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Allgemein- und Viszeralchirurgie up2date 2018; 12(01): 63-80
DOI: 10.1055/s-0043-110814
Allgemeine Chirurgie
Georg Thieme Verlag KG Stuttgart · New York

Varikose der unteren Extremitäten: wann und wie behandeln?

Andreas Bayer   *
,
Birgit Kahle   *
,
Marco Horn
,
Anna Lena Recke
,
Tobias Keck
,
Markus Kleemann
Further Information

Publication History

Publication Date:
06 February 2018 (online)

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Die Varikosis der unteren Extremität stellt eine häufige Erkrankung dar, die zu Ödemen, trophischen Störungen und Ulzerationen der Haut führen kann. In den letzten 15 Jahren haben sich neben dem klassischen operativen Verfahren der Krossektomie mit Stripping der Stammvene zunehmend minimalinvasive endoluminale Behandlungsverfahren etabliert, sodass dem modernen Phlebologen nun ein bunter Strauß an Prozeduren zur Verfügung steht. Es gilt, daraus für jeden Patienten die individuell optimale Behandlungsoption zu wählen.
Kernaussagen

  • In den vergangenen 15 Jahren haben sich verschiedene endoluminale Techniken in der Behandlung der Varikosis der unteren Extremität entwickelt und etabliert. Hierzu zählen im Wesentlichen

    • die Radiofrequenzobliteration (RFO),

    • die endovenöse Lasertherapie (EVLT) und

    • die Schaumsklerosierung.

  • Diese Techniken können zu Langezeitergebnissen führen, die denen des konventionellen Strippings mit Krossektomie vergleichbar sind.

  • Sie bringen den Vorteil der meist besseren Kosmetik und schnelleren Rekonvaleszenz, sind aber kostenintensiv und werden nicht von allen Krankenkassen übernommen.

  • Die Behandlung der Beinvenenvarikosis sollte aufgrund der dargestellten Vielzahl moderner Verfahren in spezialisierten Zentren erfolgen, in denen die dargestellten Techniken beherrscht werden.

Schlüsselwörter

Varikose - untere Extremität - Gefäßchirurgie - Venerologie - Phlebologie - Varize - Krampfader

* Andreas Bayer und Birigt Kahle haben den Beitrag zu gleichen Teilen verfasst.


 

