Zusammenfassung
Während die Varizentherapie über ca. 100 Jahre unverändert aus den 3 Prinzipien Kompression, Sklerotherapie und klassische Varizenoperation bestand, haben sich in den letzten 10 Jahren Alternativen bzw. Weiterentwicklungen, wie Schaumverödung, endovenöse Lasertherapie und Radiofrequenzobliteration entwickelt. Im Gegensatz zur klassischen Varizenoperation gibt es für die modernen Therapieverfahren prospektiv randomisierte Vergleichsstudien. Sie zeigen klar, dass die endovenös thermischen Verfahren der klassischen Operation hinsichtlich der perioperativen Komplikationsrate nicht unterlegen sind. Tendenziell scheinen die perioperativen Beschwerden der endovenösen Lasertherapie und v. a. der Radiofrequenzobliteration deutlich geringer zu sein. Die Schaumverödung stellt eine wenig invasive, insbesondere kostengünstige Alternative dar. Wenngleich die durchschnittlichen Verschlussraten der Stammvenen nach Schaumverödung nicht so gut sind wie nach endovenöser Therapie, ist die Methode initial doch sehr effektiv. Insbesondere bei einer Rezidivvarikose aus dem saphenofemoralen oder poplitealen Übergang ist die Schaumverödung als ideale Methode anzusehen. Alle Verfahren verbessern signifikant die Lebensqualität der Patienten und die mit der Varikosis verbundene Beschwerdesymptomatik. Sie stehen nicht in Konkurrenz zueinander, sondern ergänzen sich teilweise, sodass eine Kombination mehrerer Methoden durchaus sinnvoll ist.
Abstract
While the treatment of varicose veins has remained unchanged over the past 100 years based on the three principles of compression, sclerotherapy, and classic varicose vein surgery, alternative approaches and advancements in treatment have developed in the last 10 years such as foam sclerotherapy, endovenous laser therapy, and radiofrequency obliteration. In contrast to classic varicose vein surgery, prospective, randomized, comparative studies are available with respect to the modern treatment procedures. They clearly show that endovenous thermal techniques are not inferior to the classic operation regarding the perioperative complication rate. There appears to be a tendency toward considerably fewer perioperative complaints with endovenous laser therapy and in particular with radiofrequency obliteration. Foam sclerotherapy represents a minimally invasive alternative that is markedly cost-effective. Even though the occlusion rate of the root veins after foam sclerotherapy is not as good as after endovenous therapy, the method is initially very effective. Especially in cases of recurrent varicose veins from the saphenofemoral or popliteal junction, foam sclerotherapy should be considered as the ideal method. All procedures significantly improve the patients’ quality of life and the symptom complaints related to varicose veins. They are not in competition, but rather partially complement each other so that a combination of several approaches is quite judicious.
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Noppeney, T., Nüllen, H. Therapie der primären Varikosis. Internist 51, 344–350 (2010). https://doi.org/10.1007/s00108-009-2515-7
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DOI: https://doi.org/10.1007/s00108-009-2515-7