Aktuelle Aspekte der Schaumverödungstherapie

Summary

Foam sclerotherapy is an efficient and safe technique for the treatment of chronic venous insufficiency. In Germany, the multiplicity of sclerosing agents of past decades has reduced to the agent Aethoxysklerol^® (active ingredient: polidocanol). It has been shown that sclerosants are more efficient when administered as foam rather than in liquid form. Only for spider veins are liquid sclerosants equally, or more effective than their foam counterparts. Various techniques can be used to mix the sclerosant with a gas (generally normal room air, alternative: CO₂) to produce a foam. The foam's advantage over the liquid form is that it completely displaces the blood from the venous segment to be treated and thereby considerably prolongs the contact time with the vein wall. The various sclerosants lead to marked damage of the vascular endothelium and possibly, the entire venous wall. If sclerotherapy is successful, the vein is ultimately converted into a thread of connective tissue. A sufficient volume of foam is crucial to the success of sclerotherapy of trunk varices, in order to ensure adequate filling of the vessel lumen. Foam sclerotherapy reaches its limit with varicosities of more than 8 mm in diameter, because the rate of thrombosis rises sharply with foam volumes above 10 ml. Foam sclerotherapy may also be used to treat angiodysplasias, vulvar, pudendal and periulcerous varicosities and is quite often the only therapeutic option. The main complications of sclerotherapy are pain in the region of sclerothrombi, haematoma, phlebitis, induration, pigmentation and a metallic taste. Other acute complications are vasovagal reactions, paraesthesias and nausea. Anaphylactic reactions, intra-arterial injections with the possible sequelae, migraine attacks with visual disturbances (scintillating scotoma) and transient neurological deficits have indeed been reported in individual cases, but are very rare.

Consideration of the current literature shows that foam sclerotherapy is a safe and quite simple technique for all forms of varicosis. Based on the data now available, it can be stated that foam sclerotherapy is far more effective than liquid sclerotherapy.

Zusammenfassung

Die Schaumsklerosierung stellt ein effizientes und sicheres Verfahren zur Behandlung der Varikose dar. Während bei der Besenreisersklerosierung die Verödung mit flüssigen Sklerosierungsmitteln der Verödung mit Schaum gleichwertig oder überlegen ist, hat die Schaumsklerosierung sich bei den subkutanen Varizen als effektiver erwiesen. Entscheidend für den Erfolg der Sklerosierung bei Stammvarizen ist ein ausreichendes Schaum-Volumen, um die Varize ausreichend gleichmäßig füllen zu können. Da ab einem Schaumvolumen von über 10 ml die Thromboserate stark ansteigt, stößt die Schaumsklerosierung bei Stammvarizen ab einem Durchmesser von 8 mm an ihre Grenzen. Bei Angiodysplasien, vulvären und pudendalen Varizen sowie bei periulzerösen Varizen ist die Schaumsklerosierung oft die einzige Therapiemöglichkeit. Unter Berücksichtigung der aktuellen Literatur ist die Schaumsklerotherapie eine sichere und einfach anzuwendende Therapie für alle Formen der Varikose, welche bessere Verschlussraten aufweist, als die Sklerosierung in flüssiger Form.