  • Literatur

  • 1 Rabe E, Berboth G, Pannier F. et al. Epidemiologie der chronischen Venenkrankheiten. Wiener Med Wochenschr 2016; 166 (910) 260-263
    Google Scholar
  • 2 Maurins U, Hoffmann BH, Lösch C. et al. Distribution and prevalence of reflux in the superficial and deep venous system in the general population–results from the Bonn Vein Study, Germany. J Vasc Surg 2008; 48: 680-687
    CrossrefGoogle Scholar
  • 3 Vanhoutte PM, Corcaud S, de Montrion C. et al. Venous disease: from pathophysiology to quality of life. Angiology 1997; 48: 559-567
    CrossrefGoogle Scholar
  • 4 Eklöf B, Rutherford RB, Bergan JJ. et al. American Venous Forum International Ad Hoc Committee for Revision of the CEAP Classification. Revision of the CEAP classification for chronic venous disorders: Consensus statement. J Vasc Surg 2004; 40: 1248-1252
    CrossrefGoogle Scholar
  • 5 Vasquez MA, Rabe E, McLafferty RB. et al. Revision of the venous clinical severity score: Venous outcomes consensus statement: Special communication of the American Venous Forum Ad Hoc Outcomes Working Group. J Vasc Surg 2010; 52: 1387-1396
    CrossrefGoogle Scholar
  • 6 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: 2S-48S
    CrossrefGoogle Scholar
  • 7 Heyer K, Protz K, Glaeske G. et al. Epidemiology and use of compression treatment in venous leg ulcers: nationwide claims data analysis in Germany. Int Wound J 2017; 14: 338-343
    CrossrefGoogle Scholar
  • 8 Reich-Schupke S, Protz K, Dissemond J. et al. Neue Entwicklungen in der Kompressionstherapie. Dtsch Med Wochenschr 2017; 142: 679-686
    Article in Thieme ConnectGoogle Scholar
  • 9 Dissemond J, Assenheimer B, Bültemann A. et al. Kompressionstherapie bei Patienten mit Ulcus cruris venosum. J Dtsch Dermatol Ges 2016; 14: 1073-1089
    CrossrefGoogle Scholar
  • 10 Renner R, Gebhardt C, Simon JC. Compliance hinsichtlich der Kompressionstherapie bei Patienten mit floridem Ulcus cruris venosum. Med Klin 2010; 105: 1-6
    CrossrefPubMedGoogle Scholar
  • 11 Partsch H, Mosti G. Comparison of three portable instruments to measure compression pressure. Int Angiol 2010; 29: 426-430
    Google Scholar
  • 12 Heyer K, Augustin M, Protz K. et al. Effectiveness of advanced versus conventional wound dressings on healing of chronic wounds: systematic review and meta-analysis. Dermatology 2013; 226: 172-184
    CrossrefGoogle Scholar
  • 13 van den Bremer J, Moll FL. Historical overview of varicose vein surgery. Ann Vasc Surg 2010; 24: 426-432
    CrossrefGoogle Scholar
  • 14 Lill G, Hernández-Richter HJ, Golestan C. Operationstechnik bei Crossektomie und Varizenstripping nach Babcock. Med Welt 1977; 28: 331-333
    Google Scholar
  • 15 Noppeney T, Storck M, Nüllen H. et al. Perioperative quality assessment of varicose vein surgery: Commission for quality assessment of the German Society for Vascular Surgery. Langenbecks Arch Surg 2016; 401: 375-380
    CrossrefGoogle Scholar
  • 16 Sperling M, Lacativa A. Die Invaginationsextraction? Eine Modifizierung der Babcockʼschen Varicenoperation. Chirurg 1985; 56: 90-94
    Google Scholar
  • 17 Durkin M, Turton EP, Wijesinghe L. et al. Long saphenous vein stripping and quality of life – a randomised trial. Eur J Vasc Endovasc Surg 2001; 21: 545-549
    CrossrefGoogle Scholar
  • 18 Joh JH, Lee KB, Yun WS. et al. External banding valvuloplasty for incompetence of the great saphenous vein: 10-year results. Int J Angiol 2009; 18: 25-28
    Article in Thieme ConnectGoogle Scholar
  • 19 Proebstle T, van den Bos R. Endovenous ablation of refluxing saphenous and perforating veins. Vasa 2017; 46: 159-166
    CrossrefGoogle Scholar
  • 20 Dermody M, OʼDonnell TF, Balk EM. Complications of endovenous ablation in randomized controlled trials. J Vasc Surg Venous Lymphat Disord 2013; 1: 427-436.e1
    Google Scholar
  • 21 Proebstle TM, Alm BJ, Göckeritz O. et al. Five-year results from the prospective European multicentre cohort study on radiofrequency segmental thermal ablation for incompetent great saphenous veins. Br J Surg 2015; 102: 212-218
    CrossrefGoogle Scholar
  • 22 Shaidakov EV, Grigoryan AG, Ilyukhin EA. et al. Radiofrequency ablation or stripping of large-diameter incompetent great saphenous varicose veins with C2 or C3 disease. J Vasc Surg Venous Lymphat Disord 2016; 4: 45-50
    Google Scholar
  • 23 Proebstle TM, Alm J, Göckeritz O. et al. Three-year European follow-up of endovenous radiofrequency-powered segmental thermal ablation of the great saphenous vein with or without treatment of calf varicosities. J Vasc Surg 2011; 54: 146-152
    CrossrefGoogle Scholar
  • 24 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
    CrossrefGoogle Scholar
