Download PDF
Phlebologie 2012; 41(02): 77-88
DOI: 10.1055/s-0037-1621805
Originalarbeit
Schattauer GmbH

Die Sklerotherapie mit Luft- oder CO2-O2-Schaum

Anwendungsbeobachtung Article in several languages: deutsch | English
G. Hesse
,
F. X. Breu
,
A. Kuschmann
,
K. Hartmann
4   Venenzentrum Freiburg
,
N. Salomon
› Author Affiliations
Further Information

Publication History

eingereicht:11 December 2011

angenommen:02 January 2012

Publication Date:
30 December 2017 (online)

    Permissions and Reprints

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-O2 1,6 %; Sehstörungen: Luft 0,2 %, CO2-O2 2 %.

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
 

  • Literatur

  • 1 Almeide JI. Ultrasound-guided foam sclerotherapy. Endovascular today 2010; 33-35.
    Google Scholar
  • 2 Beckitt T. et al. Air versus Physiological Gas for Ultrasound Guided Foam Sclerotherapy Treatment of Varicose Veins. Eur J Vasc Endovasc Surg 2011; 1e5
    Google Scholar
  • 3 Bessereau J, Genotelle N, Chabbaut C. et al. Longterm outcome of iatrogenic gas embolism. Intensive care medicine 2010; 36 (07) 1180-1187.
    CrossrefPubMedGoogle Scholar
  • 4 Bessereau J, Coulange M. et al. Iatrogenic gas embolism after foam sclerotherapy?. Annales francaises d’anesthesie et de reanimation 2011; 13385-13385.
    Google Scholar
  • 5 Blaise S. et al. Ultrasound-Guided Sclerotherapy of the Great Saphenous Vein with 1% vs. 3% Polidocanol Foam: A Multicentre Double-Blind Randomised Trial with 3-Year Follow. Eur J Vasc Endovasc Surg 2010; 39 (06) 779-786.
    CrossrefPubMedGoogle Scholar
  • 6 Breu FX. et al. 2nd European Consensus Meeting on Foam Sclerotherapy 2006, Tegernsee Germany. Vasa 2008; 37 (071) 1
    PubMedGoogle Scholar
  • 7 Bush RG. et al. Major neurological events following foam sclerotherapy. Phlebology 2008; 23 (04) 189-192.
    CrossrefPubMedGoogle Scholar
  • 8 Cabrera J. et al. Treatment of venous malformations with sclerosant in microfoam form. Arch Dermatol 2003; 139 (011) 1409-1416.
    CrossrefPubMedGoogle Scholar
  • 9 Cabrera J. et al. In Mattassi R. et al. (Eds.) Hemangiomas and vascular malformations. Heidelberg: Springer; 2009: 171-179.
    CrossrefGoogle Scholar
  • 10 Cavezzi A. et al. Foam sclerotherapy techniques: different gases and methods of preparation, catheter versus direct injection. Phlebology 2009; 24: 247-251.
    CrossrefPubMedGoogle Scholar
  • 11 Ceulen RPM. et al. Microembolism during foam sclerotherapy of varicose veins. N Engl J Med 2008; 358: 1525-1526.
    CrossrefPubMedGoogle Scholar
  • 12 Coleridge Smith P. Chronic venous disease treated by ultrasound guides foam sclerotherapy. Eur J Vasc Endovasc Surg 2006; 32: 577-583.
    CrossrefPubMedGoogle Scholar
  • 13 Coleridge Smith P. Sclerotherapy and foam sclerotherapy for varicose veins. Phlebology 2009; 24: 260-269.
    CrossrefPubMedGoogle Scholar
  • 14 Christin F. et al. Paradoxical symptomatic air embolism after saline contrast transesophageal echocardiography Echocardiography. N.Y.: Mount Kisco 2007; 24 (08) 867-869.
    Google Scholar
  • 15 Deichmann B. et al. Apoplektischer Insult nach Sklerotherapie. Phlebologie 1995; 24: 148-152.
    Google Scholar
  • 16 Deurzen B VAN, Ceulen RP. et al. Polidocanol Concentration and Time Affect the Properties of Foam Used for Sclerotherapy. Dermatologic surgery 2011; 1-8.
