Kompressionstherapie nach invasiven Maßnahmen in der Phlebologie

Zusammenfassung

Die Versorgung eines Patienten mit Kompressionsverbänden nach invasiver Therapie gehört in der Phlebologie zu den Standardprozeduren. In der aktuellen Leitlinie zur Therapie der Varikose wird die Kompression als Routinemaßnahme nach Varizenoperation empfohlen. Auch in der aktuellen Leitlinie zur Sklerotherapie wird die Kompressionstherapie nach Verödung von Besenreiservarizen zur Verbesserung der Ergebnisse empfohlen.

Die diesen Empfehlungen zugrunde liegende Literatur besteht nur aus wenigen Stellen. Da-her wurde für die vorliegende Arbeit eine sys-temische Literaturrecherche in Medline und Pubmedcentral sowie in deutschsprachigen gefäßmedizinischen Journalen durchgeführt. Die Kompressionstherapie nach Varizenope-ration ist in der Lage postoperative Hämato-me und die Inzidenz einer Thrombophlebitis zu mindern, die Kompressionstherapie kann den postoperativen Schmerz verringern und sie reduziert das Beinvolumen postoperativ.

Aus der Literatur geht nicht hervor, wie die op-timale Dauer der postoperativen Kompression ist. Nach endovenöser Therapie gibt es nur eine prospektiv randomisierte Studie nach endovenöser Lasertherapie die zeigen konnte, dass eine exzentrische Kompression den postoperativen Schmerz signifikant mindern kann. Zur Sklerotherapie von Besenreisern und retikulären Varizen liegen mehrere Studien vor, die zei-gen konnten, dass signifikant bessere Resultate erzielt werden können, wenn Kompressionstrümpfe nach Sklerotherapie getragen werden. Es finden sich ebenso deutlich geringere Pig-mentierungen und Hämatome. Die ideale Dauer der Kompression nach Sklerotherapie von Besenreisern und retikulären Varizen liegt wohl bei drei Wochen.

Summary

The application of compression bandages after a patient has undergone invasive treatment is one of the standard procedures in phlebology. In the current guidelines on the treatment of varicose veins, compression is recommended as a routine measure following varicose vein surgery. The present guidelines on sclerotherapy also recommend compression treatment after sclerosis of spider veins in order to improve the results.

The literature on which these recommendations are based consists of only a few references. For this reason, a systematic search in Medline and PubMed Central as well as in German language journals on vascular medicine was carried out for this article. Compression treatment after varicose vein surgery can reduce postoperative haematoma and the incidence of thrombophlebitis. It can also reduce post-operative pain and leg volume. However, the optimum duration of postoperative compression is not clear from the literature. Following endovenous therapy, there is only one prospective, randomised study after endovenous laser treatment which was able to show that excentric compression can significantly reduce postoperative pain. Several studies on the sclerotherapy of spider veins and reticular varices have demonstrated that significantly better results can be achieved if compression stockings are worn after sclero-therapy. There is also considerably less pigmentation and haematoma. The ideal duration of compression after sclerotherapy of spider veins and reticular varices is probably three weeks.

Schlüsselwörter

Kompressionstherapie - Kompressionsstrümpfe - invasive Varizentherapie - Varizenoperati-on - Sklerotherapie - endovenöse Therapieverfahren

Keywords

compression therapy - compressions stockings - invasive treatment - varicose vein operation - sclerotherapy - endovenous obliteration

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