Phlebologie Phlebologie ph de-de Mon, 21 Aug 17 21:42:16 +0200 Betagte Patienten S. Reich-Schupke 27754 2017-07-24 17:42:28 Fragen zu "Diabetisches Fußsyndrom im Alter" 27753 2017-07-24 17:37:10 Diabetic foot syndrome in the elderly In elderly patients with diabetes mellitus and mild deterioration of the lower extremities, peripheral artery disease and diabetic peripheral neuropathy may contribute to the development of a diabetic foot syndrome. Early diagnosis and intervention can help to preserve the foot and thus significantly increase quality of life with diagnostic and therapeutic procedures being the same in elderly and in young patients. Non-invasive diagnosis is possible in most bed-ridden patients and should take into account reasonable therapeutic options against the background of overall morbidity, physical performance and quality of life, which should be discussed with the patient and his relatives. Multidisciplinary care structures facilitate treatment and might lead to reduced amputation rates and an improved well-being. S. Eckert (1) 27752 2017-07-24 16:52:59 Foam sclerotherapy in elderly patients B. Kahle (1), L. Friedrichsen (1), A. L. Recke (1) 27751 2017-07-24 16:15:17 Variceal surgery in the elderly: What should be observed? The need for invasive therapeutic measures in patients with varicose veins increases in an ageing population. Modern varicose vein surgery is particularly suitable for this age group, precisely because the stage of the disease is often advanced in geriatric patients. Gentle surgical techniques, such as invaginated stripping, cause the least possible operative trauma and are therefore especially suitable for the aged body. Less stressful anaesthetic techniques, such as tumescence, spinal anaesthesia or total intravenous anaesthesia with the use of a laryngeal tube, are likewise particularly well-suited for the treatment of geriatric patients with varicose veins. Special criteria regarding the ASA classification and anticoagulation must be applied when considering the perioperative risk in frequently multimorbid geriatric patients. Very few complications generally occur in patients at ASA stages 1 and 2 and under single anticoagulant therapy, and surgery is feasible even in elderly people. In the case of existing phenprocoumon treatment, bridging should be critically considered on a case-by-case basis. Perioperative prevention and management of hypothermia and special procedures to obtain postoperative convalescence should also be adapted to the particular needs of the elderly patient.... M. Dünnweber (1), A. Mumme (1) 27750 2017-07-24 16:05:10 Versorgung von Menschen mit chronischen Wunden im Pflegeheim Als Setting bietet das Pflegeheim für eine hochwertige Versorgung von Menschen mit chronischen Wunden im Grunde ein förderliches Umfeld. Betreuungsdichte, Voraussetzungen für hygienische Verbandswechsel und Ansatzpunkte für interprofessionelle Kommunikation und Zusammenarbeit bieten gute Voraussetzungen. Gleichzeitig ist das Setting Pflegeheim gekennzeichnet von besonderen Herausforderungen: Häufige Multimorbidität und vor allem Demenzerkrankungen unter den Bewohnern, aber auch fehlende spezielle Kompetenzen im Personal, vor allem aber häufig fehlende Konzepte in den Einrichtungen sind Gründe, warum bei Pflegevisiten oft Fehl- oder Unterversorgungen zu beobachten sind. Die im Alltag zu beobachtenden Strategien unter diesen Rahmenbedingungen bleiben meist Einzelaktionen. Hierzu zählt u.a. das Hinzuziehen von Homecare-Anbietern als Berater, die sich aber durch den Verkauf von Pflegeprodukten finanzieren müssen, und somit eher zur Fokussierung auf Materialien, insbesondere Verbandsmittel, beitragen als die Versorgungsstrukturen und -prozesse insgesamt zu betrachten. Zu den zu beobachtenden Strategien zählen auch Krankenhauseinweisungen oder Versuche von Mitarbeitern der Kostenträger externe Interventionen zu initiieren. In der Regel sind diese Strategien nur begrenzt erfolgreich, weil sie Strukturen und Prozesse nicht beeinflussen, und weil sie Strategien individueller Akteure sind, jedoch nicht auf Konsens und Kooperation aller Beteiligten basieren. Für eine Verbesserung der Versorgungsqualität bei Menschen mit chronischen Wunden im Pflegeheim sind aber hausinterne und interprofessionelle Konzepte erforderlich, die den Blick auf die Strukturen und Prozesse, auf Qualifikationen, Verantwortlichkeiten und Abläufe richten. Diese Konzepte sollten von Heimleitungen, Pflegefachkräften im Haus, Ärzten