PDF herunterladen
Phlebologie 2008; 37(05): 229-236
DOI: 10.1055/s-0037-1622235
Original Article
Schattauer GmbH

Endovenous procedures in varicose veins

What is the best choice today?Endovenöse Verfahren bei VarikosisWelches ist aktuell das beste Verfahren?Méthodes thérapeutiques endoveineuses des veines variqueusesQue choisir aujourd’hui ?
L. S. Kabnick
1   New York University School of Medicine, New York University Langone Medical Center, USA
,
N. Cayne
1   New York University School of Medicine, New York University Langone Medical Center, USA
,
G. Jacobowitz
1   New York University School of Medicine, New York University Langone Medical Center, USA
,
P. Lamparello
1   New York University School of Medicine, New York University Langone Medical Center, USA
,
T. Maldonado
1   New York University School of Medicine, New York University Langone Medical Center, USA
,
C. Rockman
1   New York University School of Medicine, New York University Langone Medical Center, USA
,
M. Adelman
1   New York University School of Medicine, New York University Langone Medical Center, USA
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Received: 28. Juli 2008

accepted: 29. Juli 2008

Publikationsdatum:
04. Januar 2018 (online)

Auch verfügbar auf
   Lizenzen und Reprints

Summary

Over the past ten years endoveous treatment options for varicose veins have evovled considerably, offering clinicians a multitude of options to meet the needs of their patients. The endothermal ablation procedures have moved to the forefront as the choice modality for treating truncal reflux. Both radiofrequency ablation and endovenous laser ablation are widely accepted and interchangeable, showing comparable efficacy and safety. Although numerous endovenous laser wavelengths exist, the data indicates that the differences do not affect the efficacy or postoperative recovery of the procedure. The endovenous laser innovation that has shown early evidence of improved patient outcome is the jacket-tip fiber. The versatility of sclerotherapy makes it a critical component in the endovenous treatment of varicosities. Although not approved by the Food and Drug Administration (USA), the use of a foamed sclerosing agent is the fastest growing segment of sclerotherapy and an important treatment modality in the future of varicose vein treatment. Cutaneous lasers and intense pulse light devices contribute a crucial element, enabling clinicians to treat minute veins that may be impossible to treat with other therapies.

Zusammenfassung

In den vergangenen zehn Jahren haben sich die Behandlungsmethoden für variköse Venen erheblich entwickelt. Dadurch wird Ärzten eine Vielzahl von Optionen geboten, den Patientenbedürfnissen zu entsprechen. Bei der Behandlung der Stammveneninsuffizienz sind endotherme Ablationsverfahren zur Behandlungsmethode der ersten Wahl geworden. Sowohl Radiofrequenzablation als auch endovenöse Lasertherapie sind allgemein anerkannt und gegeneinander austauschbar. Beide weisen eine vergleichbare Wirksamkeit und Sicherheit auf. Zwar existieren zahlreiche endovenöse Laserwellenlängen, aber die Daten weisen darauf hin, dass unterschiedliche Wellenlängen keinen Einfluss auf die Wirksamkeit des Verfahrens bzw. die postoperative Rekonvaleszenz haben. Das Jacket-tip-fiber-Verfahren stellt eine innovative Form der endovenösen Lasertherapie dar und konnte bereits sehr früh nachweislich bessere Ergebnisse für den Patienten erzielen. Auf Grund ihrer Vielseitigkeit ist die Sklerotherapie eine entscheidende Komponente der endovenösen Varizenbehandlung. Dabei stellt die Schaumsklerotherapie, obwohl von der Food and Drug Administration (USA) nicht zugelassen, das am schnellsten wachsende Segment in der Sklerotherapie dar und wird in Zukunft eine wichtige Option für die Therapie variköser Venen bilden. Haut-Laser und hochenergetische Blitzlampen sind weitere entscheidende Elemente der Therapie und ermöglichen Ärzten, kleinste Venen zu behandeln, die anderen Therapieformen nicht zugänglich sind.

