Phlebologie Phlebologie ph de-de Tue, 27 Jun 17 12:35:36 +0200 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 Vascular malformations Together with the vascular tumours the vascular malformations form the group of congenital vascular anomalies. However, they have to be clearly separated from each other in diagnosis. This is supported by the current ISSVA-Classification, which recently included embryological aspects of the Hamburg Classification. H.-P. Berlien (1), J. Becker-Köhnlein (1), M. Poetke (1) 27000 2016-12-14 11:51:37 Endoluminal thermal ablation of the great saphenous vein (GSV) insufficiency Objective: To evaluate and compare the five-year outcome after treatment of a varicose GSV by endovenous thermal laser ablation (EVLA) and radiofrequency ablation (RFA). Methods: In this non-randomized, prospective study, patients treated in 2007 and 2008 for complete varicosis of the GSV (CEAP: C2–C6) were divided according to the treatment technique used into three groups: RFA (VNUS ClosureFast™), EVLA 980 nm (ELVeS 980™) and EVLA 1470 nm (ELVeS 1470™). Ultrasound-guided follow-up consultations were conducted 3 days, 3 months, 1 year and 5 years after treatment. Results: 589 patients with 643 GSVs (223 RFA, 185 EVLA 980, 235 EVLA 1470) were treated under tumescent local anaesthesia. No major complications occurred and minor complications were rare (4.7–12.2 %, p=0.135). 66 % (RFA), 15 % (EVLA 980) and 32 % (EVLA 1470) of the patients were pain-free without post-operative analgesics. After 5 years, 86 % (RFA), 90 % (EVLA 980) and 93 % (EVLA 1470) of the veins were occluded (p=0.096). Ultrasound imaging revealed reflux in treated GSVs in 5–8 % of cases (p=0.73). A second ablation of the previously treated GSV was required in 5 % (RFA), 2 % (EVLA 980) and 2 % (EVLA 1470) of the patients (p=0.28). Conclusion: Endoluminal thermal ablation is an easy, safe and well tolerated method for the treatment of varicosis. Radiofrequency ablation is less painful than EVLA. RFA and EVLA 1470 are equally effective for vein closure.... F. Sporbert (1, 2), C. Zollmann (2), P. Zollmann (3), J. Veltman (2, 3), A. Gräser (4), I. Berger (2), E. Rabe (1) 27001 2016-12-14 11:51:37 CHIVA treatment of venous insufficiency and aneurysma of the GSV in a patient suffering... The treatment of patients with hemostatic problems and large varicose veins has to be carefully planned even in minimally invasive strategies as CHIVA. The treatment of a 67-year-old woman with aneurysma of the saphenofemoral junction and reflux above and below knee, skin changes (C4a) suffering von-Willebrand-Jürgens-syndrome is reported. CHIVA strategy is performed with radiofrequency (13 cm in the proximal segment). As a result the diameter ov GSV at proximal thigh is reduced from 8.2 mm to 5.4 mm postoperatively and absence of reflux. Symptoms are relieved the skin changes reverted. A satisfactory result is achieved taking little bleeding risk. E. Mendoza (1) 27002 2016-12-14 11:51:37 Die Rechte der Patienten – transparent, verlässlich und ausgewogen L. Thole (1), M. Schanz (2) 27003 2016-12-14 11:51:37 Fragen zu „Rehabilitation oder Rehabilitierung bei phlebologischangiologischen Erkrankungen“... 26715 2016-10-19 14:20:40 Congenital vascular malformations Congenital vascular anomalies may occur at any anatomical region, but genital vascular anomalies in women are rare findings. Therefore the major problems in pregnancy are due to secondary complications of vascular anomalies (especially in syndromes). Proper knowledge of these disorders and the necessities in diagnosis and management is essential. D. Schlembach (1) 26712 2016-10-19 13:58:13 Pyoderma gangrenosum – from correct diagnostics to a targeted therapy Pyoderma gangrenosum (PG) is a rarely diagnosed neutrophilic skin disorder that still remains a diagnosis of exclusion. Therefore, the diagnosis has to be done in the synopsis of typical clinical findings, patient’s history and exclusion of relevant differential diagnoses. There are numerous references to relevant comorbidities from the metabolic syndrome, rheumatoid arthritis and inflammatory bowel diseases. Of particular importance is the potential association of PG with (haematologic) neoplasms. Treatment of PG includes topical and systemic immuno-modulating or immuno-suppressant therapies. Most important are for topical as well as systemic treatments are glucocorticoids. All other treatments represent an off-label-use. Especially Cyclosporine and TNF-α-inhibitors demonstrated very good and promising clinical results. Accompanying modern moist wound-therapy concepts avoiding painful dressings and an analgesic therapy are recommended. F. Jockenhöfer (1), J. Dissemond (1) 26713 2016-10-19 13:58:13 Kongenitale Vaskuläre Anomalien H.-P. Berlien 26714 2016-10-19 13:58:13 Rehabilitation in phlebological/angiological diseases G. Gallenkemper (1), J. Frölich (1) 26707 2016-10-19 13:58:12