und externen pflegerischen Fachexperten für die Versorgung von Menschen gemeinsam entwickelt und umgesetzt werden. Die Konzepte sollten inhaltlich Qualifikationen, Zuständigkeiten und einheitliche Abläufe vorsehen und bei Bedarf die vertragliche geregelte Hinzuziehung eines unabhängigen pflegerischen Fachexperten ermöglichen, der die Pflegefachkräfte im Hause unterstützen kann.... C. Hampel-Kalthoff (1), 27748 2017-07-24 15:36:20 What should the phlebologist know from geriatrics? The treatment of elderly and very old patients presents a considerable challenge in addition to the difficult diagnosis by superimposed comorbidities and geriatric syndromes, especially in pharmacotherapy. In addition to physiological aging effects, these patients exhibit the highest exposure to pharmaceuticals, while the number of participating doctors increases with the consequence of a generally incomplete knowledge of the substances taken. In the context of phlebological treatment, therefore, the knowledge of the most important potentially risky medications is helpful, especially in the field of anticoagulation and potentially dangerous interactions with ECG changes. In the case of unacceptable combinations, electronic interaction checks should therefore always be carried out. The therapeutic principle of starting with old patients with low doses and only slowly increasing them to the target dose in order to take account of the changed distribution volumes and the altered elimination lead is useful. The first dose should not be reduced in antibiotic therapy in order to achieve adequate serum levels at an early stage. In the case of failure of a therapy, the possibility of non-intentional non-compliance in mild cognitive disorders should always be considered and, if necessary, further clarified. The early integration of geriatric therapy concepts should be considered to avoid everyday functional limitations.... C. Friedrich (1) 27747 2017-07-24 15:35:50 Dementia – a diagnostic and therapeutic challenge Dementia is characterized as a progredient loss of memory, thinking and socials skills leading to need for help in everyday activities till complete dependence on help. Beside decline of mental abilities patients also develop non-cognitive symptoms like euphoria, depression or agitation. In contrast “mild cognitive impairment” describes limited cognitive function but obtained independence in activities of daily life. The prevalence of dementia is age-related, showing an average prevalence of 4 % in 65–70 year old people. While primary dementias are still incurable, there are also dementia-like conditions which can potentially be reversed by appropriate treatment. Of great importance for the diagnosis of dementia is the assessment of the medical history both given by the patient himself as well as family members or care givers. Brief cognitive assessment tools can help to detect possible cognitive impairment. The diagnostic workup also includes a clinical examination, laboratory tests and CT/ MRI Scan. Treatment strategies depend on pathogenesis and leading symptoms. Psychosocial interventions and pharmacological therapy are used.... K. Weyer (1) 27746 2017-07-24 15:35:29 Treatment of chronicle wounds in elderly and geriatric patients In Germany, there has been a continuous increase in life expectancy for more than 135 years. The number of people aged 80 years and over will triple until 2050. Chronic wounds in different aetiologies will increase in our ageing population, with a parallel growth in numbers of comorbidities and geriatric syndromes. Beside vascular difficulties of wound healing and physiological changes in skin conditions among the elderly, we are challenged by the treatment of comorbidities such as diabetes mellitus, neurological diseases (polyneuropathy), the decrease of mobility and the increase of joint troubles, as well as cognitive, emotional and motoric deficits and even dementia. On the basis of the expected progress in age, we have selectively analysed our patients from the age of 80 up to the age of 100 years with chronic wounds, leg and foot ulcers, treated in a specialised wound care centre. Further, we performed a statistical evaluation for the geriatric medical department with focus on geriatric patients with additional wound-healing problems.... H.