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Externe Verstärkung variköser Venen in der Gefässchirurgie

External reinforcement of varicose veins in vascular surgery

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Zusammenfassung

Hintergrund

Die autologe Vene ist das Material der ersten Wahl bei Bypassoperationen. Variköse Venen gelten jedoch wegen der Rupturgefahr als ungeeignet. In der vorliegenden Arbeit werden verschiedene Möglichkeiten einer externen Ummantelung variköser Venen behandelt.

Material und Methoden

Zwischen 01.11.2002 und 28.03.2010 wurden insgesamt 24 Patienten im Alter zwischen 59 und 84 Jahren wegen einer peripheren arteriellen Durchblutungsstörung im Stadium III oder IV nach Fontaine einer infrainguinalen Bypassoperation unterzogen. Bei allen Patienten wurden variköse Venen als Bypass-Graft verwendet, nachdem die Venen extern ummantelt wurden. Dabei kamen 8-mal handelsübliche PTFE-Prothesen, 5-mal ein ultradünnes Stahlnetz (Biocompound-Graft®) und bei 11 Patienten ein Polyesternetz (ProVena®) zum Einsatz. Das Follow-up der Patienten beträgt durchschnittlich 40 Monate (minimal 2, maximal 86 Monate).

Ergebnisse

Bei 4 Patienten kam es zu einer Bypassfrühthrombose, zwei dieser Patienten mussten amputiert werden. Während des Nachbeobachtungszeitraums kam es zu 3 weiteren Bypassspätthrombosen. Die sekundäre Bypassoffenheitsrate lag nach einem Jahr bei 83%, der Extremitätenerhalt bei über 90%. 6 Patienten verstarben mit offenem Bypass und erhaltener Extremität.

Schlussfolgerung

Die Verwendung variköser, extern ummantelter Venen stellt in einem ausgewählten Patientengut eine Alternative zum Kunststoffbypass mit guten Ergebnissen dar.

Abstract

Background

Autologous veins are the material of choice for peripheral bypass surgery. Varicose veins are deemed to be inadequate because of the risk of increasing dilatation or rupture. In this paper different possibilities of external reinforcement for varicose veins are discussed.

Patients, materials and methods

From 1st November 2002 to 28th March 2010 a total of 24 patients with peripheral arterial disease underwent infrainguinal bypass surgery because of residual pain or gangrene. In all patients externally reinforced varicose veins were implanted as bypass grafts. In 8 cases a customary PTFE prosthesis was used for the external reinforcement, in 5 patients mesh tubing made of steel alloy (Biocompound-graft®) and in 11 patients a porous polyester stent (ProVena®) was used. The follow-up of the patients ranged between 2 and 86 months (mean 40 months).

Results

In four patients thrombosis occurred in the bypass early postoperatively and amputation was necessary in two of these patients. During the follow-up three additional thromboses occurred in the bypass. The secondary patency rate after 1 year was 83% and over 90% of the limbs could be saved. Of the patients six died with a working bypass and preserved extremities.

Conclusion

The use of externally reinforced varicose veins seems to offer an alternative to synthetic grafts with good results in a selected cohort of patients.

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Authors and Affiliations

  1. Univ. Klinik für Chirurgie, Klinische Abteilung für Gefäßchirurgie, Auenbruggerplatz 28, 8010, Graz, Österreich

    K. Tiesenhausen & P. Konstantiniuk

  2. Privatklinik Graz Ragnitz, Graz, Österreich

    M. Hessinger

Authors
  1. K. Tiesenhausen
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  2. P. Konstantiniuk
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  3. M. Hessinger
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Correspondence to K. Tiesenhausen.

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Tiesenhausen, K., Konstantiniuk, P. & Hessinger, M. Externe Verstärkung variköser Venen in der Gefässchirurgie. Gefässchirurgie 16, 266–272 (2011). https://doi.org/10.1007/s00772-010-0846-2

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