Zusammenfassung
Seit der Einführung der endoluminalen Methoden zur Versorgung der Varikose der V. saphena magna (VSM) sind fast 20 Jahre vergangen, sodass es an der Zeit ist, den initialen Anspruch an diese Methoden an der Erfahrung und aufgearbeiteten Evidenz zu messen. Es liegen Studien vor, aus denen ausreichend Rückschlüsse auf die derzeitige Leistungfähigkeit der endoluminalen Strategien abzuleiten sind. Die gefundene Evidenz hat manchen Anspruch der neueren Methoden relativiert, aber dadurch auch die weitere technische Entwicklung vorangetrieben. Mit der offen operativen Methode, den thermischen und nichtthermischen Verfahren liegen Alternativen vor, die einerseits aneinander gemessen werden können, andererseits ergänzend bzw. gemäß einer individualisierten Indikationsstellung eingesetzt werden können. Weitere Entwicklungen zur Ergebnisoptimierung sind zu erwarten.
Abstract
Since the introduction of endovascular options for the treatment of varicose truncal veins approximately 20 years have passed. It seems to be justified to measure the fulfilling of initial promises in relation to the experience and evidence produced by these methods. Studies are now available from which a conclusion about the capabilities of endoluminal strategies can be drawn. The evidence from these studies led to thinking in relative terms about the claims of the new methods and this knowledge also initiated further technical innovations. Open operative strategies, thermal and non-thermal options represent validated treatment variations that enable a direct comparison. In the sense of individualized indications they can be combined for optimal results in the current treatment of varicose veins. The development of further innovations to optimize treatment results is ongoing.
Literatur
Babcock W (1907) A new operation for exstirpation of varicose veins of the leg. NY Med J 86:153e6
Trendelenburg F (1891) Ueber die Unterbindung der Vena saphena magna bei Unterschenkelvaricen. Beitr Klin Chir 7:195–210
Fischer R, Linde N, Duff C, Jeanneret C, Chandler JG, Seeber P (2001) Late recurrent saphenofemoral junction reflux after ligation and stripping of the greater saphenous vein. J Vasc Surg 34:236–240
Nesbitt C, Bedenis R, Bhattacharya V, Stansby G (2014) Endovenous ablation (radiofrequency and laser) and foam sclerotherapy versus open surgery for great saphenous vein varices. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.cd005624.pub3
Disselhoff BC, der Kinderen DJ, Kelder JC, Moll FL (2011) Five-year results of a randomised clinical trial of endovenous laser ablation of the great saphenous vein with and without ligation of the saphenofemoral junction. Eur J Vasc Endovasc Surg 41:685–690
Brittenden J, Cotton SC, Elders A, Ramsay CR, Norrie J, Burr J, Campbell B, Bachoo P, Chetter I, Gough M, Earnshaw J, Lees T, Scott J, Baker SA, Francis J, Tassie E, Scotland G, Wileman S, Campbell MK (2014) A randomized trial comparing treatments for varicose veins. N Engl J Med 371:1218–1227
Christenson JT, Gueddi S, Gemayel G, Bounameaux H (2010) Prospective randomized trial comparing endovenous laser ablation and surgery for treatment of primary great saphenous varicose veins with a 2-year follow-up. J Vasc Surg 52:1234–1241
Disselhoff BC, der Kinderen DJ, Kelder JC, Moll FL (2008) Randomized clinical trial comparing endovenous laser with cryostripping for great saphenous varicose veins. Br J Surg 95:1232–1238
Flessenkamper I, Hartmann M, Stenger D, Roll S (2013) Endovenous laser ablation with and without high ligation compared with high ligation and stripping in the treatment of great saphenous varicose veins: initial results of a multicentre randomized controlled trial. Phlebology 28:16–23
Flessenkamper I, Hartmann M, Hartmann K, Stenger D, Roll S (2016) Endovenous laser ablation with and without high ligation compared to high ligation and stripping for treatment of great saphenous varicose veins: Results of a multicentre randomised controlled trial with up to 6 years follow-up. Phlebology 31:23–33
Gauw SA, Lawson JA, van Vlijmen-van Keulen CJ, Pronk P, Gaastra MT, Mooij MC (2016) Five-year follow-up of a randomized, controlled trial comparing saphenofemoral ligation and stripping of the great saphenous vein with endovenous laser ablation (980 nm) using local tumescent anesthesia. J Vasc Surg 63:420–428
Rasmussen L, Lawaetz M, Bjoern L, Blemings A, Eklof B (2013) Randomized clinical trial comparing endovenous laser ablation and stripping of the great saphenous vein with clinical and duplex outcome after 5 years. J Vasc Surg 58:421–426
Rasmussen LH, Bjoern L, Lawaetz M, Blemings A, Lawaetz B, Eklof B (2007) Randomized trial comparing endovenous laser ablation of the great saphenous vein with high ligation and stripping in patients with varicose veins: short-term results. J Vasc Surg 46:308–315
Rass K, Frings N, Glowacki P, Hamsch C, Graber S, Vogt T, Tilgen W (2012) Comparable effectiveness of endovenous laser ablation and high ligation with stripping of the great saphenous vein: two-year results of a randomized clinical trial (RELACS study). Arch Dermatol 148:49–58
Rass K, Frings N, Glowacki P, Graber S, Tilgen W, Vogt T (2015) Same site recurrence is more frequent after endovenous laser ablation compared with high ligation and stripping of the great saphenous vein: 5 year results of a randomized clinical trial (RELACS study). Eur J Vasc Endovasc Surg 50:648–656
Venermo M, Saarinen J, Eskelinen E, Vahaaho S, Saarinen E, Railo M, Uurto I, Salenius J, Alback A (2016) Randomized clinical trial comparing surgery, endovenous laser ablation and ultrasound-guided foam sclerotherapy for the treatment of great saphenous varicose veins. Br J Surg 103:1438–1444
Lawson JA, Gauw SA, van Vlijmen CJ, Pronk P, Gaastra MTW, Tangelder MJ, Mooij MC (2017) Prospective comparative cohort study evaluating incompetent great saphenous vein closure using radiofrequency-powered segmental ablation or 1470-nm endovenous laser ablation with radial-tip fibers (Varico 2 study). J Vasc Surg Venous Lymphat Disord 6:31–40
O’Donnell TF, Balk EM, Dermody M, Tangney E, Iafrati MD (2016) Recurrence of varicose veins after endovenous ablation of the great saphenous vein in randomized trials. J Vasc Surg Venous Lymphat Disord 4:97–105
Almeida JI, Min RJ, Raabe R, McLean DJ, Madsen M (2011) Cyanoacrylate adhesive for the closure of truncal veins: 60-day swine model results. Vasc Endovascular Surg 45:631–635
Schäffer N, Weingard I, Kiderlen M, Theodoridis A, Schuler L, Kriechenbauer N, Hartmann K (2018) Appositionsthrombus als Komplikation endovenöser Katheterverfahren (Post ablation thrombus extension [PATE]). Phlebologie. https://doi.org/10.12687/phleb2417-2-2018
Paravastu SC, Horne M, Dodd PD (2016) Endovenous ablation therapy (laser or radiofrequency) or foam sclerotherapy versus conventional surgical repair for short saphenous varicose veins. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD010878.pub2
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Flessenkämper, I. Therapie der Varikose: Ist die endovenöse Therapie besser als die Operation?. Gefässchirurgie 23, 219–224 (2018). https://doi.org/10.1007/s00772-018-0397-5
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DOI: https://doi.org/10.1007/s00772-018-0397-5