    PubMedGoogle Scholar
  • 17 Durandt TM. et al. The safety of intravascular carbon dioxide and its use for roentgenologic visualization of intracardiac structures. Ann Int Med 1957; 47: 191-201.
    CrossrefPubMedGoogle Scholar
  • 18 Eckmann DM. Polidocanol for endovenous microfoam sclerosant therapy. Expert Opin Investig Drugs 2009; 18 (012) 1919-1927.
    CrossrefPubMedGoogle Scholar
  • 19 Eklöf B, Rutherford RB, Bergan JJ. et al. Revision of the CEAP classification for chronic venous disorders: consensus statement. J Vasc Surg 2004; 40 (06) 1248-1252.
    CrossrefPubMedGoogle Scholar
  • 20 Forlee MV. et al. Stroke after varicose vein foam injection sclerotherapy. J Vasc Surg 2006; 43 (01) 162-164.
    CrossrefPubMedGoogle Scholar
  • 21 Frullini A. et al. High production of endothelin after foam sclerotherapy: a new pathogenetic hypothesis for neurological and visual disturbances after sclerotherapy. Phlebology. 2011: 1-6.
    Google Scholar
  • 22 Genotell N, Bessereau J AD. Is it necessary to revalue the risk of a gas embolism complicating an intervention with carbon dioxide insufflation? Answer elements. Annales françaises d’anesthèsie et de rèanimation 2008; 27: 756-757.
    PubMedGoogle Scholar
  • 23 Gillet JL. et al. Side-effects and complications of foam sclerotherapy of the great and small saphenous veins: a controlled multicentre prospective study including 1,025 patients. Phlebology 2009; 24 (03) 131-138.
    CrossrefPubMedGoogle Scholar
  • 24 Gillet JL. et al. Pathophysiology of visual disturbances occurring after foam sclerotherapy. Phlebology 2010; 25: 261-266.
    CrossrefPubMedGoogle Scholar
  • 25 Gloviczki P. Invited commentary. J Vasc Surg 2011; 53 (01) 137-138.
    CrossrefPubMedGoogle Scholar
  • 26 Guex J-J, Allaert F-A, Gillet J-L, Chleir F. Immediate and midterm complications of sclerotherapy: report of a prospective multicenter registry of 12,173 sclerotherapy sessions. Dermatologic surgery 2005; 31 (02) 123-128.
    CrossrefPubMedGoogle Scholar
  • 27 Guex J-J. Complications and side-effects of foam Sclerotherapy. Phlebology 2009; 24: 270-274.
    CrossrefPubMedGoogle Scholar
  • 28 Guex J-J. et al. The French Polidocanol Study on Long-Term Siede Effects: A Survey Covering 3,357 Patient Years. Dermatol Surg 2010; 36: 993-1003.
    CrossrefPubMedGoogle Scholar
  • 29 Jia X. et al. Systematic review of the safety and efficacy of foam sclerotherapy for venous disease of the lower limb. Brit J Surg 2007; 94 (08) 925-936.
    CrossrefPubMedGoogle Scholar
  • 30 Habegger R. et al. Lethal air embolism during arthroscopy. J Bone Joint Surg 1989; 71-B: 314-316.
    CrossrefPubMedGoogle Scholar
  • 31 Hahn M. et al. Late stroke after foam sclerotherapy. Vasa 2010; 39: 108-110.
    CrossrefPubMedGoogle Scholar
  • 32 Hamahata A. et al. Outcomes of Ultrasound-Guided Foam Sclerotherapy for Varicose Veins of the Lower Extremities: A Single Center Experience. Dermatol Surg 2011; 37: 804-809.
    PubMedGoogle Scholar
  • 33 Hamel-Desnos C. et al. Liquid versus foam sclerotherapy. Phlebology 2009; 24: 240-246.
    CrossrefPubMedGoogle Scholar
  • 34 Hanisch F. et al. Stroke following variceal sclerotherapy. Eur J Med Res 2004; 9 (05) 282-284.
    PubMedGoogle Scholar
  • 35 Hartmann K. Reversible neurological deficit after foam sclerotherapy. Eur J Vasc Endovasc Surg 2009; 38 (05) 648-649.
