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Phlebologie 2020; 49(03): 144-151
DOI: 10.1055/a-1155-3072
Schwerpunktthema Crossenrezidive

Beeinflusst das Nahtmaterial die Rezidivrate nach Krossektomie?

Does suture material influence recurrence rate after crossectomy?
Erika Mendoza
  Venenpraxis Wunstorf
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Widmung

Ich möchte diese Publikation meinem ersten Ehemann, dem Herz- und Gefäßchirurgen Dr. Hans-Arrien Berger († 2000), widmen, der mir die Liebe zu den Venen geschenkt hat.

Zusammenfassung

Einleitung Im Rahmen der Literaturrecherche für die Leitlinie Diagnostik und Therapie der Varikose der Deutschen Gesellschaft für Phlebologie fiel die weite Streuung der Krossenrezidive zwischen den verschiedenen Studien auf. Auf der Suche nach Antworten wurden die Studien nach dem Nahtmaterial analysiert, das zum Verschluss der V. femoralis communis und des Venensterns verwendet wurde, um herauszufinden, ob die Art des Materials (resorbierbar, nicht resorbierbar) eine Rolle spielen könnte.

Methode Auswertung der Literaturrecherche der DGP für die Leitlinie sowie weitere Pubmed-Recherche mit dem Stichwort Neovaskulogenese und Rezidive nach Krossektomie. Erfasst wurden die chirurgische Technik (Krossektomie allein, mit Stripping oder mit endoluminalen Verfahren sowie Krossenligatur ohne Unterbrechung des Venensterns), das Nahtmaterial, die Dauer des Follow-ups sowie die Art der Studie (prospektiv, retrospektiv, randomisiert oder nicht). Die Anzahl der Rezidive mit Neovaskulogenese bei belassenem Stumpf wurden nicht gewertet. Studienarme mit speziellen Barrieretechniken am Foramen ovale wurden ausgeschlossen. Wurde das verwendete Nahtmaterial nicht in der Publikation erwähnt, wurde mit dem Autor respektive dem Chirurgen Kontakt aufgenommen, um diese Frage zu klären.

Ergebnis 24 Studien wurden gefunden, von denen 31 Therapiearme auf die Studienkriterien passten. Weniger als die Hälfte der Studien hatten das Nahtmaterial erwähnt, aber alle Autoren antworteten prompt und wussten das Nahtmaterial genau, weil sie immer dasselbe verwenden. Die Rezidivraten bei nichtresorbierbaren Nahtmaterialien lagen zwischen 1,1 % und 12,3 %, bei resorbierbaren Nahtmaterialien zwischen 10 und 65 %.

Zusammenfassung Auch wenn es sich nicht um ein systematisches Review handeln kann, weil nur 1 der Studien tatsächlich verschiedene Nahtmaterialien verglich, sind die Ergebnisse überraschend deutlich. In Deutschland ist die Chirurgie der am häufigsten verwendete Eingriff bei der Therapie der Varikose. Eine prospektiv randomisierte Studie zur Klärung dieser Frage wäre daher sinnvoll.

Abstract

Introduction In the process of literature search for diagnostic and therapeutic guidelines for varicose veins of the German Phlebology Society (DGP) the author noticed the wide variation of saphenofemoral (SF) recurrence among various studies. In search of answers, studies that were based on suture material used for closure of the sapheno-femoral junction and the tributaries of the junction were analysed in order to determine if the type of suture material utilised (absorbable/ non absorbable) plays a role in the recurrence rate.

Methods Evaluation of the literature search of DGP for guidelines as well as furthern PubMed research with the key words neovasculogenesis and recurrence after crossectomy. Data was analyzed for the following items: surgical technique (high ligation alone, with stripping or with endoluminal procedures, as well as high ligation of the SF junction without disruption of the tributaries), suture material, duration of follow-up, type of study (prospective, retrospective, randomised or not). Recurrencies with left stump were not included in the survey. Study arms analyizing results after high ligation and special barrier techniques for closure of the foramen ovale were excluded, For included studies in which the suture material was not mentioned, the authors were contacted to determine the same.

Result 24 studies were found, of which 31 therapy arms suited the study criteria. Less than half of the studies mentioned the suture material used, but all authors replied promptly and, on account of constant usage, knew the suture material exactly. The recurrence rate with nonabsorbable sutures was between 1.1 % and 12.3 %, with absorbable sutures between 10 % and 65 %.

Summary Even if this cannot be considered a systematic review, because only one of the studies actually compared different suture materials, the results are surprisingly clear. In Germany, surgery is the most common therapeutic modality for varicosis. Thus, a prospective randomised study for clarification of the question posed would be expedient.

Schlüsselwörter

Varikose - Rezidive - V. saphena magna - Neovaskulogenese - resorbierbares Nahtmaterial - Krossektomie - Venenchirurgie

Key words

varicosis - recurrence - great saphenous vein - neovasculogenesis - absorbable suture material - crossectomy - vein surgery


Publication History

Article published online:
13 May 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 

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