Résumé

Depuis 10 ans les possibilités thérapeutiques pour les veines variqueuses ont considérablement évolué, offrant plusieurs options. Les méthodes de traitement endoveineux ont tendance à devenir peut-être le premier choix pour le traitement de reflux tronculaire. L’ablation par radiofréquence et le traitement par laser endoveineux sont largement répandus et donnent des résultats comparables en efficacité et en sécurité. Bien que de nombreuses variations de longueurs d’ondes existent pour le laser endoveineux, ces différences ne semblent pas influer sur l’efficacité de la guérison. L’innovation du laser endoveineux qui a montré les meilleurs effets provient de fibres enrobées (jacket-typ). Les résultats variables de la sclérothérapie en font une méthode discutable pour le traitement endoveineux de varicosités. Bien qu’elle ne soit pas reconnue par la FDA aux Etats-Unis, l’utilisation d’une mousse sclérosante reste le domaine prometteur de la sclérothérapie et une variante thérapeutique importante dans l’avenir du traitement des varices. Les lasers cutanés et les appareils à pulsation lumineuse intense restent utilisables pour le traitement de microvaricosités que l’on peut traiter par d’autres méthodes.

Keywords

Varicose veins - radiofrequency ablation - endovenous laser ablation - sclerotherapy

Schlüsselwörter

Variköse Venen - Radiofrequenzablation - endovenöse Lasertherapie - Sklerotherapie

Mots clés

Varices des membres inférieurs - ablation par radiofréquence - traitement par laser endoveineux - sclérothérapie
 

