Leitlinie: Sklerosierungsbehandlung der Varikose

E. Rabe; H. Gerlach; F. X. Breu; S. Guggenbichler; M. Stücker; F. Pannier

doi:10.1055/s-0037-1621819

Phlebologie, Inhaltsverzeichnis

Phlebologie 2012; 41(04): 206-213
DOI: 10.1055/s-0037-1621819

Leitlinie der Deutschen Gesellschaft für Phlebologie

Schattauer GmbH

Leitlinie: Sklerosierungsbehandlung der Varikose

der Deutschen Gesellschaft für Phlebologie (ICD 10: I83.0, I83.1, I83.2, I83.9)5AWMF-Leitlinien-Register-Nr.: 037/015 Entwicklungsstufe: S1

Authors

E. Rabe

¹Klinik und Poliklinik für Dermatologie und Allergologie der Rheinischen Friedrich-Wilhelms Universität Bonn;
H. Gerlach

²T6, Mannheim
F. X. Breu
S. Guggenbichler
M. Stücker

⁵Kliniken der Ruhr-Universität Bochum im St. Maria-Hilf Krankenhaus;
F. Pannier

⁶Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsklinikum Köln

Abstract

Diese Leitlinie wurde im Auftrag der Deutschen Gesellschaft für Phlebologie (DGP) ausgearbeitet, vom Vorstand und im wissenschaftlichen Beirat der DGP am 15.06.2001 verabschiedet, am 26.09.2007 sowie im Mai 2012 novelliert und ersetzt die Vorversion vom November 2007. Diese Leitlinie berücksichtigt den aktuellen Stand der Literatur, aber nicht die in jedem Fall unterschiedlichen Zulassungsbestimmungen für die verschiedenen Pharmaka.

Leitlinien sind systematisch erarbeitete Empfehlungen, um den Arzt in Klinik und Praxis bei Entscheidungen über eine angemessene Versorgung des Patienten im Rahmen spezifischer klinischer Umstände zu unterstützen. Leitlinien gelten für Standardsituationen und berücksichtigen die aktuellen, zu den entspre- chenden Fragestellungen zur Verfügung stehenden wissenschaftlichen Erkenntnisse. Leitlinien bedürfen der ständigen Überprüfung und eventuell der Änderung auf dem Boden des wissenschaftlichen Erkenntnisstandes und der Praktikabilität in der täglichen Praxis. Durch die Leitlinien soll die Methodenfreiheit des Arztes nicht eingeschränkt werden. Ihre Beachtung garantiert nicht in jedem Fall den diagnostischen und therapeutischen Erfolg. Leitlinien erheben keinen Anspruch auf Vollständigkeit. Die Entscheidung über die Angemessenheit der zu ergreifenden Maßnahmen trifft der Arzt unter Berücksichtigung der in-dividuellen Problematik.