Keywords

Sclerotherapy - foam - varicosis

Schlüsselwörter

Schaumverödungstherapie - Schaum - Varikosis

• Literatur

• 1 Alos J, Carreno P, Lopez J A. et al. Efficacy and safety of sclerotherapy using Polidocanol foam: A controlled clinical trial. Eur J Vasc Endovasc Surg 2006; 31: 101-107.
• 2 Barrett JM, Allen B, Ockelford A, Goldman MP. Microfoam ultrasound-guided sclerotherapy of varicose veins in 100 legs. Dermatol Surg 2004; 30: 6-12.
• 3 Bergan J, Pascarella L, Mekenas L. Venous disorders: Treatment with sclerosant foam. J Cardiovasc Surg 2006; 47: 9-18.
• 4 Bidwai 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.
• 5 Bountouroglou DG, Azzam M, Kakkos SK. et al. Ultrasound-guided foam sclerotherapy combined with sapheno-femoral ligation compared to surgical treatment of varicose veins: early results of a randomised controlled trial. Eur J Vasc Endovasc Surg 2006; 31: 93-100.
• 6 Breu FX, Partsch B. Reversible neurologische Komplikationen bei der Schaumsklerotherapie (Comment on Forlee MV et al.). Phlebologie 2006; 3: 115-116
• 7 Breu FX, Guggenbichler S, Wollmann JC. 2^nd European Consensus Meeting on Foam Sclerotherapy 2006, Tegernsee, Germany. Vasa 2008; S71: 3-29.
• 8 Breu FX, Guggenbichler S. Eurpean Consensus Meeting on foam sclerotherapy 2003, Tegernsee, Germany. Dermatol Surg 2004; 30: 709-717.
• 9 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.
• 10 Cabrera J, Cabrera Jr J, Garcia-Olmedo A, Redondo P. Treatment of venous malformations with sclerosant in microfoam form. Arch Dermatol 2003; 139: 1409-1416.
• 11 Cabrera J, Redondo P, Becerra A. et al. Ultrasound-guided injection of Polidocanol microfoam in the management of venous leg ulcers. Arch Dermatol 2004; 140: 667-673.
• 12 Cavezzi A, Frullini A, Ricci S, Tessari L. Treatment of varicose veins by foam sclerotherapy: two clinical series. Phlebology 2002; 17: 13-18.
• 13 Ceulen RPM, Bullens-Goessens YIJM, Pi-Van de Venne SJA. et al. Outcomes and side effects of duplex-guided sclerotherapy in the treatment of freat saphenous veins with 1% versus 3% Polidocanol foam: results of a randomised controlled trial with 1-year follow-up. Dermatol Surg 2007; 33: 276-281.
• 14 Creton D, Uhl FJ. Foam sclerotherapy combined with surgical treatment for recurrent varicose veins: short term results. Eur J Vasc Surg 2007; 33: 619-624.
• 15 Cutrer FM, Sorensen AG, Weisskoff RM. et al. Perfusion-weighted imaging defects during spontaneous migrainous aura. Ann Neurol 1989; 43: 25-31.
• 16 Drake LA, Dinehart SM, Goltz R. et al. Guidelines of care for sclerotherapy treatment of varicose and teleangiectatic leg veins. J Am Acad Dermatol 1996; 34: 523-528.
• 17 Forlee MV, Grouden M, Moore DJ, Shanik G. Stroke after varicose vein foam injection sclerotherapy. J Vasc Surg 2006; 43: 162-164.
• 18 Guex JJ, Allaert FA, Gillet JL. Immediate and midterm complications of sclerotherapy: Report of a prospective multicenter registry of 12 173 sclerotherapy sessions. Dermatol Surg 2005; 31: 123-128.
• 19 Guex JJ. Foam sclerotherapy: an overview of use for primary venous insufficiency. Semin Vasc Surg 2005; 18: 25-29.
• 20 Goldman MP. Sclerotherapy: treatment of varicose and teleangiectatic leg veins. 2nd . ed. Mosby; 1995
• 21 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.
• 22 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 sclerotherapy of the long saphenous vein: Initial results. Dermatol Surg 2003; 29: 1170-1175.
• 23 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 ranodmised, double-blind trail with 2-year-follow-up: “The 3/1 Study”. Eur J Vasc Endovasc Surg 2007; 34: 723-729.
• 24 Henriet JP. Expérience durant trois années de la mousse de Polidocanol dans le traitement des varices réticulaires et des varicosités. Phlébologie 1999; 52: 277-282.
• 25 Hertzman PA, Owens R. Rapid healing of chronic venous ulcers following ultrasound-guided foam sclerotherapy. Phlebology 2007; 22: 34-39.
• 26 Hill D, Hamilton R, Fung T. Assessment of techniques to reduce sclerosant foam migration during ultrasound-guided sclerotherapy of the great saphenous vein. J Vasc Surg 2008; 48: 934-939.
• 27 Ikeda M, Kambayashi J, Iwamoto S. et al. Haemostasis activation during sclerotherapy of lower extremity varices. Throm Res 1996; 82: 87-95.
• 28 Jia X, Mowatt G, Burr JM. et al. Systemic review of foam sclerotherapy for varicose veins. Br J Surg 2007; 94: 925-936.
• 29 Kakkos Sk, Bountouroglu DG, Azzam M. et al. Effectiveness and safety of ultrasound-guided foam sclerotherapy for recurrent varicose veins: Immediate results. J Endovasc Ther 2006; 13: 357-364.
• 30 Kern P, Ramelet AA, Wutschert 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.
