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Phlebologie 2020; 49(03): 144-151
DOI: 10.1055/a-1155-3072
Schwerpunktthema Crossenrezidive

Beeinflusst das Nahtmaterial die Rezidivrate nach Krossektomie?

Does suture material influence recurrence rate after crossectomy?
Erika Mendoza
  Venenpraxis Wunstorf
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Widmung

Ich möchte diese Publikation meinem ersten Ehemann, dem Herz- und Gefäßchirurgen Dr. Hans-Arrien Berger († 2000), widmen, der mir die Liebe zu den Venen geschenkt hat.

Zusammenfassung

Einleitung Im Rahmen der Literaturrecherche für die Leitlinie Diagnostik und Therapie der Varikose der Deutschen Gesellschaft für Phlebologie fiel die weite Streuung der Krossenrezidive zwischen den verschiedenen Studien auf. Auf der Suche nach Antworten wurden die Studien nach dem Nahtmaterial analysiert, das zum Verschluss der V. femoralis communis und des Venensterns verwendet wurde, um herauszufinden, ob die Art des Materials (resorbierbar, nicht resorbierbar) eine Rolle spielen könnte.

Methode Auswertung der Literaturrecherche der DGP für die Leitlinie sowie weitere Pubmed-Recherche mit dem Stichwort Neovaskulogenese und Rezidive nach Krossektomie. Erfasst wurden die chirurgische Technik (Krossektomie allein, mit Stripping oder mit endoluminalen Verfahren sowie Krossenligatur ohne Unterbrechung des Venensterns), das Nahtmaterial, die Dauer des Follow-ups sowie die Art der Studie (prospektiv, retrospektiv, randomisiert oder nicht). Die Anzahl der Rezidive mit Neovaskulogenese bei belassenem Stumpf wurden nicht gewertet. Studienarme mit speziellen Barrieretechniken am Foramen ovale wurden ausgeschlossen. Wurde das verwendete Nahtmaterial nicht in der Publikation erwähnt, wurde mit dem Autor respektive dem Chirurgen Kontakt aufgenommen, um diese Frage zu klären.

Ergebnis 24 Studien wurden gefunden, von denen 31 Therapiearme auf die Studienkriterien passten. Weniger als die Hälfte der Studien hatten das Nahtmaterial erwähnt, aber alle Autoren antworteten prompt und wussten das Nahtmaterial genau, weil sie immer dasselbe verwenden. Die Rezidivraten bei nichtresorbierbaren Nahtmaterialien lagen zwischen 1,1 % und 12,3 %, bei resorbierbaren Nahtmaterialien zwischen 10 und 65 %.

Zusammenfassung Auch wenn es sich nicht um ein systematisches Review handeln kann, weil nur 1 der Studien tatsächlich verschiedene Nahtmaterialien verglich, sind die Ergebnisse überraschend deutlich. In Deutschland ist die Chirurgie der am häufigsten verwendete Eingriff bei der Therapie der Varikose. Eine prospektiv randomisierte Studie zur Klärung dieser Frage wäre daher sinnvoll.

Abstract

Introduction In the process of literature search for diagnostic and therapeutic guidelines for varicose veins of the German Phlebology Society (DGP) the author noticed the wide variation of saphenofemoral (SF) recurrence among various studies. In search of answers, studies that were based on suture material used for closure of the sapheno-femoral junction and the tributaries of the junction were analysed in order to determine if the type of suture material utilised (absorbable/ non absorbable) plays a role in the recurrence rate.

Methods Evaluation of the literature search of DGP for guidelines as well as furthern PubMed research with the key words neovasculogenesis and recurrence after crossectomy. Data was analyzed for the following items: surgical technique (high ligation alone, with stripping or with endoluminal procedures, as well as high ligation of the SF junction without disruption of the tributaries), suture material, duration of follow-up, type of study (prospective, retrospective, randomised or not). Recurrencies with left stump were not included in the survey. Study arms analyizing results after high ligation and special barrier techniques for closure of the foramen ovale were excluded, For included studies in which the suture material was not mentioned, the authors were contacted to determine the same.