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Referenzen

Literatur
1 Rabe E, Pannier F, Gerlach H, Breu FX, Guggenbichler S, Wollmann JC. Leitlinie Sklerosierungsbehandlung der Varikose. Phlebologie 2008; 37: 27-34.
2 Drake LA, Dinehart SM, Goltz RW. et al. Guidelines of care for sclerotherapy treatment of varicose and teleangiectatic leg veins. J Am Acad Dermatol 1996; 34: 523-528.
3 Rabe E, Pannier-Fischer F, Gerlach H. et al. Guidelines for sclerotherapy of varicose veins. Dermatol Surg 2004; 30: 687-693.
4 Einarsson E, Eklöf B, Neglén P. Sclerotherapy or Surgery as Treatment for Varicose Veins: A Prospective Randomized Study. Phlebology 1993; 8: 22-26.
5 Malouf GM. Ambulatory Venous Surgery versus Sclerotherapy. Hawaii Med J 2000; 59: 248-249.
6 Bullens-Goessens YIJM, Mentink LF. et al. Ultrasound-guided sclerotherapy of the insufficient short saphenous vein. Phlebologie 2004; 33: 89-91.
7 Schultz-Ehrenburg U, Tourbier H. Doppler-kontrollierte Verödungsbehandlung der Vena saphena magna. Phlebol u Proktol 1984; 13: 117-122.
8 Vin F. Principes de la Sclérothéraphie des Troncs Saphènes Internes. Phlebologie 1997; 50: 229-234.
9 Wright D, Gobin JP, Bradbury AW. et al. Varisolve European Phase III Investigators Group. Varisolve® polidocanol microfoam compared with surgery or sclerotherapy in the management of varicose veins in the presence of trunk vein incompetence: European randomized controlled trial. Phlebology 2006; 21: 180-190.
10 Cavezzi A, Frullini A, Ricci S, Tessari L. Treatment of varicose veins by foam sclerotherapy: Two clinical series. Phlebology 2002; 17: 13-18.
11 Hamel-Desnos C, Desnos P, Wollmann JC. et al. Evaluation of the efficacy of Polidocanol in the form of foam compared with liquid form in sclero therapy of the long saphenous vein: Initial results. Dermatol Surg 2003; 29: 1170-1175.
12 Hamel-Desnos C, Ouvry P, Benigni JP. et al. Comparison of 1% and 3% Polidocanol Foam in Ultrasound Guided Sclerotherapy of the Great Saphenous Vein: A Randomised, Double-Blind Trial with 2 Year-Follow-up. “The 3/1 Study" Eur J Vasc Endovasc Surg 2007; 34: 723-729.
13 Rabe E, Otto J, Schliephake D, Pannier F. Efficacy and Safety of Great Saphenous Vein Sclerotherapy Using Standardised Polidocanol Foam (ESAF): A Randomised Controlled Multicentre Clinical Trial. Eur J Endovasc Vasc Surg 2008; 35: 2238-2245.
14 Breu FX, Guggenbichler Wollmann JC. 2nd European Consensus Meeting on Foam Sclerotherapy, 28-30 April 2006, Tegernsee, Germany. Vasa 2008; 37 (Suppl. 71) 1-32.
15 Kreussler Fachinformationen Aethoxysklerol 0,25% / 0,5% / 1% / 2% /3% Stand Oktober. 2009. Chemische Fabrik Kreussler & Co GmbH
16 Guex JJ, Allaert F-A, Gillet J-L. Immediate and midterm complications of sclerotherapy: Report of a prospective multicenter registry of 12,173 sclerotherapy sessions. Dermatol Surg 2005; 31: 123-128.
17 Munavalli GS, Weiss RA. Complications of sclerotherapy. Semin Cutan Med Surg 2007; 26: 22-28.
18 Weiss RA, Weiss MA. Incidence of Side Effects in the Treatment of Telangiectasias by Compression Sclerotherapy: Hypertonics Saline vs. Polidocanol. J Dermatol Surg Oncol 1990; 16: 800-804.
19 Gillet JL, Guedes JM, Guex JJ. et al. Side effects amd complications of foam sclerotherapy of the great and small saphenous veins: a controlled multicentre prospective study including 1025 patients. Phlebology 2009; 24: 131-138.
20 Feied CF, Jackson JJ, Bren TS. et al. Allergic Reactions to Polidocanol for Vein Sclerosis. J Dermatol Surg Oncol 1994; 20: 466-468.
21 Pradalier A, Vincent D, Hentschel V. et al. Allergie aux sclérosants des varices. Rev Fr Allergol 1995; 35: 440-443.
22 Morrison N, Cavezzi A, Bergan J, Partsch H. Regarding „stroke after varicose vein foam injection sclerotherapy“. J Vasc Surg 2006; 44: 224-225.
23 Passariello F. Sclerosing foam and patent foramen ovale. The final report. In: Word Congress of the International Union of Phlebology; 2007 Jun 18-20; Kyoto, Japan. Int Angiol 2007; 26: 87
24 Wagdi P. Migräne und offenes Foramen Ovale: nur ein vorübergehender Hoffnungsschimmer?. Kardiovasc Med 2006; 9: 32-36.
