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Phlebologie 2025; 54(03): 114-121
DOI: 10.1055/a-2380-2093
Curriculare Fortbildung

Therapie der Rezidivvarikose

Treatment of Recurrent Varicose Veins
Stefania Gerontopoulou
,
Knuth Rass
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Die Rezidivvarikose stellt ein häufiges, medizinisch und gesundheitsökonomisch relevantes Problem nach Behandlung einer Varikose dar und wird in der Literatur, je nach Definition, Behandlungsmethode und Beobachtungszeit, mit unterschiedlichen Häufigkeiten dokumentiert [1] [2]. Somit kommt der Prävention insbesondere durch Optimierung der primären Behandlung eine große Bedeutung zu. Obwohl die Rezidivvarikose einen negativen Einfluss auf die Lebensqualität der Patienten aufweist, liegt aktuell nur eine geringe Evidenz zur Auswahl der geeignetsten Behandlungsmethode vor [3] [4].

Abstract

Varicose vein recurrence after treatment is a frequent, medically and economically relevant problem and is documented in the literature with different frequencies depending on the treatment method and duration of the follow-up period. Therefore, prevention through an optimized primary treatment is of great importance. Although recurrent varicose veins are common and have a negative impact on the patient's quality of life, there is currently limited evidence, making it difficult to decide on the most effective treatment method.

Kernaussagen

  • Die Rezidivvarikose ist von erheblicher medizinischer und ökonomischer Relevanz, die Prävention durch eine optimale Primärtherapie spielt also eine wichtige Rolle.

  • Eine sorgfältige klinische und duplexsonografische Untersuchung sowie der Patientenwunsch führen schließlich zu der Auswahl des Behandlungsverfahrens.

  • Für die Therapie der Rezidivvarikose kommen die offen-chirurgische Therapie, endovenös-thermische Ablationsverfahren und die Ultraschall-gesteuerte Schaumsklerosierung allein oder in Kombination zum Einsatz.

  • Crossenrezidive mit einem belassenen Stumpf lassen sich mit langfristig sehr guten Ergebnissen durch eine offene Revision mit Barrieretechniken behandeln.

  • Die Revisionschirurgie setzt eine umfangreiche Erfahrung des Operateurs voraus.

  • Bei persistierenden Stammvenensegmenten oder Crossenrezidiven über die V. saphena anterior sollte die Möglichkeit einer endovenös-thermischen Ablation geprüft werden.

  • Bei Neovaskularisation mit kleinkalibrigen Gefäßen ohne Nachweis eines Stumpfes sollte die Ultraschall-gesteuerte Schaumsklerosierung eingesetzt werden.

Schlüsselwörter

Rezidivvarikose - Crossenrezidiv - offene Crossenrevision - Laserablation - Schaumsklerosierung - Prävention

Keywords

recurrent varicose veins - recurrent saphenofemoral incompetence - inguinal reoperation - endovenous laser ablation - foam sclerotherapy - prevention


Publication History

Received: 03 February 2025

Accepted after revision: 10 March 2025

Article published online:
16 April 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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