A, Ari M. et al. Mid-term results in the treatment of varicose veins with N-butyl cyanoacrylate. Phlebology 2017; 32: 665-669
  • 44 Gibson K, Ferris B. Cyanoacrylate closure of incompetent great, small and accessory saphenous veins without the use of post-procedure compression: Initial outcomes of a postmarket evaluation of the VenaSeal System (the WAVES Study). Vascular 2017; 25: 149-156
  • 45 Chan YC, Law Y, Cheung GC. et al. Predictors of recanalization for incompetent great saphenous veins treated with cyanoacrylate glue. J Vasc Intervent Radiol 2017; 28: 665-671
  • 46 Chan YC, Law Y, Cheung GC. et al. Cyanoacrylate glue used to treat great saphenous reflux: Measures of outcome. Phlebology 2017; 32: 99-106
  • 47 Proebstle TM, Alm J, Dimitri S. et al. The European multicenter cohort study on cyanoacrylate embolization of refluxing great saphenous veins. J Vasc Surg Venous Lymphat Disord 2015; 3: 2-7