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Phlebologie 2016; 45(04): 201-206
DOI: 10.12687/phleb2317-4-2016
Systematic Review
Schattauer GmbH

Aktuelle klinische Evidenz zur endovenösen Laserablation (EVLA) aus randomisierten Studien

Article in several languages: English | deutsch
K. Rass
1   Vein and Skin Center, Eifelklinik St. Brigida, Simmerath/Germany
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Publication History

Received: 20 June 2016

Accepted: 21 June 2016

Publication Date:
21 December 2017 (online)

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Zusammenfassung

Hintergrund Die Entwicklung der endovenöse Laserablation (EVLA) insuffizienter Stammvenen hat sich bisher in drei Schritten vollzogen: EVLA #1 (810-980 nm), EVLA #2 (1064-1500 nm) und EVLA #3– optimierte Laseremission (Radialfaser, Tulip, Jacket-Tip). Angesichts der Vielzahl der Verfahren stellt sich die Frage nach dem Stellenwert im Vergleich zu Crossektomie und Stripping (C/S) und anderen endovenösen Therapien.

Methoden PubMed Recherche zum Vergleich von EVLA mit C/S, Radiofrequenzablation (RFA), Schaumsklerotherapie, Dampfablation in randomisierten Studien (RCT).

Ergebnisse Es wurden 24 RCTs identifiziert: n=15 beinhalten Vergleiche mit C/S, n=9 mit anderen Verfahren. Langzeit-Studien (n=6) weisen auf eine Überlegenheit von C/S bzgl. klinischer und duplexsonographischer Rezidive hin. 15 Studien berichten über kurzfristige Ergebnisse, die eine Unterlegenheit der EVLA #1 gegenüber EVLA #2, EVLA #3 und RFA belegen.

Schlussfolgerungen Laser der 1. Generation sind bzgl. Nebenwirkungen und Langzeitwirksamkeit anderen Therapieverfahren unterlegen. Angesichts der jüngsten Publikationen sollte C/S weiterhin als Kontrollarm in RCTs, die die Wertigkeit der EVLA untersuchen, fungieren.