25 Forlee MV, Grouden M, Moore DJ. et al. Stroke after varicose vein foam injection sclerotherapy. J Vasc Surg 2006; 43: 162-164.
26 Breu FX, Marshall M. Sklerotherapie mit Polidocanol in einer angiologisch-phlebologischen Spezialpraxis. Prospektive und retrospektive Erhebung über Ergebnisse und Komplikationen. Phlebologie 2003; 32: 76-80.
27 Myers KA, Jolley D. Factors Affecting the Risk of Deep Venous Occlusion after Ultrasound-guided Sclerotherapy for Varicose Vein. Eur J Vasc Endovasc Surg 2008; 36: 602-605.
28 Hamel-Desnos C, Ouvry P, Desnos P. et al. Sclérothérapie et thrombophilie: Démarche pour un consensus dans la sclérothérapie chez les thrombophiles, Phlébologie. 2003; 56: 165-169.
29 Hanisch F, Müller T, Krivocuca M, Winterholler M. Stroke following variceal sclerotherapy. Eur J Med Res 2004; 9: 282-284.
30 Busch RG, Derrick M, Manjoney D. Major neurological events following foam sclerotherapy. Phlebology 2008; 23: 189-192.
31 Yamaki T, Nozaki M, Sakurai H. et al. Multiple Small-Dose Injections can reduce the passage of sclerosant foam into deep veins during foam sclerotherapy for varicose veins. Eur J Endovasc Surg 2008. online Oct. 2008
32 Goldman MP, Sadick NS, Weiss RA. Cutaneous Necrosis, Telangiectatic Matting and Hyperpigmentation following Sclerotherapy. Dermatol Surg 1995; 21: 19-29.
33 Bergan JJ, Weiss RA, Goldman MP. Extensive tissue necrosis following high concentration sclerotherapy for varicose veins. Dermatol Surg 2000; 26: 535-542.
34 Geukens J, Rabe E, Bieber T. Embolia cutis medicamentosa of the foot after sclerotherapy. Eur J Dermatol 1999; 9: 132-133.
35 Oesch A, Stirnemann P, Mahler F. The Acute Ischemic Syndrome of the Foot after Sclerotherapy of Varicose Veins. Schweiz. Med. Wochenschr 1984; 114: 1155-1158.
36 Weiss RA, Sadick NS, Goldman MP, Weiss MA. Postsclerotherapy compression: controlled comparative study of duration of compression and its effects on clinical outcome. Dermatol Surg 1999; 25: 105-108.
37 Van der Plas JPL, Lambers JC, van Wersch JW, Koehler PJ. Reversible ischaemic neurological deficit after sclerotherapy of varicose veins. Lancet 1994; 343: 428
38 Zipper SG. Nervus peronäus-Schaden nach Varizensklerosierung mit Aethoxysklerol. Versicherungsmedizin 2000; 4: 185-187.
39 Grondin L, Young R, Wouters L. Sclérothérapie ècho-guidée et sécurité: Comparison des techniques. Phlebologie 1997; 50 (02) 241-245.
40 Guex JJ. Ultrasound Guided Sclerotherapy (USGS) for Perforating Veins. Hawaii Med J 2000; 59 (06) 261-262.
41 Schadeck M, Allaert FA. Résultats à long terme de la Sclérothérapie des Saphènes internes. Phlebologie 1997; 50 (02) 257-262.
42 Wollmann JC. The history of sclerosing foams. Dermatol Surg 2004; 30: 694-703.
43 Sadoun S, Benigni JP, Sica M. Étude prospective de l'efficacité de la mousse de sclérosant dans le traitement des varices tronculaires des membres inférieurs. Phlébologie 2002; 55: 259-262.
44 Alos J, Carreno P, Lopez JA. et al. Efficacy and safety of sclerotherapy using Polidocanol foam: A controlled clinical trial. Eur J Vasc Endovasc Surg 2006; 31: 101-107.
45 Ceulen RPM, Bullens-Goessens YIJM, Pi-Van De Venne SJA. Outcomes and side effects of duplexguided sclerotherapy in the treatment of great saphenous veins with 1% versus 3% Polidocanol foam: Results of a randomized controlled trial with 1-year follow-up. Dermatol Surg 2007; 33: 276-281.
46 Kahle B, Leng K. Efficacy of sclerotherapy in varicose veins – a prospective, blinded placebocontrolled study. Dermatol Surg 2004; 30: 723-728.
47 Rao J, Wildemore JK, Goldmann MP. Double-blind prospective comparative trial between foamed and liquid Polidocanol and Natrium Tetradecyl Sulfate in the treatment of varicose and telangiectatic leg veins. Dermatol Surg 2005; 31 (06) 631-635.
48 Yamaki T, Nozaki M, Iwasaka S. Comparative study of duplex-guided foam sclerotherapy and duplexguided liquid sclerotherapy for the treatment of superficial venous insufficiency. Dermatol Surg 2004; 30: 718-722.
49 Ouvry P, Allaert FA, Desnos P, Hamel-Desnos C. Efficacy of Polidocanol Foam versus Liquid in Sclerotherapy of the Great Saphenous Vein: A Multicenter Randomised Controlled Trial with a 2-year Followup. Eur J Vasc Surg 2008; 36: 366-370.