-J. Hermanns (1), P. Waldhausen (2) 27745 2017-07-24 15:35:07 Non-thermal endovenous treatment: acrylat adhesion of varicose saphenous veins Endovenous treatment of varicose veins, especially thermal procedures using laser and radio frequencies, has become established as an effective alternative to surgery by stripping and high ligation. Although these methods are very sparing and patient-friendly, they also entail risks and side effects. The risk of damage to peripheral and motor nerves is certainly lower than with open surgery, however, it still exists as a result of heat application and tumescent anaesthesia. Several non-thermal procedures which do not require the use of tumescent anaesthesia are coming onto the market. They carry a significantly lower risk of nerve lesions while remaining highly effective. The present work analyses the current state of knowledge on the latest to be developed, cyanoacrylate adhesion of incompetent saphenous veins. T. Hirsch 27624 2017-06-09 11:59:37 Fragen zu "Endothermale ablative Behandlung von Stammveneninsuffizienzen" 27621 2017-06-09 10:44:05 A review of endothermal laser ablative treatment of incompetent saphenous veins Endovenous treatment of incompetent great and small saphenous veins has become firmly established as an alternative to crossectomy and stripping operations. Among other thermal and non-thermal procedures, endovenous laser ablation (EVLA) is one of the most frequently used methods. Development of the procedure has continued since its introduction in 1998: the low wavelengths used at first (810 nm) resulted in a high rate of complications (ecchymosis, pain), and over the years systems using longer wavelengths have been developed with increasingly fewer side effects. The effectiveness of the wavelength most frequently used today (1470 nm) has been reported in numerous studies. The most frequent side effects include endovenous heat-induced thrombosis (EHIT), nerve damage and ecchymosis; major complications like lung embolism are reported very rarely. L. Schuler (1), K. Hartmann (1) 27620 2017-06-08 16:20:55 Secondary findings in Duplex Ultrasound Investigations of the veins of the lower limb The diagnosis of venous diseases and abnormalities has gained a new dimension with duplex ultrasound, which is now regarded as the gold standard for leg vein examination. The combination of B scan, doppler and colour-coding of the blood flow in duplex ultrasound offers a simple, highly predictive, non-invasive diagnosis of venous disease. It provides important information not only on the haemodynamic function but also on the patient‘s anatomy, allowing a diagnostic „look left, look right“. As a result, secondary findings frequently crop up during systematic duplex ultrasound examination of the superficial and deep leg veins. This Advanced Learning in Pictures presents the most common secondary findings in vein surgery consultations. N. Devereux, J. Woitalla, G. Bruning 27619 2017-06-08 16:20:37 „Korruption oder Kooperation“ M. Frehse (1), B. F. Koch (2) 27618 2017-06-08 16:14:14 The mechano-chemical endovenous ablation (MOCA) for the treatment of varicosal veins The endovenous therapies for varicosal veins have partially replaced surgical procedures. Beside thermal ablation based on laser or high frequency other, catheter based techniques are at hand. The non thermal mechano-chemical ablation (MOCA), that can be performed under local anesthesia, has developed as a safe and effective alternative at reasonable costs since its certification in 2011. A combination of MOCA and surgical treatment or foam sclerotherapy can be performed in the same setting or sequentially. J. Teßarek (1) 27617 2017-06-08 16:13:58 Radiofrequency ablation of varicose veins Background: In the search of alternative techniques to high ligation and stripping (HL/S) in the treatment of varicose veins, catheter-ablation methods have been implemented since 1998. Besides endovenous laser techniques (ELT) radiofrequency ablation (RFA) is a successful device in treating insufficiency of the Great (GSV) and Small saphenous vein (SSV). Methods: This review article sums up publications on Closure Plus™, ClosureFAST™, RFITT® (Celon Method), and EVRF®. It discusses the actually favorized treatment protocols and study results. Results of meta-analysis are presented, too. Results: The Closure Plus™ catheter was the first radiofrequency technique to be licensed in Europe in 1998. Trials and meta-analyzes show occlusion rates of 81–89 % after 5 years. The consecutive technique was the ClosureFAST™ (CLF) catheter that was introduced in 2007 and offered more standardization in treatment. Published data show