Schlüsselwörter

Endovenöse Laserablation - Evidenz - randomisierte kontrollierte Studien
 

  • References

  • 1 Almeida JI, Kaufman J, Göckeritz O, Chopra P, Evans MT, Hoheim DF, Makhoul RG, Richards T, Wenzel C, Raines JK. Radiofrequency endovenous ClosureFAST versus laser ablation for the treatment of great saphenous reflux: a multicenter, single-blinded, randomized study (RECOVERY study). J Vasc Interv Radiol 2009; 20 (06) 752-759.
    CrossrefPubMedGoogle Scholar
  • 2 Brittenden J, Cotton SC, Elders A, Ramsay CR, Norrie J, Burr J, Campbell B, Bachoo P, Chetter I, Gough M, Earnshaw J, Lees T, Scott J, Baker SA, Francis J, Tassie E, Scotland G, Wileman S, Campbell MK. A randomized trial comparing treatments for varicose veins. N Engl J Med 2014; 371 (13) 1218-1227.
    CrossrefPubMedGoogle Scholar
  • 3 Carradice D, Mekako AI, Mazari FA, Samuel N, Hatfield J, Chetter IC. Clinical and technical outcomes from a randomized clinical trial of endovenous laser ablation compared with conventional surgery for great saphenous varicose veins. Br J Surg 2011; 98 (08) 1117-1123.
    CrossrefPubMedGoogle Scholar
  • 4 Christenson JT, Gueddi S, Gemayel G, Bounameaux H. Prospective randomized trial comparing endovenous laser ablation and surgery for treatment of primary great saphenous varicose veins with a 2-year follow-up. J Vasc Surg 2010; 52: 1234-1241.
    CrossrefPubMedGoogle Scholar
  • 5 Darwood RJ, Theivacumar N, Dellagrammaticas D, Mavor AI, Gough MJ. Randomized clinical trial comparing endovenous laser ablation with surgery for the treatment of primary great saphenous varicose veins. Br J Surg 2008; 95: 294-301.
    CrossrefPubMedGoogle Scholar
  • 6 De Maeseneer MG, Vandenbroeck CP, Hendriks JM, Lauwers PR, van Schil PE. Accuracy of duplex evaluation one year after varicose vein surgery to predict recurrence at the sapheno-femoral junction after five years. Eur J Vasc Endovasc Surg 2005; 29: 308-312.
    CrossrefPubMedGoogle Scholar
  • 7 De Maeseneer MG, Pichot O, Cavezzi A, Earnshaw J, van Rij A, Lurie F, Smith PC. Duplex ultrasound investigation of the veins of the lower limbs after treatment for varicose veins – UIP consensus document. Eur J Vasc Endovasc Surg 2011; 42: 89-102.
    CrossrefPubMedGoogle Scholar
  • 8 Disselhoff BC, der Kinderen DJ, Kelder JC, Moll FL. Five-year results of a randomized clinical trial comparing endovenous laser ablation with cryostripping for great saphenous varicose veins. Br J Surg 2011; 98 (08) 1107-1111.
    CrossrefPubMedGoogle Scholar
  • 9 Disselhoff BC, der Kinderen DJ, Kelder JC, Moll FL. Five-year results of a randomised clinical trial of endovenous laser ablation of the great saphenous vein with and without ligation of the saphenofemoral junction. Eur J Vasc Endovasc Surg 2011; 41 (05) 685-690.
    CrossrefPubMedGoogle Scholar
  • 10 Doganci S, Demirkilic U. Comparison of 980 nm laser and bare-tip fibre with 1470 nm laser and radial fibre in the treatment of great saphenous vein varicosities: a prospective randomised clinical trial. Eur J Vasc Endovasc Surg 2010; 40 (02) 254-259.
    CrossrefPubMedGoogle Scholar
  • 11 Eberhardt RT, Reffetto JD. Chronic venous insufficiency. Circulation 2005; 111: 2398-2409.
    CrossrefPubMedGoogle Scholar
  • 12 Evans CJ, Fowkes FGR, Ruckley CV. et al. Prevalence of varicose veins and chronic venous insufficiency in men and women in the general population: Edinburgh Vein Study. J Epidemiol Community Health 1999; 53: 149-153.
    CrossrefPubMedGoogle Scholar
  • 13 Flessenkämper I, Hartmann M, Hartmann K, Stenger D, Roll S. Endovenous laser ablation with and without high ligation compared to high ligation and stripping for treatment of great saphenous varicose veins: Results of a multicentre randomised controlled trial with up to 6 years follow-up. Phlebology 2016; 31 (01) 23-33.
    CrossrefPubMedGoogle Scholar
  • 14 Gauw SA, Lawson JA, van Vlijmen-van Keulen CJ, Pronk P, Gaastra MT, Mooij MC. Five-year followup of a randomized, controlled trial comparing saphenofemoral ligation and stripping of the great saphenous vein with endovenous laser ablation (980 nm) using local tumescent anesthesia. J Vasc Surg 2016; 63 (02) 420-428.
    CrossrefPubMedGoogle Scholar
  • 15 Gloviczki P, Comerota AJ, Dalsing MC. et al. The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg 2011; 53 (Suppl. 05) 2S-48S.
    CrossrefPubMedGoogle Scholar
  • 16 Goode SD, Chowdhury A, Crockett M, Beech A, Simpson R, Richards T, Braithwaite BD. Laser and radiofrequency ablation study (LARA study): A randomized study comparing radiofrequency ablation an endovenous laser ablation (810 nm). Eur J Vasc Endovasc Surg 2010; 40: 246-253.
    CrossrefPubMedGoogle Scholar
  • 17 Lattimer CR, Kalodiki E, Azzam M, Makris GC, Somiayajulu S, Geroulakos G. Interim results on abolishing reflux alongside a randomized clinical trial on laser ablation with phlebectomies versus foam sclerotherapy. Int Angiol 2013; 32 (04) 394-403.
    Google Scholar
  • 18 Lin Y, Ye CS, Huang XL, Ye JL, Yin HH, Wang SM. A random, comparative study on endovenous laser therapy and saphenous veins stripping fort he treatment of great saphenous vein incompetence. Zhongua Yi Xue Za Zhi 2007; 87 (43) 3043-3046.
    Google Scholar
  • 19 Mozafar M, Atqiaee K, Haghighatkhah H, Taheri MS, Tabatabaey A, Lotfollahzadeh S. Endovenous laser ablation of the great saphenous vein versus high ligation: long-term results. Lasers Med Sci 2014; 29 (02) 765-771.