• 31 Kölbel T, Hinchliffe RJ, Lindblad B. Catheter-directed foam sclerotherapy of axial saphenous reflux: eraly results. Phlebology 2007; 22: 219-222.
• 32 Künzlberger B, Pieck C, Altmeyer P, Stücker M. Migraine ophthalmique with reversible scotomas after sclerotherapy with liquid 1% polidocanol. Dermatol Surg 2006; 32: 1410-1413.
• 33 Mancini S, Mariani F, De Sando D. et al. Sclerose de la grande saohene, istologie et microscopie elettronique des alternations chez l’homme. In: Davy A, Stemmer R. (ed). Phlebologie: 10 Congres Mondial Union Internationale des Phlebologie. Paris: John Libbey Eurotext Ltd; 1989: 769-771.
• 34 McCollum C, Bhowmick A, Harper D. US experience with varisolve Polidocanol microfoam. Int Angiol 2001; 20: 86.
• 35 Meyers KA, Jolley D, Clough A, Kirwan J. Outcome of ultrasound.guided sclerotherapy for varicose veins: Medium-term results assessed by ultrasound surveillance. Eur J Vasc Endovasc Surg 2007; 33: 116-121.
• 36 Min RJ, Navarro L. Transcatheter duplex ultrasound-guided sclerotherapy for treatment of greater of greater saphenous vein reflux: preliminary report. Dermatol Surg 2000; 26: 410-414.
• 37 Monfreux A. Traitement sclérosant des troncs saphéniens et leurs collatérales de gros calibre par la méthode mus. Phlébologie 1997; 50: 351-353.
• 38 Morrison N, Neuhardt DL, Hansen K. et al. Tracking foam to the heart and brain following ultrasound-guided sclerotherapy of lower extremity veins. Aust N Z J Phlebol 2007; 10: 6-10.
• 39 Morrison N, Neuhardt DL, Rogers CR. et al. Comparison of side effects using air and carbon dioxide foram for endovenous chemical ablation. J Vasc Surg 2008; 47: 830-836.
• 40 Myers KA, Jolley D, Clough A, Kirwan J. Outcome of ultrasound-guided sclerotherapy for varicose veins: Medium-term results assessed by ultrasound surveillance. Eur J Vasc Endovasc Surg 2007; 33: 116-121.
• 41 Nitecki S, Bass A. Ultrasound-guided foam sclerotherapy in patients with Klippel-Trenaunay syndrome. IMAJ 2007; 9: 72-75.
• 42 Noppeney T, Nüllen H. Treatment of primary varicosis. Internist (Berl) 2010; 51: 344-350.
• 43 Orsini C, Brotto M. Immediate pathologic effects on the vein wall of foam scleortherapy. Dermatol Surg 2007; 33: 1250-1254.
• 44 Ouvry P, Allaert FA, Desnos P. Hamel-Desnos Efficacy of polidocanol foam versus liquid in sclerotherapy of the great saphenous vein: a multicentre randomised controlled trial with a two-year follow-up. Eur J Vasc Endovasc Surg 2008; 36: 366-370.
• 45 Pascarella L, Bergan JJ, Yamada C, Mekenas L. Venous angiomata: treatment with sclerosant foam. Ann Vasc Surg 2005; 19: 457-464.
• 46 Rabe E, Otto J, Schliephake D, Pannier F. Efficacy and safety of great saphenous vein sclerotherapy using standarised polidocanol foam (ESAF): A randomised controlled multicentre clinical trial. Eur J Vasc Endovasc Surg 2008; 35: 238-245.
• 47 Rabe E, Pannier F, Gerlach H. et al. Leitlinie: Sklerosierungsbehandlung der Varikose. Phlebologie 2008; 37: 27-34.
• 48 Reich-Schupke S, Altmeyer P, Stücker M. Therapie der Stammvarikose der Vena saphena magna mittels Katheter-gestützter Mikroschaumsklerosierungstherapie ohne Heparinprophylaxe: Fallserie und Literaturübersicht. Phlebologie 2008; 37: 198-203.
• 49 Reich-Schupke S, Weyer K, Altmeyer P, Stücker M. Treatment of varicose tributaries with sclerotherapy with polidocanol 0.5 % foam. Vasa 2010; 39: 169-174.
• 50 Stücker M, Reich S, Hermes N, Altmeyer P. Safety and efficiency of perilesional sclerotherapy in leg ulcer patients with postthrombotic syndrome and/ or oral anticoagulation with phenprocoumon. J Dtsch Dermatol Ges 2006; 4: 734-738.
• 51 Tessari L, Cavezzi A, Frullini A. Preliminary experience with a new sclerosing foam in the treatment of varicose veins. Dermatol Surg 2001; 27: 58-60.
• 52 Wildenhues B. Catheter-assisted foam sclerotherapy: A new minimally-invasive method for the treatment of trunk varicosis of the long and short saphenous veins. Phlebologie 2005; 34: 165-170.
• 53 Wollmann JC. An experimental model to pinpoint properties and behaviour of sclerosing foams. American College of Phlebology, 17^th Annual Congress. San Diego, California: 2003
• 54 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.
• 55 Yamaki T, Nozaki M, Fujiwara O, Yoshida E. Duplex-guided foam sclerotherapy for the treatment of the symptomatic venous malformations of the face. Dermatol Surg 2002; 28: 619-622.
• 56 Yamaki T, Nozaki M, Iwasaka S. Comparative study of duplex-guided foam sclerotherapy and duplex-guided liquid sclerotherapy for the treatment of superficial venous insufficiency. Dermatol Surg 2004; 30: 718-722.
• 57 Yamaki T, Nozaki M, Sasaki K. Acute massive pulmonary embolism following high ligation combined with compression sclerotherapy for varicose veins report of a case. Dermatol Surg 1999; 25: 321-325.