occlusion rates of 98 % after 5 years and low profile on complications. Also in 2007 a bipolar radiofrequency technique called RFITT was presented. Due to lack of standards in treatment protocol it could not get accepted as well as CLF despite of good treatment results (92–98 % occlusion rates after 12 months) and low complications. A new RFA device called EVRF® shows weak evidence so far. Conclusion: Radiofrequency ablation of varicose veins has become a well-established treatment alternative to HL/S mostly represented by CLF.... J. Tesmann 27616 2017-06-08 16:13:25 Krähen über dem Weizenfeld, anno 1890 W. Hach (1) 27615 2017-06-08 16:13:08 Ratschow-Medaille 2016 an Prof. Dr. med. Peter Gloviczki E. Rabe 27130 2017-02-06 09:21:22 Agenesis of the inferior vena cava and antithrombin III deficiency associated with recurring venous... Abnormalities of vena cava inferior are rare malformations and are often discovered by chance. While patients with duplication or left-sided position of the vena cava inferior rarley become clinically apparent the agenesis of the vena cava is associated with an increased rate of deep vein thrombosis. We report a 36 year-old man with recurrent venous thrombosis in which a computer thomography the suspected diagnosis of vena cava inferior agenesis secures and thus a lifelong anticoagulation indicates. J. Lukaseder (1), R. Feldmann (1), A. Steiner (1) 27131 2017-02-06 09:21:22 CHIVA performed with endoluminal heat technique: Laser versus VNUS Introduction: Since its description the CHIVA strategy was performed with surgical techniques. After the introduction of endoluminal heat techniques these might be applied also in the CHIVA context. Method: 104 patients were investigated before and 3–6 months after the treatment of the great saphenous vein (GSV) with CHIVA strategy using enoluminal heat techniques to close the groin segment (VNUS ClosureFast™ or LASER [1470 nm, Intros radial]). General data (age, sex, BMI) and phlebological data (QoL as reflected in VCSS, clinics as C[CEAP], refilling time after muscle pump measured with light reflection rheography, diameters of GSV at the groin and proximal thigh, as well as diameters of the common femoral vein) were measured and compared. Results: Significant reduction of diameters of GSV at proximal thigh from 6.5 ± 1.6 to 3.7 ± 1.1 and VFC from 15.2 ± 2.3 to 14.8 ± 2.2 were recorded, as well as reduction of clinical scores (VCSS from 5.6 ± 3.1 to 2.2 ± 2 and C[CEAP] from 3.2 ± 1 to 2.1 ± 1.1). Refilling time improved from 20.3 ± 11 to 28.8 ± 10.2. Results are comparable to those achieved after surgical crossectomy and published in other series. Conclusion: The disconnection of the insufficiency point at the saphenofemoral junction seems to be possible in the context of CHIVA Strategy applying endoluminal heat technique. No difference could be found between both techniques, LASER or VNUS ClosureFast™.... E. Mendoza (1), F. Amsler (1) 27132 2017-02-06 09:21:22 Chronic venous insufficiency S. Reich-Schupke (1) 27133 2017-02-06 09:21:22 Erratum to: “Reality of outpatient care with medical compression stockings – Follow-up analysis of... C. Schwahn-Schreiber (1), M. Marshall (2), R. Murena-Schmidt (3) 27134 2017-02-06 09:21:22 Large vein reconstructions in the endovascular era1 Max Ratschow was a remarkable physician and an international authority in the field of angiology and the Ratschow lectureship helps to fulfill this pioneer’s life purpose: to advance evaluation and treatment of vascular diseases. The 2017 Max Ratschow lecture covers some recent advances and controversies in venous diseases. Phlebology, once a neglected field of angiology, is a discipline that has been in constant progress during the past decades. Endovascular techniques revolutionized treatment of patients with large vein obstruction and provided safe, minimally invasive procedures with excellent long term results. Attention now need to focus on comparative studies to provide scientific evidence of efficacy of venous angioplasty and stenting with properly organized randomized controlled trials. Further attempts are needed to develop special venous stents and to decrease thrombotic complications and formation of pseudointima that cause in-stent restenosis. Open and hybrid reconstructions are safe and durable, but the number of procedures in general is small and special training and expertise for reconstructive venous surgery is recommended. Autologous vein should be used for infrainguinal