    CrossrefPubMedGoogle Scholar
  • 36 Hawkins IF. et al. Carbon dioxide (CO2) digital subtraction angiography: 26-year experience at the University of Florida. Eur Radiol 1998; 8 (03) 391-402.
    CrossrefPubMedGoogle Scholar
  • 37 Hlastala MP. et al. Absorption of in vivo inert gas bubbles. Respir Physiol 1975; 24 (02) 147-158.
    CrossrefPubMedGoogle Scholar
  • 38 Kas A. et al. Cerebellar infarction after sclerotherapy for leg varicosities. Presse Med 2000; 29 (035) 1935
    PubMedGoogle Scholar
  • 39 Künzlberger B, Pieck C, Altmeyer P SM. Migraine Ophthalmique liquid 1% polidocanol. Dermatol Surg 2006; 32: 1410-1413.
    PubMedGoogle Scholar
  • 40 Leslie-Mazwi TM. et al. Intra-arterial air thrombogenesis after cerebral air embolism complicating lower extremity sclerotherapy. Neurocrit Care 2009; 11: 247-250.
    CrossrefPubMedGoogle Scholar
  • 41 Linde Gas Therapeutics GmbH 85716 Unterschleißheim. http://www.linde-gastherapeutics.de Fachinformation/Zusammenfassung der Merkmale des Arzneimittels
    Google Scholar
  • 42 Liu FC. et al. Hemodynamic changes caused by venous gas embolism in dogs: comparisons among air, carbon dioxide and oxygen. Acta Anaesthesiol Sin 2001; 39 (02) 71-76.
    PubMedGoogle Scholar
  • 43 Ma RW. et al. Three cases of stroke following peripheral venous interventions. Phlebology 2011; 26 (07) 280-284.
    CrossrefPubMedGoogle Scholar
  • 44 Maeseneer M De. The endovenous revolution. The Br J Surg 2011; 98 (08) 1037-1038.
    PubMedGoogle Scholar
  • 45 Morrison N. et al. Comparisons of side effects using air and carbon dioxide foam for endovenous chemical ablation. J Vasc Surg 2008; 47 (04) 830-836.
    CrossrefPubMedGoogle Scholar
  • 46 Morrison N. et al. Foamsclerotherapy : Cardiac and cerebral monitoring. Phlebology 2009; 24: 252-259.
    CrossrefPubMedGoogle Scholar
  • 47 Morrison N. et al. Incidence of Side Effects Using Carbon Dioxide-Oxygen Foam for Chemical Ablation of Superficial Veins of the Lower Extremity. Eur J Vasc Endovasc Surg 2010; 40 (03) 407-413.
    CrossrefPubMedGoogle Scholar
  • 48 Myers KA. Evaluation of published reports of foam sclerotherapy: what do we know conclusively?. Phlebology 2009; 24 (06) 275-280.
    CrossrefPubMedGoogle Scholar
  • 49 NICE Ultrasound-guided foam sclerotherapy for varicose veins Target date for publication of guidance: 2009 IPG ISBN 978–1–84936–065–4 N1978 1P.
    Google Scholar
  • 50 O'Hare JL, Earnshaw JJ. The use of foam sclerotherapy for varicose veins: a survey of the members of the Vascular Society of Great Britain and Ireland. Eur J Vasc Endovasc Surg 2007; 34 (02) 232-235.
    CrossrefPubMedGoogle Scholar
  • 51 Palm MD, Guiha IC, Goldman MP. Foam sclerotherapy for reticular veins and nontruncal varicose veins of the legs: a retrospective review of outcomes and adverse effects. Dermatologic surgery 2010; 36 Suppl (Suppl. 02) 1026-1033.
    CrossrefPubMedGoogle Scholar
  • 52 Pannier-Fischer F, Rabe E. Epidemiology of chronic venous diseases. Der Hautarzt 2003; 54 (011) 1037-1044.
    CrossrefPubMedGoogle Scholar
  • 53 Parsi K. Paradoxical embolism, stroke and sclerotherapy. Phlebology 2011; 1-21.
    PubMedGoogle Scholar
  • 54 Picard C. et al. Foam sclerotherapy: a possible cause of ischaemic stroke?. J Neurol Neurosurg Psychiatry 2010; 81: 582-583.
    CrossrefPubMedGoogle Scholar
