Die endovasale Lasertherapie varikös veränderter Stammvenen: Eine effektive und komplikationsarme Alternative zum Venenstripping?

Zusammenfassung

Die endovasale Lasertherapie (EVLT) ist eine neue, minimal-invasive Methode in der Therapie varikös veränderter Stammvenen und wird als wirksame und komplikationsarme Alternative zur Behandlung mittels chirurgischer Entfernung (Stripping) diskutiert. Die kurz- und mittelfristigen Erfolgsraten entsprechen sowohl hinsichtlich der Ausschaltung des venösen Refluxes (90 - 98 %) als auch hinsichtlich des Rückgangs sichtbarer Varizen (85 %) und subjektiver Beschwerden wie Schwere- und Spannungsgefühl (96 %) denen der chirurgischen Entfernung. Die Komplikationsrate ist mit ca. 1 - 3 % im Vergleich zur chirurgischen Therapie (bis 30 %) deutlich geringer. Die Häufigkeit einer Rezidivvarikose der behandelten Vene wird nach endovasaler Lasertherapie mittelfristig mit 7 - 9 % beschrieben und liegt somit niedriger als nach chirurgischen Eingriffen (10 - 20 %). In der vorliegenden Übersichtsarbeit möchten wir anhand der aktuellen Literatur und eigenen Erfahrungen eine Übersicht zu Indikation und Kontraindikation, zu Technik und Pathophysiologie des laserinduzierten Venenverschlusses sowie zu Ergebnissen und möglichen Komplikationen des Verfahrens geben.

Abstract

Endovenous laser therapy (EVLT) is a new, minimally invasive therapeutic option for treating primary varicose veins and provides an effective and safe alternative to conventional surgical management (stripping). Short-term and intermediate-term outcome is comparable to surgical stripping in terms of elimination of venous reflux (90 % - 98 %), resolution of visible varices (85 %), and improvement of subjective complaints such as sensations of heaviness and tension (96 %). Complications occur in 1 % - 3 % of cases, which is markedly below the rate of conventional surgical management (up to 30 %). The intermediate-term incidence of recurrent varicosis in a vein treated by EVLT depends on the laser fluence applied and is reported to range from 7 % - 9 % compared to 10 % - 20 % after surgical intervention. Based on a review of the current literature and our own experience, this survey article presents an overview of the indications and contraindications, the technique and pathophysiology of laser-induced venous occlusion, and the results and possible complications of EVLT.

Key words

Interventional radiology - vascular interventions - laser - varicosis - vein

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