    CrossrefPubMedGoogle Scholar
  • 20 Nandhra S, El-sheikha J, Carradice D, Wallace T, Souroullas P, Samuel N, Smith G, Chetter IC. A randomized clinical trial of endovenous laser ablation versus conventional surgery for small saphenous varicose veins. J Vasc Surg 2015; 61 (03) 741-746.
    CrossrefPubMedGoogle Scholar
  • 21 Nesbitt C, Bedenis R, Bhattacharya V. et al. Endovenous ablation (radiofrequency and laser) and foam sclerotherapy versus conventional surgery for great saphenous vein varices. Cochrane Database Syst Rev 2014; 07: CD005624.
    Google Scholar
  • 22 Nordon IM, Hinchliffe RJ, Brar R, Moxey P, Black SA, Thompson MM, Loftus IM. A prospective double-blind randomized controlled trial of radiofrequency versus laser treatment of the great saphenous vein in patients with varicose veins. Ann Surg 2011; 254 (06) 876-881.
    CrossrefPubMedGoogle Scholar
  • 23 Pröbstle TM, Sandhofer M, Kargl A. et al. Thermal damage of the inner vein wall during endovenous laser treatment: key role of energy absorption by intravascular blood. Dermatol Surg 2002; 28: 596-600.
    PubMedGoogle Scholar
  • 24 Rabe E, Pannier-Fischer F, Bromen K. et al. Bonn Vein Study by the German Society of Phlebology. Epidemiological study to investigate the prevalence and severity of chronic venous disorders in the urban and rural residential populations. Phlebologie 2003; 32: 1-14.
    Article in Thieme ConnectGoogle Scholar
  • 25 Rasmussen LH, Lawaetz M, Bjoern L, Vennits B, Blemings A, Eklof B. Randomized clinical trial comparing endovenous laser ablation, radiofrequency ablation, foam sclerotherapy and surgical stripping for great saphenous varicose veins. Br J Surg 2011; 98 (08) 1079-1087.
    CrossrefPubMedGoogle Scholar
  • 26 Rasmussen L, Lawaetz M, Bjoern L, Blemings A, Eklof B. Randomized clinical trial comparing endovenous laser ablation and stripping of the great saphenous vein with clinical and duplex outcome after 5 years. J Vasc Surg 2013; 58 (02) 421-426.
    CrossrefPubMedGoogle Scholar
  • 27 Rass K, Frings N, Glowacki P, Gräber S, Tilgen W, Vogt T. Same site recurrence is more frequent after endovenous laser ablation compared with high ligation and stripping of the great saphenous vein – 5-year results of a randomized clinical trial (RELACS study). Eur J Vasc Endovasc Surg 2015; 50: 648-656.
    CrossrefPubMedGoogle Scholar
  • 28 Shepherd AC, Gohel MS, Brown LC, Metcalfe MJ, Hamish M, Davies AH. Randomized clinical trial of VNUS® ClosureFast™ radiofrequency ablation versus laser for varicose veins. Br J Surg 2010; 97: 810-818.
    CrossrefPubMedGoogle Scholar
  • 29 Spreafico G, Piccioli A, Bernardi E, Giraldi E, Pavei P, Borgoni R, Nosadini A, Baccaglini U. Endovenous laser ablation of great and small saphenous vein incompetence with a 1470-nm laser and radial fiber. J Vasc Surg Venous Lymphat Disord 2014; 02 (04) 403-410.
    Google Scholar
  • 30 Theivacumar NS, Darwood R, Gough MJ. Neovascularisation and recurrence 2 years after varicose vein treatment for sapheno-femoral and great saphenous vein reflux: a comparison of surgery and endovenous laser ablation. Eur J Vasc Endovasc Surg 2009; 38: 203-237.
    CrossrefPubMedGoogle Scholar
  • 31 Van den Bos RR, Malskat WS, De Maeseneer MG, de Roos KP, Groeneweg DA, Kockaert MA, Neumann HA, Nijsten T. Randomized clinical trial of endovenous laser ablation versus steam ablation (LAST trial) for great saphenous varicose veins. Br J Surg 2014; 101 (09) 1077-1083.
    CrossrefPubMedGoogle Scholar
  • 32 Van der Velden SK, Biemans AA, De Maeseneer MG, Kockaert MA, Cuypers PW, Hollestein LM, Neumann HA, Nijsten T, van den Bos RR. Fiveyear results of a randomized clinical trial of conventional surgery, endovenous laser ablation and ultrasound-guided foam sclerotherapy in patients with great saphenous varicose veins. Br J Surg 2015; 102 (10) 1184-1194.
    CrossrefPubMedGoogle Scholar
  • 33 Van der Velden SK, Pichot O, van den Bos RR. et al. Management strategies for patients with varicose veins (C2-C6): Results of a worldwide survey. Eur J Vasc Endovasc Surg 2015; 49: 213-20.
    CrossrefPubMedGoogle Scholar
  • 34 Van der Velden SK, Lawaetz M, De Maeseneer MGR. et al. on behalf of the Members of the Predictors of Endovenous Thermal Ablation Group. Predictors for recanalization of the great saphenous vein in randomized controlled trials one year after endovenous thermal ablation. Eur J Vasc Endovasc Surg. 2016 Mar 16. doi: 10.1016/j.ejvs.2016.01.021. [Epub ahead of print].
    PubMedGoogle Scholar
  • 35 Vuylsteke M, De Bo TH, Dompe G. et al. Endovenous laser treatment: is there a clinical difference between using a 1500 nm and a 980 nm diode laser? A multicenter randomised clinical trial. Int Angiol 2011; Aug; 30 (04) 327-334.
    Google Scholar
  • 36 Vuylsteke ME, Thomis S, Mahieu P, Mordon S, Fourneau I. Endovenous laser ablation of the great saphenous vein using a bare fibre versus a tulip fibre: a randomised clinical trial. Eur J Vasc Endovasc Surg 2012; 44 (06) 587-592.
    CrossrefPubMedGoogle Scholar
  • 37 Weiss RA. Comparison of endovenous radiofrequency versus 810 nm diode laser occlusion of large veins in an animal model. Dermatol Surg 2002; 28: 56-61.
    PubMedGoogle Scholar
  • 38 Wittens C, Davies AH, Bækgaard N. et al. Editor’s Choice - Management of Chronic Venous Disease: Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2015; 49: 678-737.
    CrossrefPubMedGoogle Scholar