Result 24 studies were found, of which 31 therapy arms suited the study criteria. Less than half of the studies mentioned the suture material used, but all authors replied promptly and, on account of constant usage, knew the suture material exactly. The recurrence rate with nonabsorbable sutures was between 1.1 % and 12.3 %, with absorbable sutures between 10 % and 65 %.

Summary Even if this cannot be considered a systematic review, because only one of the studies actually compared different suture materials, the results are surprisingly clear. In Germany, surgery is the most common therapeutic modality for varicosis. Thus, a prospective randomised study for clarification of the question posed would be expedient.

Schlüsselwörter

Varikose - Rezidive - V. saphena magna - Neovaskulogenese - resorbierbares Nahtmaterial - Krossektomie - Venenchirurgie

Key words

varicosis - recurrence - great saphenous vein - neovasculogenesis - absorbable suture material - crossectomy - vein surgery


Publication History

Article published online:
13 May 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 

  • Literatur

  • 1 De Maeseneer MG, Vandenbroeck CP, Hendriks JM. et al. Accuracy of duplex evaluation one year after varicose vein surgery to predict recurrence at the saphenofemoral junction after five years. Eur J Vasc Endovasc Surg 2005; 29 (03) 308-312
    CrossrefPubMedGoogle Scholar
  • 2 Pannier F, Noppeney T, Alm J. et al. S2k Leitlinie Diagnostik und Therapie der Varikose. https://www.awmf.org/uploads/tx_szleitlinien/037-018l_S2k_Varikose_Diagnostik-Therapie_2019-07.pdf
    Google Scholar
  • 3 Franceschi C. Théorie et Pratique de la Cure Conservatrice et Hémodynamique de l’Insuffisance Veineuse en Ambulatoire. Précy-sous-Thil: 1988. (Armançon)
    Google Scholar
  • 4 Franceschi C, Cappelli M, Ermini S. et al CHIVA: hemodynamic concept, strategy and results. Int Angiol 2016; 35 (01) 8-30 . Epub 2015 Jun 5
    Google Scholar
  • 5 Gianesini S, Delfrate R, Cappelli M. et al. CHIVA Surgical Tips and Tricks. In: Zamboni P, Mendoza E, Gianesini S. (Eds) Saphenous Vein-Sparing Strategies in Chronic Venous Disease. Springer; 2018: 181-202
    CrossrefGoogle Scholar
  • 6 Mendoza E. Does the suture material influence the outcome after high ligation of great saphenous vein? (Letter to the Editor). VASA 2020; 49 (02) 153-155
    CrossrefPubMedGoogle Scholar
  • 7 Fischer R, Linde N, Duff C. et al. Late recurrent saphenofemoral junction reflux after ligation and stripping of the greater saphenous vein. J Vasc Surg 2001; 34 (02) 236-240
    CrossrefPubMedGoogle Scholar
  • 8 Cappelli M, Molino-Lova R, Giangrandi I. et al. Ligation of the saphenofemoral junction tributaries as risk factor for groin recurrence. J Vasc Surg Venous Lymphatic Disorders 2018; 6 (02) 224-229
    PubMedGoogle Scholar
  • 9 Papapostolou G, Altenkämper H, Bernheim C. et al. Die LaVaCro-Studie: Langzeitergeb- nisse der Varizenoperation mit Crossektomie und Stripping der V. saphena magna, Interimsergebnisse nach 1 Jahr. Phlebologie 2013; 42: 253-260
    Article in Thieme ConnectGoogle Scholar
  • 10 Carandina S, Mari C, De Palma M. et al. Varicose vein stripping vs haemodynamic correction (CHIVA): a long term randomised trial. Eur J Vasc Endovasc Surg 2008; 35: 230-237
    CrossrefPubMedGoogle Scholar
  • 11 Kluess HG, Rabe E, Mulkens PJM. Welche Bedeutung hat das Naht-Material in der Varienchirurgie?. Abstrakt Vasomed 1998 April (Suppl.)
    Google Scholar
  • 12 Flessenkämper I, Hartmann M, Stenger D. et al. Endovenous laser ablation with and without high ligation compared with high ligation and stripping in the treatment of great saphenous varicose veins: initial results of a multicentre randomized controlled trial. Phlebology 2013; 28: 16-23