  • References

  • 1 Adrian RM. Treatment of leg telangiectasias using a long-pulse frequency-doubled neodymium : YAG laser at 532 nm. Dermatol Surg 1998; 24: 19.
    PubMedSuche in Google Scholar
  • 2 Allegra C, Antignani PL, Carlizza A. Recurrent varicose veins following surgical treatment: our experience with five years follow-up. Eur J Vasc Endovasc Surg 2007; 33: 751-756.
    CrossrefPubMedSuche in Google Scholar
  • 3 Almeida JI, Raines JK. FDA-Approved sodium tetradecyl sulfate (STS) versus compounded STS for venous sclerotherapy. Dermatol Surg 2007; 33: 1037-1044.
    PubMedSuche in Google Scholar
  • 4 Anderson RR, Jaenicke KF, Parrish JA. Mechanisms of selective vascular changes caused by dye lasers. Lasers Surg Med 1983; 3: 211-215.
    CrossrefPubMedSuche in Google Scholar
  • 5 AngioDynamics Inc.. NeverTouch VenaCure™ Kit Featuring: Gold Tip Technology brochure. Queensbury: AngioDynamics Inc.; 2007
    Suche in Google Scholar
  • 6 AngioDynamics Inc.. VenaCure™ Procedure Kit Featuring NeverTouch Gold-Tipped Fiber Instructions For Use. Queensbury: AngioDynamics Inc.; 2007
    Suche in Google Scholar
  • 7 Anvari B, Milner TE, Tanenbaum BS, Nelson JS. A comparative study of human skin thermal response to sapphire contact and cryogen spray cooling. IEEE Trans Biomed Eng 1998; 45: 934-941.
    CrossrefPubMedSuche in Google Scholar
  • 8 Babilas P, Shafirstein G, Baumler W. et al. Selective photothermolysis of blood vessels following flashlamp-pumped pulsed dye laser irradiation: In vivo results and mathematical modeling are in agreement. J Invest Dermatol 2005; 125: 343-352.
    CrossrefPubMedSuche in Google Scholar
  • 9 Baccaglini U, Spreafico G, Castoro C, Sorrentino P. Consensus conference on sclerotherapy or varicose veins of the lower limbs. Phlebology 1997; 12: 2-16.
    CrossrefSuche in Google Scholar
  • 10 Barrett JM, Allen B, Ockelford A, Goldman MP. Microfoam ultrasound-guided sclerotherapy of varicose veins in 100 legs. Dermatol Surg 2004; 30: 6-12.
    PubMedSuche in Google Scholar
  • 11 Belcaro G, Cesarone MR, Di Renzo A. et al. Foamsclerotherapy, surgery, sclerotherapy, and combined treatment for varicose veins: a 10-year, prospective, randomized, controlled trial (VEDICO trial). Angiology 2003; 54: 307-315.
    CrossrefPubMedSuche in Google Scholar
  • 12 Bergan J, Pascarella L, Mekenas L. Venous disorders: treatment with sclerosant foam. J Cardiovasc Surg 2006; 47: 115-124.
    Suche in Google Scholar
  • 13 Bergan J. Overview: Treatment of Venous Insufficiency. In: Bergan J. (ed). The Vein Book. Boston: Elsevier; 2007
    Suche in Google Scholar
  • 14 Bernstein EF, Kornbluth S, Brown DB, Black J. Treatment of spider veins using a 10 millisecond pulse-duration frequency-doubled neodymium : YAG laser. Dermatol Surg 1999; 25: 316.
    CrossrefPubMedSuche in Google Scholar
  • 15 BioForm Medical Inc.. Aethoxysklerol Sclerosing Agent. www.bioform.com/products/aethoxysklerol.html [acessed 20 March 2008].
  • 16 Biolitec Inc.. ELVeS® PL : The Gentle Standard in Endovenous Therapies brochure. East Longmeadow: biolitec Inc.; 2008
    Suche in Google Scholar
  • 17 Bioniche Pharma Group. FDA Submission: Sotradecol® (sodium tetradecyl sulfate injection 1%, 3%). Belleville: Bioniche Pharma Group; 2004
    Suche in Google Scholar
  • 18 BTG International LTG. Product pipeline: Varisolve® . www.btgplc.com/BTGDevelopmentProgrammes/228/Varisolvesupregsup.html [accessed 20 April 2008].
  • 19 Cavezzi A, Frullini A, Ricci S, Tessari L. Treatment of varicose veins by foam sclerotherapy: Two clinical series. Phlebology 2002; 17: 13-18.
    CrossrefSuche in Google Scholar
  • 20 CoolTouch Inc.. Laser Endovenous Treatment for Varicose Veins Brochure. Roseville: CoolTouch Inc.; 2004
    Suche in Google Scholar
  • 21 Davis LT, Duffy DM. Determination of incidence and risk factors for postsclerotherapy telangiectatic matting of the lower extremity: a retrospective analysis. J Dermatol Surg Oncol 1990; 16: 327-330.
    CrossrefPubMedSuche in Google Scholar
  • 22 Desmyttère J, Grard C, Wassmer B, Mordon S. Endovenous 980-nm laser treatment of saphenous veins in a series of 500 patients. J Vasc Surg 2007; 46: 1242-1247.
    CrossrefPubMedSuche in Google Scholar
  • 23 Dietzek A. ClosureFAST is better than first generation radiofrequency ablation – a quantum leap forward. 34th Veith Symposium. New York: Nov 14–18 2007
    Suche in Google Scholar
  • 24 Dornier MedTech. Medilas D Multibeam Technology: Ideal Wavelength. http://www.dornier.com/americas/english_gb/products/lasers/compactDiode/technology.htm [accessed 15 April 2008].
