Die Sklerotherapie mit Luft- oder CO2-O2-Schaum

G. Hesse; F. X. Breu; A. Kuschmann; K. Hartmann; N. Salomon

doi:10.1055/s-0037-1621805

Phlebologie, Inhaltsverzeichnis

Phlebologie 2012; 41(02): 77-88
DOI: 10.1055/s-0037-1621805

Originalarbeit

Schattauer GmbH

Die Sklerotherapie mit Luft- oder CO₂-O₂-Schaum

Anwendungsbeobachtung Artikel in mehreren Sprachen: deutsch | English

Autoren

G. Hesse
F. X. Breu
A. Kuschmann
K. Hartmann

⁴Venenzentrum Freiburg
N. Salomon

Abstract

Zusammenfassung

Ziel und Durchführung: Die Wirksamkeit und Nebenwirkungen der ultraschallgeführten Polidocanol-Schaumsklerosierung (FS) wurde in dieser Anwendungsbeobachtung (AWB) für Luft-FS und CO₂-O₂-FS über ein internetbasiertes Protokoll dokumentiert.

Material und Methoden: An der AWB nahmen 11 Zentren teil, neun Zentren arbeiteten mit Luft-FS, zwei Zentren mit CO₂-O₂-FS. Verwendet wurden zugelassene Medikamente. In 553 Behandlungen wurde bei 376 Patienten für die Luft-FS Polidocanol (Aethoxysklerol^®, Kreussler) mit 0,25 % bis 4 % verwendet. In 152 Behandlungen erfolgte bei 125 Patienten die CO₂-O₂-FS mit Polidocanol 1–3 %, mit CO₂(Laparox^®, Linde) und mit O₂ (Conoxia^®, Linde) im Verhältnis 70:30. Die Abfüllung bei der CO₂-O₂-FS erfolgte steril mittels der Massendurchfluss-Messtechnik. Eine klinische Ab-schlussuntersuchung und Ultraschallkontrolle erfolgte zirka 4–6 Wochen nach der letzten Therapie.

Ergebnisse: Krampfadern größer als 3 mm wurden bei Luft-FS im Durchschnitt mit 5,3 ml, bei der CO₂-O₂–FS mit 8,2 ml behandelt; der Unterschied war signifikant. Nebenwirkungen: Hyperpigmentierungen: Luft 23,3 %, CO₂-O₂ 13,6 %; Hämatom: Luft 14,4 %, CO₂-O₂ 2,5 %; Migräne: Luft 0,1 %, CO₂-O₂ keine; Matting: Luft 1,4 %, CO₂-O₂ kein; Brennen: Luft 11,7 %, CO₂-O₂5,5 %; Thrombo-sen: Luft 1,1 %, CO₂-O₂1,6 %; Sehstörungen: Luft 0,2 %, CO₂-O₂2 %.

In beiden Gruppen ergab sich kein Unterschied in der Sicherheit bei durchschnittlich 5,3 ml Schaum in der Luft-FS und 8,2 ml Schaum in der CO₂-O₂-FS. Lokale Nebenwirkungen waren in der CO₂-O₂-Gruppe geringer; in dieser Gruppe war die Behandlung effektiver, da größere Vo-lumen sicher angewandt werden konnten. In beiden Gruppen traten keine zentralneurologischen Nebenwirkungen auf, alle Sehstörungen waren innerhalb von 20 Minuten ohne zusätzliche Therapie spontan reversibel.

Conclusio: Die hier publizierten Ergebnisse stimmen mit über 1 000 Behandlungen für CO₂-O₂-FS aus der Literatur überein. Unter CO₂-O₂-FS trat in diesen Arbeiten keine TIA oder Apoplexe auf. Die CO₂-O₂-FS erscheint ins-gesamt für größere Krampfadern wirksamer als die Luft-FS. Die Verwendung der physiologischen Gase CO₂-O₂ in der FS ist möglicherweise sicherer als die Luft-FS. Klare Beweise stehen hier noch aus und die mögliche Komplikation der iatrogenen Gasembolie muss immer be-rücksichtigt werden.

Schlüsselwörter

CO₂-O₂-Schaumsklerosierung - Luft-Schaum -sklerosierung - Wirksamkeit - Nebenwirkun-gen - Sehstörungen

Volltext

Referenzen

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