    CrossrefPubMedGoogle Scholar
  • 13 Frings N, Tran P, Gelle A. et al. Freies Endothel des Magna-Krossenstumpfes und Neoreflux/Neoangiogenese, Vorläufige Mitteilung. Phlebologie 2004; 33: 156-159
    Article in Thieme ConnectGoogle Scholar
  • 14 Gianesini S, Menegatti E, Mahagoni AM. et al. Mini-invasive high-tie by clip apposition versus crossectomy by ligature: Long-term outcomes and review of the available therapeutic options. Phlebology 2017; 32 (04) 249-255
    CrossrefPubMedGoogle Scholar
  • 15 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
    CrossrefPubMedGoogle Scholar
  • 16 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
    Google Scholar
  • 17 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 (01) 23-33
    CrossrefPubMedGoogle Scholar
  • 18 Cappelli M, Molino Lova R. et al. Ambulatory Conservative Hemodynamic Management of Varicose Veins: Critical Analysis of Results at 3 Years. Ann Vasc Surg 2000; 14: 376-384
    CrossrefPubMedGoogle Scholar
  • 19 Frings N, Nelle A, Tran P. et al. Reduction of neoreflux after correctly performed ligation of the saphenofemoral junction. A randomized trial. Eur J Vasc Endovasc Surg 2004; 28 (03) 246-252
    CrossrefPubMedGoogle Scholar
  • 20 Theivacumar NS, Harwood R, Gough MJ. Neovascularisation and recurrence 2 years after varicose vein treatment for sapheno-femoral and great saphenous vein reflux: a comparison of surgery and endogenous laser ablation. Eur J Vasc Endovasc Surg 2009; 38 (02) 203-207
    CrossrefPubMedGoogle Scholar
  • 21 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
    CrossrefPubMedGoogle Scholar
  • 22 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
    CrossrefPubMedGoogle Scholar
  • 23 Frings N, Tran VTP, Nelle A. et al. Crossenrezidiv der Vena saphena magna trotz korrekter Crossektomie: Neoangiogenese. Phlebologie 1999; 28: 144-148
    Article in Thieme ConnectGoogle Scholar
  • 24 van der Velden SK, Biemans AA, De Maeseneer MG. et al. Five-year results of a randomized clinical trial of conventional surgery, endovenous laser ablation and ultrasound-guided foam sclerotherapy in patients with great saphenous varicose veins. Br J Surg 2015; 102: 1184-1194
    CrossrefPubMedGoogle Scholar
  • 25 Jones L, Braithwaite BD, Kelvin D. et al. Neovascularisation is the principal cause of varicose vein recurrence: results of a randomized trial of stripping the long saphenous vein. Eur J Vasc Endovasc Surg 1996; 12 (04) 442-445
    CrossrefPubMedGoogle Scholar
  • 26 Kluess HG, Gallenkemper G, Mulkens PJM. et al Die modifizierte Crossektomie der Vena saphena magna – farbduplexsonografische Kontrolle nach 2,5 Jahren. Abstract. Vasomed 1997; 4 (Suppl.): 9 (Congress of German Society of Phlebology 1997)
    Google Scholar
  • 27 Disselhoff BC, der Kinderen DJ, Kelder JC. et al. Five-year results of a randomized clinical trial comparing endovenous laser ablation with cryostripping for great saphenous varicose veins. Br J Surg 2011; 98: 1107-1111
    CrossrefPubMedGoogle Scholar
  • 28 Dwerryhouse S, Davies B, Carradine K. et al. Stripping the long saphenous vein reduces the rato of reoperation for recurrent varicose veins: Five-year results of a randomized trial. J Vasc Surg 1999; 29 (04) 589-592
    CrossrefPubMedGoogle Scholar
  • 29 NICE (National Institute for Health Care Excellence). Varicose veins: diagnosis and management, Clinical guideline [CG168] Published date: July 2013. https://www.nice.org.uk/guidance/cg168
    Google Scholar