Subscribe to RSS
Download PDF
DOI: 10.1055/s-0037-1622308
Foam sclerotherapy of ulcus cruris venosum
Stellenwert der Schaumsklerosierung in der Behandlung des Ulcus cruris venosumPublication History
Received:
08 April 2010
accepted:
08 April 2010
Publication Date:
04 January 2018 (online)
Summary
The management of chronic venous leg ulcers is often sophisticated. The impact of pathophysiological findings of venous haemodynamics is relevant for the concept of the treatment in the individual subject. Thus elimination of reflux is thought to b relevant for the healing of venous leg ulcers. Mostly, patients with venous leg ulcers are elder persons with some relevant co-morbidities like diabetes, hypertension , cardiac or respiratory insufficiency.
In many studies foam sclerotherapy (FS) has been shown to be an effective and safe procedure in the treatment of varicose veins. Therefore, FS plays an important role in the management of chronic venous leg ulcers in addition to compression therapy. We could demonstrate in a 18 patients that FS did not influence pulse rate and oxygen saturation. Very important is the aspect that FS can be performed effectively in patients under anticoagulation. The possibility to treat the patients in an outpatient setting with low costs and rapidly makes FS very attractive in comparison to alternative surgical techniques.
Zusammenfassung
In der Therapie des Ulcus cruris venosum spielen kausale Behandlungsoptionen eine entscheidende Rolle. Dabei steht die effektive Reduktion der ambulatorischen venösen Hypertonie im Vordergrund. Etablierte Verfahren sind die Kompressionstherapie und verschiedene Reflux-ausschaltende invasive Verfahren. Die Sklerosierungstherapie, insbesondere die Schaumsklerosierung besitzt dabei in Hinblick auf ihre minimale Invasivität einen besonderen Stellenwert. Auch bei kardiovaskulär eingeschränkten Patienten unter oraler Dauerantikoagulation ist die Schaumsklerosierung peri ulzeröser Varizen eine effektive und sichere Therapieoption des Ulcus cruris.
-
Literatur
- 1 Breu FX, Guggenbichler S, Wollmann JC. Duplex ultrasound and efficacy criteria in foam sclerotherapy from the 2nd European Consensus Meeting on Foam Sclerotherapy 2006, Tegernsee, Germany. Vasa 2008; 37: 90-95.
- 2 Breu FX, Guggenbichler S. European consensus meeting on foam sclerotherapy. April 4–6, 2003, Tegernsee, Germany. Dermatol Surg 2004; 30: 709-717.
- 3 Bush RG, Derrick M, Manjoney D. Major neurological events following foam sclerotherapy. Phlebology 2008; 23: 189-192.
- 4 Cabrera J, Redondo P, Becerra A, Garrido C, Cabrera Jr J, Garcia-Olmedo MA, Sierra A, Lloret P, Martinez-Gonzales MA. Ultrasound-guided injection of Polidocanol microfoam in the management of venous leg ulcers. Arch Dermatol 2004; 140: 667-673
- 5 Dissemond J. Wann ist eine Wunde chronisch?. Hautarzt 2006; 57: 55.
- 6 Forlee MV, Grouden M, Moore DJ, Shanik G. Stroke after varicose vein foam injection sclerotherapy. J Vasc Surg 2006; 43: 162-164.
- 7 Hach W, Hach-Wunderle V. Die Rezirkulationskreise der primären Varikose. Berlin: Springer; 1994: 27-48.
- 8 Hanisch F, Muller T, Krivokuca M, Winterholler M. Stroke following variceal sclerotherapy. Eur J Med Res 2004; 9: 282-284.
- 9 Jia X, Mowatt G, Burr JM, Cassar K, Cook J, Fraser C. Systematic review of foam sclerotherapy for varicose veins. Br J Surg 2007; 94: 925-936.
- 10 Jünger M, Häfner HM. Interface pressure under a ready made compression stocking developed for the treatment of venous ulcers over a period of six weeks. Vasa 2003; 32: 87-90.
- 11 Jünger M, Wollina U, Kohnen R, Rabe E. Efficacy and tolerability of an ulcer compression stocking for therapy of chronic venous ulcer compared with a below-knee compression bandage: results from a prospective, randomized, multicentre trial. Curr Med Res Opin 2004; 20: 1613-1623.
- 12 Kahle B, Tetsch N. Thromboembolieprophylaxe bei kathetergeführter Schaumsklerosierung – sinnvoll oder unnötig?. Vasomed 1/2009 30-31.
- 13 Nicolaides AN, Allegra C, Bergan JJ. et al. Management of chronic venous disorders of the lower limbs. Guidelines According to Scientific Evidence. Int Angiol 2008; 27: 1-59.
- 14 Pannier F, Rabe E. Endovenöse Lasertherapie mit dem 980-nm-Diodenlaser bei Ulcus cruris venosum. Phlebologie 2007; 36: 179-185.
- 15 Rabe E, Pannier-Fischer F, Bromen K, Schuldt K, Stang A, Poncar C, Wittenhorst M, Bock E, Weber S, Jöckel KH. 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; 32: 1-14.
- 16 Rush JE, Wright DD. More on microembolism and foam sclerotherapy. N Engl J Med 2008; 359: 656-657.
- 17 Schumacher N, Merl V, Kahle B. Änderung der Sauerstoffsättigung bei Schaumsklerosierung von großkalibrigen Varizen. 81. Jahrestagung der Norddeutschen Dermatologischen Gesellschaft (NDG) 5.–7. September 2008 in Lübeck 903-916.
- 18 Stücker M, Reich S, Hermes N, Altmeyer P. Safety and efficacy of perilesional sclerotherapy in leg ulcer patients with postthrombotic syndrome and/ or oral anticoagulation with phenprocoumon. J Dtsch Dermatol Ges 2006; 4: 734-738.
- 19 Viarengo LM, Potério-Filho J, Potério GM. et al. Endo venous laser treatment for varicose veins in patients with active ulcers: measurement of intravenous and perivenous temperatures during the procedure. Dermatol Surg 2007; 10: 1234-1242.