  • 25 Dover JS, Sadick NS, Goldman MP. The role of lasers and light sources in the treatment of leg veins. Dermatol Surg 1999; 24: 328-336.
    Suche in Google Scholar
  • 26 Eremia S, Li C, Umar SH. A side-by-side comparative study of 1064 nm Nd:YAG, 810 nm diode and 755 nm alexandrite lasers for treatment of 0.3–3 mm leg veins. Dermatol Surg 2002; 28: 224-230.
    PubMedSuche in Google Scholar
  • 27 Food and Drug Administration. Search of the MAUDE adverse event reporting system. http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/search.CFM accessed 13 April 2008].
  • 28 Frullini A, Cavezzi A. Sclerosing Foam in the Treatment of Varicose Veins and Telangiectasias: History and Analysis of Safety and Complications. Dermatol Surg 2002; 28: 11-15.
    PubMedSuche in Google Scholar
  • 29 Goldman MP, Sadick NS, Weiss RA. Cutaneous necrosis, telangiectatic matting, and hyperpigmentation following sclerotherapy. Etiology, prevention, and treatment. Dermatol Surg 1995; 21: 19-29.
    CrossrefPubMedSuche in Google Scholar
  • 30 Goldman MP. Treatment of varicose and telangiectatic leg veins: double-blind prospective comparative trial between aethoxyskerol and sotradecol. Dermatol Surg 2002; 28: 52-55.
    PubMedSuche in Google Scholar
  • 31 Hingorani AP, Ascher E, Markevich N. et al. Deep venous thrombosis after radiofrequency ablation of greater saphenous vein: A word of caution. J Vasc Surg 2004; 40: 500-504.
    CrossrefPubMedSuche in Google Scholar
  • 32 Hohenleutner U, Walther T, Wenig M. et al. Leg telangiectasia treatment with a 1.5 ms pulsed dye laser, ice cube cooling of the skin and 595 vs 600 nm: preliminary results. Lasers Surg Med 1998; 23: 72-78.
    CrossrefPubMedSuche in Google Scholar
  • 33 Kabnick LS, Caruso JA. Jacket-Tip Laser Fiber vs. Bare-Tip Laser Fiber for Endothermal Venous Ablation of the Great Saphenous Vein: Are the Results the Same?. Presented at the 16th Annual Controversies and Updates in Vascular Surgery. Paris, France: January 18–19 2008
    Suche in Google Scholar
  • 34 Kabnick LS. Outcome of different endovenous laser wavelengths for great saphenous vein ablation. J Vasc Surg 2006; 43: 88-93.
    CrossrefPubMedSuche in Google Scholar
  • 35 Kolbel T, Hinchliffe RJ, Lindblad B. Catheter-directed foam sclerotherapy of axial saphenous reflux: early results. Phlebology 2007; 22: 219-222.
    CrossrefPubMedSuche in Google Scholar
  • 36 Kostas TT, Ioannou CV, Veligrantakis M. et al. The appropriate length of great saphenous vein stripping should be based on the extent of reflux and not on the intent to avoid saphenous nerve injury. J Vasc Surg 2007; 46: 1234-1241.
    CrossrefPubMedSuche in Google Scholar
  • 37 Lumsden AB, Peden EK. Clinical use of the new ClosureFAST™ radiofrequency catheter: Segmental ablation technique facilitates quick and simple procedures. Endovascular Today. 2007 Supplement.
    PubMedSuche in Google Scholar
  • 38 Lupton J, Alster T, Romero P. Clinical comparison of sclerotherapy versus long-pulsed Nd:YAG laser treatment for lower extremity telangiectasias. Dermatol Surg 2002; 28: 694-697.
    PubMedSuche in Google Scholar
  • 39 Mackey EG, Almeida JI, Raines JK. Saphenous vein ablation: Do different laser wavelengths translate into different patient experiences?. Endovascular Today 2006; 45-48.
    Suche in Google Scholar
  • 40 McMeekin TO. Treatment of spider veins of the leg using a long-pulsed Nd:YAG laser (Versa-Pulse) at 532 nm. J Cutan Laser Ther 1999; 1: 179.
    CrossrefPubMedSuche in Google Scholar
  • 41 Min RJ, Khilnani N, Zimmet SE. Endovenous laser treatment of saphenous vein reflux: Longterm results. J Vasc Interv Radiol 2003; 14: 991-996.
    CrossrefPubMedSuche in Google Scholar
  • 42 Min RJ, Navarro L. Transcatheter duplex ultrasound-guided sclerotherapy for treatment of greater saphenous vein reflux: Preliminary report. Dermatol Surg 2000; 26: 10-14.
    Suche in Google Scholar
  • 43 Min RJ, Zimmet SE, Isaacs MN, Forrestal MD. Endovenous Laser Treatment of the Incompetent Greater Saphenous Vein. J Vasc Interv Radiol 2001; 12: 1167-1171.
    CrossrefPubMedSuche in Google Scholar
  • 44 Monfreux A. Traitement sclerosant des troncs saphenies et leurs collaterals de gros caliber par la method. MUS Phlebologie 1997; 50: 351-353.
    Suche in Google Scholar
  • 45 Munavalli GS, Weiss RA. Complications of sclerotherapy. Semin Cutan Med Surg 2007; 26: 22-28.
    CrossrefPubMedSuche in Google Scholar
  • 46 Navarro S. Endolaser – a three year follow-up report: Implication on crossectomy and ligation and stripping. Presented at the 16th Annual Congress American College of Phlebology. Fort Lauderdale, FL: Nov 2002
    Suche in Google Scholar
