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Offene und endovenöse Therapie des Crossenrezidivs

Open and endovenous treatment of recurrent saphenous vein incompetence

  • Leitthema
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Zusammenfassung

Hintergrund

Die Therapie von Crossenrezidiven ist komplex, die Komplikationsraten hoch und nötige Behandlungen müssen oft wiederholt werden. Die Prävention und Auswahl der passenden Therapiemethode sind also von großer Bedeutung.

Fragestellung

Gibt es effektive Maßnahmen zur Prävention von Crossenrezidiven? Welche Vor- und Nachteile bestehen für die Behandlungsverfahren? Welche Empfehlungen werden in den Leitlinien und Studien ausgesprochen?

Material und Methoden

Diese Übersichtsarbeit basiert auf einer Literaturrecherche bei PubMed und aktuell verfügbaren Leitlinien zur Frage der Präventions- und Therapiemöglichkeiten des Crossenrezidivs.

Ergebnisse

Zu den präventiven Maßnahmen saphenofemoraler Eingriffe zählen die niveaugleiche saphenofemorale Ligatur, möglichst in Kombination mit einer Barrieremaßnahme bei der offenen Operation sowie die „Laser-Crossektomie“ und Mitbehandlung einer vorhandenen V. saphena accessoria anterior (VSAA) bei den endovenös thermischen Ablationsverfahren (EVTA). Evidenzbasierte Daten zu präventiven Maßnahmen im Rahmen saphenopoplitealer Eingriffe existieren nicht. Die offen-chirurgische Therapie und die ultraschallgesteuerte Schaumsklerosierung (UGSS) sind grundsätzlich bei allen Formen von Crossenrezidiven anwendbar. EVTA-Verfahren weisen anatomische Limitationen bei der Anwendung auf. Die Empfehlungen der internationalen Leitlinien tendieren zu einem Einsatz weniger invasiver Methoden (EVTA, UGSS, Phlebektomie) zur Behandlung inguinaler und poplitealer Crossenrezidive.

Schlussfolgerungen

Eine Tendenz zu den weniger invasiven Verfahren ist zu erkennen, obwohl eine Evidenz aus kontrollierten randomisierten Studien fehlt. Daher sollten für die Auswahl der am besten geeigneten Therapie die anatomischen Gegebenheiten, die Vorstellungen des Patienten und die Expertise des Therapeuten mit einfließen. Zur Effektivität der poplitealen Crossenrevision liegen keine systematischen Untersuchungen vor. Mehr kontrollierte prospektive Studien sind nötig, um dieses komplexe Thema zu erleuchten.

Abstract

Background

The management of saphenofemoral and saphenopopliteal incompetence is complex. The complication rates are high and redo treatment is often unavoidable. Preventive steps and selection of the best treatment method are also very important.

Objective

Are there effective measures for prevention of recurrent saphenofemoral or saphenopopliteal incompetence? What are the advantages and disadvantages for the treatment procedures? Which recommendations are given in current guidelines and clinical trials?

Material and methods

This review article is based on a systematic literature search in PubMed and currently available guidelines dealing with the prevention and management of recurrent saphenofemoral or saphenopopliteal incompetence.

Results

The preventive measures for saphenofemoral interventions include flush saphenofemoral ligation, preferably combined with a barrier technique for open surgery or laser crossectomy including treatment of an anterior accessory saphenous vein when present, using the endovenous thermal ablation procedure (EVTA). Evidence-based data on preventive measures during saphenopopliteal interventions do not exist. Open surgical treatment and ultrasound-guided foam sclerotherapy (UGSS) are in principal equally suitable for use with all forms of recurrent varicose veins. The EVTA procedures show anatomical limitations in the application. The recommendations of the international guidelines suggest the use of minimally invasive interventions (EVTA, UGSS, phlebectomy) for the treatment of inguinal and popliteal saphenous vein recurrences.

Conclusion

Minimally invasive interventions are regarded as being more favorable to treat groin or popliteal fossa recurrence, although evidence from randomized controlled studies is lacking. Therefore, the anatomical conditions, patient preferences and expertise of the surgeon should also be taken into account for selection of the most suitable treatment. No systematic investigations on the effectiveness of popliteal saphenous vein revision are available. More controlled prospective studies are necessary to illuminate this complex topic.

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Authors and Affiliations

  1. Zentrum für Venen und periphere Arterien, Eifelklinik St. Brigida GmbH & Co. KG, Kammerbruchstr. 8, 52152, Simmerath, Deutschland

    Knuth Rass

  2. Zentrum für Venen- und Dermatochirurgie, Krankenhaus Tabea GmbH & Co. KG, 22587, Hamburg, Deutschland

    Stefania Aglaia Gerontopoulou

Authors
  1. Knuth Rass
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  2. Stefania Aglaia Gerontopoulou
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Correspondence to Knuth Rass.

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Interessenkonflikt

K. Rass und S.A. Gerontopoulou geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Rass, K., Gerontopoulou, S.A. Offene und endovenöse Therapie des Crossenrezidivs. Gefässchirurgie 27, 108–116 (2022). https://doi.org/10.1007/s00772-022-00865-6

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