50 Kern P, Ramelet AA, Wütschert R. et al. Single-blind, randomized study comparing Chromated Glycerin, Polidocanol solution and Polidocanol foam for treatment of telangiectatic leg veins. Dermatol Surg 2004; 30: 367-372.
51 McCoy S, Evans A, Spurrier N. Sclerotherapy for Leg Telangiectasia – A Blinded Comparative Trial of Polidocanol and Hypertonic Saline. Dermatol Surg 1999; 25: 381-386.
52 Norris MJ, Carlin MC, Ratz JL. Treatment of essential telangiectasia: Effects of increasing concentrations of polidocanol. J Am Acad of Dermatol 1989; 20: 643-649.
53 Rabe E, Schliephake D, Otto J, Breu F X, Pannier F. Sclerotherapy of telangiectases and reticular veins: a double-blind, randomized, comparative clinical trial of polidocanol, sodium tetradecyl sulphate and isotonic saline (EASI study). Phlebology 2010; 25: 124-131.
54 Rasmussen LH. et al. Randomized clinical trial comparing endovenous laser ablation,radiofrequency ablation, foam sclerotherapy and surgicalstripping for great saphenous varicose veins. Br J Surg 2011; 98: 1079-1087.
55 Ceulen RPM, Jagtmann EA, Sommer A, Teule GJJ, Schurink GWH, Kemerink GJ. Blocking the saphenafemoral junction during ultrasound guided foam sclerotherapy – assessment of a presumed safety-measure procedure. Eur J Vasc Endovasc Surg 2010; 40: 772-776.
56 Blaise S, Bosson JL, Diamand JM. Ultrasound guided sclerotherapy of the great saphenous vein with 1 % vs 3 % Polidocanol foam: a multicentre double-blind randomised trial with 3 year follow up. Eur J Vasc Endovasc Surg 2010; 39
57 Chapman-Smith P, Browne A. Prospective five year study of ultrasound guided foam sclerotherapy in the treatment of great saphenous vein reflux. Phlebology 2009; 24: 183-188.
58 Kern P, Ramelet AA, Wütschert R, Hayoz D. Compression after sclerotherapy for telangiectasias and reticular leg veins. A randomized controlled study. J Vas Surg 2007; 45: 1212-1216.
59 Goldman PM, Beaudoing D, Marley W. et al. Compression in the Treatment of Leg Teleangiectasia: A Preliminary Report. J Dermatol Surg Oncol 1990; 16: 322-325.
60 Stanley PRW, Bickerton DR, Campbell WB. Injection sclerotherapy for varicose veins – a comparison of materials for applying local compression. Phlebology 1991; 6: 37-39.
61 Brodersen JP. Catheter-assisted vein sclerotherapy: A new approach for sclerotherapy of the greater saphenous vein with a double-lumen balloon catheter. Dermatol Surg 2007; 33: 469-475.
62 Wildenhues B. Catheter-assisted foam sclerotherapy: A new minimally invasive method fort he treatment of trunk varicosis of the long and short saphenous veins. Phlebologie 2005; 34: 165-170.
63 Hahn M, Schulz T, Jünger M. Sonographically guided, transcatheter foam sclerotherapy of the great saphenous vein. Medical and oeconomic aspects. Phlebologie 2007; 36: 309-312.
64 Bidewai A, Beresford T, Dialynas M. et al. Balloon control of the saphenofemoral junction during foam sclerotherapy : proposed innovation. J Vasc Surg 2007; 46: 145-147.
65 Kölbel T, Hinchliffe RJ, Lindbal B. Catheter-directed foam sclerotherapy of axial saphenous reflux. Early results. Phlebology 2007; 22: 219-222.
66 Stücker M, Reich S, Hermes N. et al. Safety and efficiency of perilesional sclerotherapy in leg ulcer patients with postthrombotic syndrome and/or oral anticoagulation with Phenprocoumon. JDDG 2006; 4: 734-738.
67 De Waard MM, Der Kinderen DJ. Duplex ultrasonography-guided foam sclerotherapy of incompetent perforator veins in a patient with bilateral venous leg ulcers. Dermatol Surg 2005; 31: 580-583.
68 Hertzman PA, Owens R. Rapid healing of chronic venous ulcers following ultrasound-guided foam sclerotherapy. Phlebology 2007; 22: 34-39.
69 Pang KH, Bate GR, Darvall KAL, Adam DJ, Bradbury AW. Healing and recurrence rates following ultrasound guided foam sclerotherapy of superficial venous reflux in patients with chronic venous ulceration. Eur J Vasc endovasc Surg 2010; 40: 790-795.
70 Yamaki T, Nozaki M, Sakurai H. et al. Prospective randomized efficacy of ultrasound-guided foam sclerotherapy compared with ultrasound-guided liquid sclerotherapy in the treatment of symptomatic venous malformations. J Vasc Surg 2008; 47: 578-584.