Langzeitergebnisse und Analysen von Zusammenhängen 5 Jahre nach Varizenstripping

Zusammenfassung

Ziel: Überprüfung der Rezidivquote und -einteilung sowie Analyse weiterer Zusammenhänge.

Patienten, Methode: 5 Jahre postoperativ wurden bei 93 Patienten 131 operierte Krossen (inguinal: 117, popliteal: 14) klinisch sowie doppler- und duplexsonographisch nachuntersucht (Quote: 48 %). Die Befunde wurden in 4 Gruppen eingeteilt: 1) Krossenrezidive mit Indikation zur Rekrossektomie, 2) operationsbedürftige Befunde ohne Indikation zur Rekrossektomie, 3) Rezidivvarikosis ohne klinische Relevanz und 4) keine Rezidivvarikosis. Aktuelle Beschwerden, Nebendiagnosen und klinische Einteilungen wurden dokumentiert.

Ergebnisse: 8.5 % der Patienten wiesen inguinale, 28,6 % popliteale Rezidive auf (in Bezug auf die jeweils operierten Krossen. Gesamt: 10,7 %). 11,5 % der Patienten wurden Gruppe 2 zugeordnet, 77,8 % Gruppe 3 und 4. In den Analysen der Zusammenhänge fanden sich signifikante Unterschiede zwischen Beschwerdesymptomatik und Nachuntersuchungsbefund sowie BMI und Nachuntersuchungsbefund.

Schlussfolgerungen: Trotz korrekter Krossektomie finden sich operationsbedürftige Krossenrezidive. Adipöse Patienten entwickeln diese signifikant häufiger. Die Indikation zur operativen Sanierung einer Insuffizienz der Vena saphena parva (VSP) sollte aufgrund höherer Rezidivquoten eher zurückhaltend gestellt werden. Die gewählte Rezidiveinteilung erweist sich als sinnvoll.

Summary

Aim: Review of the rate and classification of recurrences, as well as the analysis of other correlations.

Patients, Methods: 5 years after surgery, 131 operated saphenous vein junctions (inguinal: 117, popliteal: 14) in 93 patients were re-examined clinically and with Doppler and duplex ultrasonography (ratio: 48 %). The results were classified into 4 groups: 1) Recurrence of junctional varicosity with a repeat operation indicated, 2) Surgery-requiring findings, but a repeat operation is not indicated, 3) Varicose vein recurrence of no clinical relevance and 4) No recurrence of varicose veins. Current symptoms, secondary diagnoses and clinical classifications were documented.

Results: 8.5 % of patients showed inguinal recurrences, 28.6 % popliteal recurrences (relating to the operated junction in each case. Total: 10.7 %). 11.5 % of patients were classified as Group 2, 77.8 % as Group 3 and 4. The analysis of correlations found significant differences between symptoms and follow-up findings as well as between BMI and follow-up findings.

Conclusions: Despite correct high ligation and division, surgery-requiring junctional recurrences can occur. These are significantly more frequent in obese patients. Due to higher recurrence rates, a rather cautious approach to surgical treatment of short saphenous vein (SSV) incompetence is indicated. The chosen classification of recurrences proved meaningful.

Schlüsselwörter

Rezidivquote - Rezidiveinteilung - Varizenchirurgie - Adipositas - Beschwerden

Keywords

Recurrence rate - recurrence classification - varicose vein surgery - obesity - symptoms

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