reconstructions and for treatment of unilateral iliac vein obstruction with a femoro-femoral cross-over bypass (Palma procedure). IVC and iliac vein reconstructions with ePTFE grafts provide superb result in patients who need excision of malignant tumors invading large veins. Open and hybrid reconstructions are here to stay and they remain excellent options for those patients who are unsuitable for or fail endovascular repair.... P. Gloviczki (1) 27135 2017-02-06 09:21:22 Treatment of chronic ulcers Chronic ulcers (CUs) are a major cause of morbidity and mortality with increasing prevalence, in part due to the ageing population, and an increase of risk factors such as diabetes and obesity. CUs are caused by numerous diseases including venous dysfunction, diabetes mellitus, infections, peripheral neuropathy, pressure, and atherosclerosis. The current standard therapy for CUs includes compression, surgical débridement, infection control, and adequate wound dressings. As a high percentage of CUs do not adequately heal or quickly relapse with standard treatments, additional therapeutic approaches are pursued, termed “advanced wound care therapies”. Here, an overview on commonly applied therapies lacking significant evidence for wound healing is reviewed, followed by therapies with significant evidence supporting the routine use in the treatment of CUs, and a short outlook in a possible future wound treatment landscape. To give a résumé, the presented literature reveals that most of the commonly applied topical and advanced ulcer treatments largely lack solid scientific evidence for the induction or acceleration of wound healing. Surprisingly only “classical” treatments such as wound cleansing, débridement and compression have significant evidence. Novel approaches such as bilayered skin reconstructs, cell suspensions or extracorporal shock waves seem promising. Considering the increasing number of ulcer patients, there is a strong need for further basic research to fully understand all factors involved in wound development and healing of the various ulcer pathophysiologies, and the urgent need for prospective clinical trials comparing the various treatment options.... C. Busch (1, 2), I. Aschermann (1), C. D. Mnich (2) 27129 2017-02-06 09:21:21 Postoperative quality of life, satisfaction, and skin condition after varicose vein surgery Background: Compression is performed postoperatively with the intention of minimising side effects, such as bleeding and haematoma in the area of operation, as well as postoperative oedema and pain. Compression stocking manufacturing has incorporated the addition of skin care products into the yarn material in recent years. However, the benefits of these products remain controversial. In addition, the length of the compression stocking is disputed in terms of its effectiveness. This effectiveness was investigated in the present study. Method: Before surgery, 160 patients with indication of surgical removal of varicose veins were randomly divided into four groups with different types of compression stockings in each case. In each group, 40 patients received a knee-length stocking (length A–D), thigh-length stocking (length A–G), knee-length stocking with Aloe vera or thigh-length stocking with AV. At time 0 (before surgery), one week and 8 weeks after surgery, skin moisture was measured as an objective parameter, quality of life was determined using the Freiburger questionnaire of quality of life in veinous disease (FLQA-vs), benefit to patients was evaluated using the patient benefit index (PBI-v) and further subjective parameters were investigated with a free-text questionnaire. After surgery, the extent of haematoma was determined using the point count method. Result: After surgery, at both post-operative times, the FLQA-vs decreased significantly (corresponding to a better quality of life), and the PBI-v increased. In the group with aloe, pruritus was significantly lower, comfort and skin moisture were increased, and skin condition was significantly improved. The extent of haematoma decreased regardless of the length of the stockings. Conclusion: A benefit of AV as a skin care additive was observed. This finding was objectively confirmed based on the skin moisture. The multifactorial quality of life was not affected by the skin care additive. Thigh-length compression stockings did not provide a measurable benefit.... W. Kath (1), G. Bruning (2), A. Langenbruch (3), M. Augustin (3) 26999 2016-12-14 11:51:37