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Phlebologie 2010; 39(04): 193-200
DOI: 10.1055/s-0037-1622312
Review
Schattauer GmbH

Aktuelle Aspekte der Schaumverödungstherapie

Foam sclerotherapy – An update
S. Kobus
1   Venenzentrum der dermatologischen und gefäßchirurgischen Kliniken, Ruhr-Universität Bochum
,
S. Reich-Schupke
1   Venenzentrum der dermatologischen und gefäßchirurgischen Kliniken, Ruhr-Universität Bochum
,
P. Altmeyer
1   Venenzentrum der dermatologischen und gefäßchirurgischen Kliniken, Ruhr-Universität Bochum
,
M. Stücker
1   Venenzentrum der dermatologischen und gefäßchirurgischen Kliniken, Ruhr-Universität Bochum
› Author Affiliations
Further Information

Publication History

Received: 31 March 2010

accepted: 07 June 2010

Publication Date:
05 January 2018 (online)

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Summary

Foam sclerotherapy is an efficient and safe technique for the treatment of chronic venous insufficiency. In Germany, the multiplicity of sclerosing agents of past decades has reduced to the agent Aethoxysklerol® (active ingredient: polidocanol). It has been shown that sclerosants are more efficient when administered as foam rather than in liquid form. Only for spider veins are liquid sclerosants equally, or more effective than their foam counterparts. Various techniques can be used to mix the sclerosant with a gas (generally normal room air, alternative: CO2) to produce a foam. The foam's advantage over the liquid form is that it completely displaces the blood from the venous segment to be treated and thereby considerably prolongs the contact time with the vein wall. The various sclerosants lead to marked damage of the vascular endothelium and possibly, the entire venous wall. If sclerotherapy is successful, the vein is ultimately converted into a thread of connective tissue. A sufficient volume of foam is crucial to the success of sclerotherapy of trunk varices, in order to ensure adequate filling of the vessel lumen. Foam sclerotherapy reaches its limit with varicosities of more than 8 mm in diameter, because the rate of thrombosis rises sharply with foam volumes above 10 ml. Foam sclerotherapy may also be used to treat angiodysplasias, vulvar, pudendal and periulcerous varicosities and is quite often the only therapeutic option. The main complications of sclerotherapy are pain in the region of sclerothrombi, haematoma, phlebitis, induration, pigmentation and a metallic taste. Other acute complications are vasovagal reactions, paraesthesias and nausea. Anaphylactic reactions, intra-arterial injections with the possible sequelae, migraine attacks with visual disturbances (scintillating scotoma) and transient neurological deficits have indeed been reported in individual cases, but are very rare.

Consideration of the current literature shows that foam sclerotherapy is a safe and quite simple technique for all forms of varicosis. Based on the data now available, it can be stated that foam sclerotherapy is far more effective than liquid sclerotherapy.

Zusammenfassung

Die Schaumsklerosierung stellt ein effizientes und sicheres Verfahren zur Behandlung der Varikose dar. Während bei der Besenreisersklerosierung die Verödung mit flüssigen Sklerosierungsmitteln der Verödung mit Schaum gleichwertig oder überlegen ist, hat die Schaumsklerosierung sich bei den subkutanen Varizen als effektiver erwiesen. Entscheidend für den Erfolg der Sklerosierung bei Stammvarizen ist ein ausreichendes Schaum-Volumen, um die Varize ausreichend gleichmäßig füllen zu können. Da ab einem Schaumvolumen von über 10 ml die Thromboserate stark ansteigt, stößt die Schaumsklerosierung bei Stammvarizen ab einem Durchmesser von 8 mm an ihre Grenzen. Bei Angiodysplasien, vulvären und pudendalen Varizen sowie bei periulzerösen Varizen ist die Schaumsklerosierung oft die einzige Therapiemöglichkeit. Unter Berücksichtigung der aktuellen Literatur ist die Schaumsklerotherapie eine sichere und einfach anzuwendende Therapie für alle Formen der Varikose, welche bessere Verschlussraten aufweist, als die Sklerosierung in flüssiger Form.

Keywords

Sclerotherapy - foam - varicosis

Schlüsselwörter

Schaumverödungstherapie - Schaum - Varikosis
 

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