Crossektomie und Stripping vs. endothermische Ablation der V. saphena magna: Was können wir aus aktuellen Langzeitanalysen lernen?

Zusammenfassung

Hintergrund: Die Therapie der Stammvarikose erfolgt weltweit mit unterschiedlicher Präferenz endovenös, überwiegend thermoablativ, oder offen-chirurgisch. Aktuell liegt jedoch eine Evidenz aus Langzeitstudien (Nachbeobachtungszeit ≥ 5 Jahre) vor, die eine erneute Betrachtung der Wertigkeit der Therapieverfahren notwendig macht. Methoden: Systematische Literaturrecherche zu Langzeitstudien, in denen endovenös thermische Ablationsverfahren mit Crossektomie und Stripping der V. saphena magna verglichen werden. Deskriptive Auswertung der Ergebnisse. Ergebnisse: Langzeitstudien liegen nahezu ausschließlich für den Vergleich mit endovenöser Laserablation und Lichtwellenleitern der 1. Generation (810–980 nm) vor. Während hinsichtlich der Krankheitsschwere und der postoperativen Lebensqualität keine Unterschiede zu beobachten sind, ist die Rate duplexsonographischer und klinischer Crossenrezidive nach Crossektomie signifikant geringer. Schlussfolgerungen: Valide Langzeitstudien zu den heute überwiegend verwendeten endothermischen Ablationstechniken im Vergleich zur offenen Operation fehlen, sind aber angesichts der Befunde aus Studien mit Lasern der 1. Generation dringend geboten.

Schlüsselwörter

Crossektomie/Stripping - Endothermische Ablation - randomisierte kontrollierte Studien - Rezidiv

• Literatur

• 1 Brittenden J, Cotton SC, Elders A, Tassie E, Scotland G, Ramsay CR, Norrie J, Burr J, Francis J, Wileman S, Campbell B, Bachoo P, Chetter I, Gough M, Earnshaw J, Lees T, Scott J, Baker SA, MacLennan G, Prior M, Bolsover D, Campbell MK. Clinical effectiveness and cost-effectiveness of foam sclerotherapy, endovenous laser ablation and surgery for varicose veins: results from the Comparison of LAser, Surgery and foam Sclero-therapy (CLASS) randomised controlled trial.. Health Technol Assess 2015; 19: 1-342.
• 2 Chang SL, Huang YL, Lee MC, Hu S, Hsiao YC, Chang SW, Chang CJ, Chen PC. Association of varicose veins with incident venous thromboembolism and peripheral artery disease.. JAMA 2018; 319: 807-817.
• 3 Cotton SC, MacLennan G, Brittenden J, Prior M, Francis J. Behavioural recovery after treatment for varicose veins.. Br J Surg 2016; 103: 374-381.
• 4 Darvall KA, Bate GR, Adam DJ, Bradbury AW. Generic health-related quality of life is significantly worse in varicose vein patients with lower limb symptoms independent of CEAP clinical grade.. Eur J Vasc Endovasc Surg 2012; 44: 341-344.
• 5 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.
• 6 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.
• 7 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.
• 8 Eberhardt RT, Reffetto JD. Chronic venous insufficiency.. Circulation 2005; 111: 2398-2409.
• 9 Gauw SA, Lawson JA, van Vlijmen-van Keulen CJ, Pronk P, Gaastra MT, Mooij MC. Five-year follow-up 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: 420-428.
• 10 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.
• 11 Hamann SAS, Giang J, De Maeseneer MGR, Nijsten TEC, van den Bos RR. Five year results of great saphenous vein treatment: A Meta-Analysis.. Eur J Vasc Endovasc Surg 2017; 54: 760-770.
• 12 Kheirelseid EAH, Crowe G, Sehgal R, Liakopoulos D, Bela H, Mulkern E, McDonnell C, O’Donohoe M. Systematic review and meta-analysis of randomized controlled trials evaluating long-term outcomes of endovenous management of lower extremity varicose veins.. J Vasc Surg Venous Lymphat Disord 2018; 6: 256-270.
• 13 Lawaetz M, Serup J, Lawaetz B, Lars B, Blemings A, Eklof B, Rasmussen L. Comparison of endovenous ablation techniques, foam sclerotherapy and surgical stripping for great saphenous varicose veins.. extended 5-year follow-up of a RCT. Int Angiol 2017; 36: 281-288.
• 14 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; 7: CD005624
• 15 NICE clinical guideline 168. Varicose veins in the legs – the diagnosis and management of varicose veins.. Issued: July 2013. http://guidance.nice.org.uk/CG168
• 16 Pan Y, Zhao J, Mei J, Shao M, Zhang J. Comparison of endovenous laser ablation and high ligation and stripping for varicose vein treatment: a meta-analysis.. Phlebology. 2014; 29: 109-119.
• 17 Perrin MR, Guex JJ, Ruckley CV, de Palma RG, Royle JP, Eklof B, Nicolini P, Jantet G. Recurrent varices after surgery (REVAS), a consensus document.. REVAS group. Cardiovasc Surg 2000; 8: 233-245.
• 18 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.
• 19 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.
• 20 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.
• 21 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.
• 22 Rass K. Current clinical evidence on endovenous laser ablation (EVLA) from randomised trials.. Phlebologie 2016; 45: 201-206.
• 23 Shepherd AC, Gohel MS, Lim CS, Hamish M, Davies AH. The treatment of varicose veins: an investigation of patient preferences and expectations.. Phlebology 2010; 25: 54-65.
• 24 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; 2 (04) 403-410.
• 25 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.
• 26 Vähäaho S, Halmesmäki K, Albäck A, Saarinen E, Venermo M. Five-year follow-up of a randomized clinical trial comparing open surgery, foam sclero-therapy and endovenous laser ablation for great saphenous varicose veins.. Br J Surg 2018; 105: 686-691.
• 27 Van der Velden SK, Biemans AA, De Maeseneer MG, Kockaert MA, Cuypers PW, Hollestein LM, Neumann HA, Nijsten T, van den Bos RR. Five-year 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: 1184-1194.
• 28 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: 213-220.
• 29 Van der Velden SK, Lawaetz M, De Maeseneer MGR, Hollestein LM, Nijsten TEC, van den Bos RR. 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; 52 (02) 234-241.
• 30 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.