Endovenöse thermoablative Verfahren zur Behandlung der Stammvarikose – Radiofrequenz und/oder Laser

Zusammenfassung

Die endovenöse Thermoablation ist ein neues, minimal-invasives perkutanes Verfahren zur Behandlung der Stammvarikose mit diversen Vorteilen gegenüber der herkömmlichen chirurgischen Ligation und Exhairese. Zu den endovenösen Thermoablationsverfahren gehören die endovenöse Lasertherapie (ELT) und die Radiofrequenzablation (RFA). Der Verschluss der inkompetenten Vene wird durch die hitzeinduzierte Zerstörung des Endothels erreicht. Diese Eingriffe erfolgen zum Großteil in Tumeszenzanästhesie. Aufgrund einer verkürzten Rekonvaleszenz sowie geringerer postoperativer Schmerzen und einer insgesamt erniedrigten Morbidität, empfehlen die 2011 erschienenen Leitlinien des Amercian Venus Forums und der American Society of Vascular Surgery die endovenöse Thermoablation der inkompetenten Vena saphena gegenüber der chirurgischen Ligation und Exhairese. Allerdings bedarf es mehr vergleichender Studien mit Lasern höherer Wellenlängen und eines längeren Follow-ups gegen RFA, um eine abschließende Empfehlung zu Gunsten einer der beiden endovenösen Therapien aussprechen zu können.

Abstract

Endovenous thermal ablation of the saphenous veins is a relatively new, minimally invasive percutaneous procedure with several advantages over standard open surgery. It includes EVLA and RFA. Occlusion of the treated vein is achieved by heat delivered into the vein through the percutaneously placed laser fiber or an RF catheter mostly in local tumescent anesthesia. Because of reduced convalescence and less pain and morbidity, the American Venous Forum and the American Society of Vascular Surgery recommended in their 2011 guidelines, endovenous thermal ablation for treatment of the incompetent saphenous vein over open surgery. However, further trials with higher wavelength EVLA, as well as with long-term follow-up, are needed before any conclusion on the use of any EVLA vs RFA can be made.

• Literatur

• 1 Rabe E, Pannier-Fischer F, Bromen F et al. Bonner Venenstudie der Deutschen Gesellschaft für Phlebologie*. Epidemiologische Untersuchung zur Frage der Häufigkeit und Ausprägung von chronischen Venenkrankheiten in der städtischen und ländlichen Wohnbevölkerung. Phlebologie 2003; 1-14
• 2 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
• 3 Charing Cross. 35th International Symposium. London: 09.04.2013
• 4 Rautio T, Ohinmaa A, Perälä J et al. Endovenous obliteration versus conventional stripping operation in the treatment of primary varicose veins: a randomized controlled trial with comparison of the costs. J Vasc Surg 2002; 35: 958-965
• 5 Hinchliffe RJ, Ubhi J, Beech A et al. A prospective randomised controlled trial of VNUS closure versus surgery for the treatment of recurrent long saphenous varicose veins. Eur J Vasc Endovasc Surg 2006; 31: 212-218
• 6 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
• 7 Navarro L, Min RJ, Boné C. Endovenous laser: a new minimally invasive method of treatment for varicose veins -- preliminary observations using an 810 nm diode laser. Dermatol Surg 2001; 27: 117-122
• 8 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
• 9 Darwood RJ, Theivacumar N, Dellagrammaticas D et al. Randomized clinical trial comparing endovenous laser ablation with surgery for the treatment of primary great saphenous varicose veins. Br J Surg 2008; 95: 294-301
• 10 Kalteis M, Berger I, Messie-Werndl S et al. High ligation combined with stripping and endovenous laser ablation of the great saphenous vein: early results of a randomized controlled study. J Vasc Surg 2008; 47: 822-829
• 11 Pronk P, Gauw SA, Mooij MC et al. Randomised controlled trial comparing sapheno-femoral ligation and stripping of the great saphenous vein with endovenous laser ablation (980 nm) using local tumescent anaesthesia: one year results. Eur J Vasc Endovasc Surg 2010; 40: 649-656
• 12 Rass K, Frings N, Glowacki P et al. Comparable effectiveness of endovenous laser ablation and high ligation with stripping of the great saphenous vein: two-year results of a randomized clinical trial (RELACS study). Arch Dermatol 2012; 148: 49-58
• 13 Gale SS, Lee JN, Walsh ME et al. A randomized, controlled trial of endovenous thermal ablation using the 810-nm wavelength laser and the ClosurePLUS radiofrequency ablation methods for superficial venous insufficiency of the great saphenous vein. J Vasc Surg 2010; 52: 645-650
• 14 Morrison N. Saphenous ablation: what are the choices, laser or RF energy. Semin Vasc Surg 2005; 18: 15-18
• 15 Almeida JI, Kaufman J, Göckeritz O et al. Radiofrequency endovenous ClosureFAST versus laser ablation for the treatment of great saphenous reflux: a multicenter, single-blinded, randomized study (RECOVERY study). J Vasc Interv Radiol 2009; 20: 752-759
• 16 Shepherd AC, Gohel MS, Brown LC et al. Randomized clinical trial of VNUS ClosureFAST radiofrequency ablation versus laser for varicose veins. Br J Surg 2010; 97: 810-818
• 17 Rasmussen LH, Lawaetz M, Bjoern L et al. Randomized clinical trial comparing endovenous laser ablation, radiofrequency ablation, foam sclerotherapy and surgical stripping for great saphenous varicose veins. Br J Surg 2011; 98: 1079-1087