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Venenoperation in Kombination mit Sklerotherapie

Alternative zur Babcock-Operation bei primärer Stammvarikose der V. saphena magna Grad IV nach Hach

Vein surgery in combination with sclerotherapy

Alternative to Babcock’s operation for primary varicosis of the great saphenous vein Hach grade IV

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Zusammenfassung

Hintergrund

Bei der Behandlung der Stammvarikose der V. saphena magna Stadium IV nach Hach durch die modifizierte Babcock-Operation treten häufig Schädigungen des N. saphenus auf. Wir kombinierten Krossektomie und partielles Stripping mit der Sklerosierungstherapie insuffizienter Venenabschnitte und Vv. perforantes am Unterschenkel.

Patienten, Methoden

129 Beine wurden behandelt, zunächst durch Krossektomie und partielles Stripping, 6 Wochen postoperativ durch Sklerosierungstherapie insuffizienter Venenabschnitte und Perforantes am Unterschenkel. Vor der Venenoperation (A), 6 Wochen postoperativ (vor Sklerotherapie, B) sowie 9 Monate nach Abschluss der Sklerosierungstherapie (C) wurden die venöse Wiederauffüllzeit (T0) und venöse Pumpleistung (V0) bestimmt und eine Duplexsonographie durchgeführt. Die subjektiven Intensitäten von 7 Beinbeschwerden wurden erfasst.

Ergebnisse

T0 verlängerte sich postoperativ (B) hochsignifikant von 13,3 s ± 3,8 auf 27,0 s ± 4,9, bei (C) weiterhin hochsignifikant auf 32,4 s ± 7,6. V0 verbesserte sich von A nach B von 3,2% ± 1,8 auf 4,2% ± 2,6 (hochsignifikant) und zum Zeitpunkt C mit 5,8% ± 3,1 erneut hochsignifikant. Sechs Beine (4,7%) hatten bei (C) wieder Refluxe im Leistenbereich, 5 Unterschenkel (3,9%) Perforansinsuffizienzen. Bei (B) bestanden Sensibilitätsstörungen an 4 Beinen, bei (C) an keinem. Alle sieben abgefragten Beinbeschwerden verbesserten sich sowohl von A nach B als auch von B nach C signifikant.

Schlussfolgerungen

Die Sklerotherapie verbessert hämodynamische Parameter und Beschwerden signifikant gegenüber der alleinigen Operation und minimiert gleichzeitig das Risiko einer Schädigung des N. saphenus.

Abstract

Background

Treatment of primary varicosis of the great saphenous vein (GSV) with reflux of the total GSV (down to the ankle or Hach grade 4) by the modified Babcock operation may lead to damage of the saphenous nerve. We combined high saphenofemoral ligation and partial stripping with sclerotherapy of incompetent veins and perforators of the lower leg.

Population and method

A total of 129 legs were treated first by high ligation and partial stripping, 6 weeks postoperatively by sclerotherapy of the remaining incompetent parts of the GSV and incompetent perforators of the lower legs. Before surgery (A), 6 weeks after the operation (before sclerotherapy B) and 9 months after completion of sclerotherapy (C) the venous refilling time (T0) and venous ejection fraction (V0) were evaluated and Duplex scanning performed. The subjective intensity of 7 different complaints of the legs was assessed.

Results

The T0 was highly significantly prolonged from 13.3 s ± 3.8 to 27.0 s ± 4.9 by the operation (B) and again highly significantly to 32.4 s ± 7.6 at (C). At (C) six legs (4.7%) had refluxes in the groin and in five lower legs (3.9%) recurrent incompetent perforators. At (B) there were sensory neurologic deficits in four legs and at (C) in none. All seven assessed complaints improved significantly from point A to B as well as from B to C.

Conclusions

Sclerotherapy significantly improves hemodynamic parameters and subjective complaints compared to operative treatment alone and minimizes the risk of saphenous nerve injury.

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Authors and Affiliations

  1. Hautarztzentrum, Am Plärrer 19–21, 90443, Nürnberg, Deutschland

    R. Nordmeier

  2. Hautarztpraxis, MVZ Ev. Jung-Stilling-Krankenhaus, Siegen, Deutschland

    C. El Gammal

  3. Klinik für Gefäßchirurgie, St. Josef-Hospital, Universitätsklinik der Ruhr-Universität Bochum, Bochum, Deutschland

    A. Mumme

  4. Dermatologische Klinik, Diakonie Klinikum Bethesda, Freudenberg, Deutschland

    S. El Gammal

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  1. R. Nordmeier
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  2. C. El Gammal
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  4. S. El Gammal
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Correspondence to R. Nordmeier.

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Nordmeier, R., El Gammal, C., Mumme, A. et al. Venenoperation in Kombination mit Sklerotherapie. Gefässchirurgie 17, 659–664 (2012). https://doi.org/10.1007/s00772-012-1038-z

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  • DOI: https://doi.org/10.1007/s00772-012-1038-z

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