  • 25 Gauw SA, Lawson JA, van Vlijmen-van Keulen CJ. et al. Five-year follow-up of a randomized, controlled trial comparing saphenofemoral ligation and stripping of the great saphenous vein with endovenous laser ablation (980 nm) using local tumescent anesthesia. J Vasc Surg 2016; 63: 420-428
    CrossrefGoogle Scholar
  • 26 Lawaetz M, Serup J, Lawaetz B. et al. Comparison of endovenous ablation techniques, foam sclerotherapy and surgical stripping for great saphenous varicose veins. Extended 5-year follow-up of a RCT. Int Angiol 2017; 36: 281-288
    Google Scholar
  • 27 Flessenkämper I, Hartmann M, Hartmann K. et al. Endovenous laser ablation with and without high ligation compared to high ligation and stripping for treatment of great saphenous varicose veins: Results of a multicentre randomised controlled trial with up to 6 years follow-up. Phlebology 2016; 31: 23-33
    CrossrefGoogle Scholar
  • 28 OʼDonnell TF, Balk EM, Dermody M. et al. Recurrence of varicose veins after endovenous ablation of the great saphenous vein in randomized trials. J Vasc Surg Venous Lymphat Disord 2016; 4: 97-105
    Google Scholar
  • 29 Kalteis M, Adelsgruber P, Messie-Werndl S. et al. Five-year results of a randomized controlled trial comparing high ligation combined with endovenous laser ablation and stripping of the great saphenous vein. Dermatol Surg 2015; 41: 579-586
    CrossrefPubMedGoogle Scholar
  • 30 Marston WA, Crowner J, Kouri A. et al. Incidence of venous leg ulcer healing and recurrence after treatment with endovenous laser ablation. J Vasc Surg Venous Lymphat Disord 2017; 5: 525-532
    Google Scholar
  • 31 Luebke T, Brunkwall J. Cost-effectiveness of endovenous laser ablation of the great saphenous vein in patients with uncomplicated primary varicosis. BMC Cardiovasc Disord 2015; 15: 138
    CrossrefGoogle Scholar
  • 32 Carradice D, Mekako AI, Mazari FA. et al. Randomized clinical trial of endovenous laser ablation compared with conventional surgery for great saphenous varicose veins. Br J Surg 2011; 98: 501-510
    CrossrefPubMedGoogle Scholar
  • 33 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
    CrossrefGoogle Scholar
  • 34 Whiteley MS. Glue, steam and Clarivein–Best practice techniques and evidence. Phlebology 2015; 30 (2 Suppl): 24-28
    Google Scholar
  • 35 Milleret R, Huot L, Nicolini P. et al. Great saphenous vein ablation with steam injection: results of a multicentre study. Eur J Vasc Endovasc Surg 2013; 45: 391-396
    CrossrefGoogle Scholar
  • 36 Rabe E, Otto J, Schliephake D. 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: 238-245
    CrossrefGoogle Scholar
  • 37 Uncu H. Sclerotherapy: a study comparing polidocanol in foam and liquid form. Phlebology 2010; 25: 44-49
    CrossrefGoogle Scholar
  • 38 Rasmussen L, Lawaetz M, Serup J. et al. Randomized clinical trial comparing endovenous laser ablation, radiofrequency ablation, foam sclerotherapy, and surgical stripping for great saphenous varicose veins with 3-year follow-up. J Vasc Surg Venous Lymphat Disord 2013; 1: 349-356
    PubMedGoogle Scholar
  • 39 Rabe E, Pannier F. Sclerotherapy of varicose veins with polidocanol based on the guidelines of the German Society of Phlebology. Dermatol Surg 2010; 36 Suppl 2: 968-975
    CrossrefGoogle Scholar
  • 40 Witte ME, Zeebregts CJ, de Borst GJ. et al. Mechanochemical endovenous ablation of saphenous veins using the ClariVein: A systematic review. Phlebology 2017; 32: 649-657
    CrossrefGoogle Scholar
  • 41 Argyriou C, Papasideris C, Antoniou GA. et al. The effectiveness of various interventions versus standard stripping in patients with varicose veins in terms of quality of life. Phlebology 2017; DOI: 10.1177/0268355517720307.
    Google Scholar
  • 42 Bootun R, Lane TR, Davies AH. The advent of non-thermal, non-tumescent techniques for treatment of varicose veins. Phlebology 2016; 31: 5-14
    Google Scholar
  • 43 Eroglu E, Yasim A, Ari M. et al. Mid-term results in the treatment of varicose veins with N-butyl cyanoacrylate. Phlebology 2017; 32: 665-669
    CrossrefGoogle Scholar
  • 44 Gibson K, Ferris B. Cyanoacrylate closure of incompetent great, small and accessory saphenous veins without the use of post-procedure compression: Initial outcomes of a post-market evaluation of the VenaSeal System (the WAVES Study). Vascular 2017; 25: 149-156
    CrossrefPubMedGoogle Scholar
  • 45 Chan YC, Law Y, Cheung GC. et al. Predictors of recanalization for incompetent great saphenous veins treated with cyanoacrylate glue. J Vasc Intervent Radiol 2017; 28: 665-671
    CrossrefGoogle Scholar
  • 46 Chan YC, Law Y, Cheung GC. et al. Cyanoacrylate glue used to treat great saphenous reflux: Measures of outcome. Phlebology 2017; 32: 99-106
    CrossrefGoogle Scholar
  • 47 Proebstle TM, Alm J, Dimitri S. et al. The European multicenter cohort study on cyanoacrylate embolization of refluxing great saphenous veins. J Vasc Surg Venous Lymphat Disord 2015; 3: 2-7
    Google Scholar