  • 55 Plas van der JP, Lambers JC. et al. Reversible ischaemic neurological deficit after sclerotherapy of varicose veins. Lancet 1994; 8894: 428-428.
    Google Scholar
  • 56 Rabe E. et al. Efficacy and safety of great saphenous vein sclerotherapy using standardised polidocanol foam (ESAF): a randomised controlled multicentre clinical trial. Eur J Vasc Endovasc Surg 2008; 35 (02) 238-245.
    CrossrefPubMedGoogle Scholar
  • 57 Ramelet A, Monti M. Phlebologie. Fribourg: Verlag Masson 1988; 1990: 227
    Google Scholar
  • 58 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 (08) 1079-1087.
    CrossrefPubMedGoogle Scholar
  • 59 Raymond-Martimbeau P. Outcomes of Ultrasound-Guided Foam Sclerotherapy for Varicose Veins of the Lower Extremities: Single Center Experience. Dermatol Surg 2011; 37: 810-811.
    PubMedGoogle Scholar
  • 60 Regan J D. et al. Clinical significance of cerebrovascular gas emboli during polidocanol endovenous ultra-low nitrogen microfoam ablation and correlation with magnetic resonance imaging in patients with right-to-left shunt. J Vasc Surg 2011; 53 (01) 131-137.
    CrossrefPubMedGoogle Scholar
  • 61 Rush JE. More on Microembolism and Foam Sclerotherapy. N Engl J Med 2008; 359: 6
    CrossrefGoogle Scholar
  • 62 Sarvananthan T, Shepherd AC. et al. Neurological complications of sclerotherapy for varicose veins. J Vasc Surg 2011; 1-9.
    PubMedGoogle Scholar
  • 63 Schuller-Petrovic S, Pavlovic M. et al. Subcutaneous injection of liquid and foamed polidocanol: extravasation is not responsible for skin necrosis during reticular and spider vein sclerotherapy. J Europ Acad Derm Ven 2011; 25: 983-986.
    Google Scholar
  • 64 Shub C. et al. Detecting intrapulmonary right-toleft shunt with contrast echocardiography. Observations in a patient with diffuse pulmonary arteriovenous fistulas. Mayo Clin Proc 1976; 51 (02) 81-84.
    PubMedGoogle Scholar
  • 65 Stautner-Brückmann C Passager. Halbseitensymptomatik nach Schaumsklerotherapie. Vasa 2009; 24: 131-138.
    Google Scholar
  • 66 Stickland MK. et al. Intra-pulmonary shunt and pulmonary gas exchange during exercise in humans. J Physiol 2004; 1: 321-329.
    Google Scholar
  • 67 Svenarud P, Persson M, Linden J van der. Effect of CO2 insufflation on the number and behavior of air microemboli in open-heart surgery: a randomized clinical trial. Circulation 2004; 109 (09) 1127-1132.
    CrossrefPubMedGoogle Scholar
  • 68 Wandrup JH. Quantifying pulmonary oxygen transfer deficits in critically ill patients. Acta Anaesthesiol Scand Suppl 1995; 107: 37-44.
    Google Scholar
  • 69 Wollmann JC. Sclerosant foams Stabilities, physical properties and rheological behavior. Phlebologie 2010; 4: 208-217.
    Article in Thieme ConnectGoogle Scholar
  • 70 Wright D, Gobin JP, Bradbury a W. et al. 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 (04) 180-190.
    CrossrefGoogle Scholar
  • 71 Wright DD. High prevalence of right-to-left shunt in patients with symptomatic great saphenous incompetence and varicose veins. J Vasc Surg 2010; 51 (01) 104-107.
    CrossrefPubMedGoogle Scholar
  • 72 Yamaki T. et al. Comparative study of duplexguided foam sclerotherapy and duplex-guided liquid sclerotherapy for the treatment of superficial venous insufficiency. Dermatologic surgery 2004; 30 (05) 718-722.
    PubMedGoogle Scholar