  • 47 Perrin M. Endovenous treatment of lower-limb varices by laser and radiofrequency. Phlebolymphology 2005; 48: 337-346.
    Suche in Google Scholar
  • 48 Proebstle TM, Lehr HA, Kargl A. et al. Endovenous treatment of the greater saphenous vein with a 940 nm diode laser: thrombotic occlusion after endoluminal thermal damage by laser generated steam bubbles. J Vasc Surg 2002; 35: 729-736.
    CrossrefPubMedSuche in Google Scholar
  • 49 Proebstle TM, Moehler T, Gul D, Herdemann S. Endovenous treatment of the great saphenous vein using a 1320-nm Nd:YAG laser causes fewer side effects than using a 940-nm diode laser. Dermatol Surg 2005; 31: 1678-1684.
    PubMedSuche in Google Scholar
  • 50 Proebstle TM, Sandhofer M, Kargl A. et al. Thermal damage of the inner vein wall during endovenous treatment: key role of energy absorption by intravascular blood. Dermatol Surg 2002; 28: 596-600.
    PubMedSuche in Google Scholar
  • 51 Proebstle TM, Vago B, Alm J. et al. Treatment of the incompetent great saphenous vein by endovenous radiofrequency powered segmental thermal ablation: First clinical experience. J Vasc Surg 2008; 47: 151-156.
    CrossrefPubMedSuche in Google Scholar
  • 52 Proebstle TM. Comparison of endovenous ablation techniques: New technologies and techniques allow more choice in endovenous ablation. Endovascular Today. 2007 Supplement.
    PubMedSuche in Google Scholar
  • 53 Proebstle TM. PowerPoint Presentation: Endovenous laser: comparison of different lasers. http://bibamed.agcl.com/cx_2006/Sat1340Proebstle.pdf [accessed 18 April 2008].
  • 54 Rautio T, Ohinmaa A, Pera J. et al. Endovenous obliteration versus conventional stripping operation in the treatment of primary varicose veins: A randomized controlled trial with comparison of costs. J Vasc Surg 2002; 35: 958-965.
    CrossrefPubMedSuche in Google Scholar
  • 55 Reichert D. Evaluation of the long-pulse dye laser for the treatment of telangiectasias. Dermatol Surg 1998; 24: 737.
    PubMedSuche in Google Scholar
  • 56 Sadick N, Sorhaindo L. Laser Treatment of Telangiectasias and Reticular Veins. In: Bergan J. (ed). The Vein Book. Boston: Elsevier; 2007
    Suche in Google Scholar
  • 57 Sadick NS, Weiss RA, Goldman MP. Advances in laser surgery for leg veins: Bimodal wavelength approach to lower extremity vessels, new cooling techniques, and longer pulse durations. Dermatol Surg 2002; 28: 16-20.
    PubMedSuche in Google Scholar
  • 58 Sadick NS. Laser Treatment of Leg Veins. Skin Therapy Letter 2004; 9.
    PubMedSuche in Google Scholar
  • 59 Sadick NS. Sclerotherapy of varicose and telangiectatic leg veins: minimal sclerosant concentration of hypertonic saline and its relationship to vessel diameter. J Dermatol Surg Oncol 1991; 18: 47-52.
    Suche in Google Scholar
  • 60 Schroeter CA, Wilder D, Reineke T. et al. Clinical significance of an intense, pulsed light source on leg telangiectasias of up to 1 mm diameter. Eur J Dermatol 1997; 7: 38.
    Suche in Google Scholar
  • 61 Tessari L, Cavezzi A, Frullini A. Preliminary experience with a new sclerosing foam in the treatment of varicose veins. Dermatol Surg 2001; 27: 58-60.
    PubMedSuche in Google Scholar
  • 62 Tessari L. Nouvelle technique d’obtention de la sclero-mousse. Phlébologie 2000; 53: 129.
    Suche in Google Scholar
  • 63 Thibault P. Sclerotherapy and Ultrasound-Guided Sclerotherapy. In: Bergan J. (ed). The Vein Book. Boston: Elsevier; 2007
    Suche in Google Scholar
  • 64 Timperman PE, Sichlau M, Ryu RK. Greater energy delivery improves treatment success of endovenous laser treatment of incompetent saphenous veins. J Vasc Interv Radiol 2004; 15: 1061-1063.
    CrossrefPubMedSuche in Google Scholar
  • 65 Vascular Solutions Inc.. VariLase Bright Tip Fiber brochure. Minneapolis: Vascular Solutions; 2007
    Suche in Google Scholar
  • 66 VNUS® Medical Technologies Inc.. VNUS® ClosureFAST™ catheter instructions for use. San Jose: VNUS Medical Technologies Inc.; 2007
    Suche in Google Scholar
  • 67 VNUS® Medical Technologies Inc.. VNUS® ClosureFAST™ Radiofrequency brochure. San Jose: VNUS Medical Technologies Inc.; 2006
    Suche in Google Scholar
  • 68 Weiss RA, Feied CF, Weiss MA. Vein Diagnosis and Treatment: A Comprehensive Approach. New York: McGraw-Hill; 2001: 211-221.
    Suche in Google Scholar
  • 69 Weiss RA, Weiss MA. Sclerotherapy Treatment of Telangiectasias. In: Bergan J. (ed). The Vein Book. Boston: Elsevier; 2007
    Suche in Google Scholar
  • 70 Zimmet SE. Sclerotherapy treatment of telangiectasias and varicose veins. Techniques in Vascular and Interventional Radiology 2003; 6: 116-120.
    CrossrefPubMedSuche in Google Scholar