Endochirurgie versus offene Chirurgie der Varikose

Abstract

Open and endovenous surgery of varicose veins provides an excellent way to treat varicose veins. However, there are great differences in the how the techniques are performed. No matter which procedure is carried out, there are standards that should be observed. The state of the art of open venous surgery with radical crossectomy is well-known, but unfortunately is still not always performed correctly nowadays. The state of the art of endovenous surgery has unfortunately not yet been sufficiently documented, but should be based on open-surgical techniques. How the standard of both methods today is (or should be) is described in detail in this work. A recurrence definition which applies to both techniques, is set up.

Ablösung der Lasersondenspitze – eine seltene Komplikation der endoluminalen Therapie

“…The set laser power was 10 watts. The proximal 3 cm of the great saphenous vein were treated with a total of 551 joules, i. e., 183 J/cm, following the recommendations of Spreafico et al [3] and Hartmann et al [4]. Hereafter, the probe was continuously withdrawn with an average energy of 84.4 J/cm.…”

“…Die eingestellte Laserleistung betrug 10 W. Die proximalen 3 cm der V. saphena magna wurden in Anlehnung an die Empfehlungen von Spreafico et al [3] und Hartmann et al [4] mit insgesamt 551 J, d. h. 183 J/cm behandelt. Hiernach wurde die Sonde kontinuierlich mit einer mittleren Energie von 84,4 J/cm zurückgezogen.…”

Endovenous (minimally invasive) procedures for treatment of varicose veins

“…With theses radial probes, alsoa saphenofemoral recurrance with a persiting saphenofemoral stump can nowadays be accurately occluded. [10].…”

“…It is also known that in endovenous procedures, recurrence preferentially occurs via the anterior accessory saphenous vein (AASV) [4,8,9]. Therefore, the trend is towards an endovenous crossectomy, i.e., the treatment of the long saphenous vein is carried out up to the saphenofemoral junction, which again was not previously possible with bare fibers but which is no longer a problem with the modern radially radiating laser fibers and modern RFA techniques [10]. Whether prophylactic occlusion of the AASV in the region of the saphenofemoral junction should be promoted, ashasalwaysbeenthestandardinsurgical crossectomy, must be shown in further studies.…”

Die Chirurgie der Vena saphena parva – endoluminal oder operativ

“…Insofern ist die Rezidivdefinition in beiden Techniken völlig different. Auf die Problematik der Vergleichbarkeit von Ergebnissen der offenen und endoluminalen OP-Technik haben wir kürzlich bereits hingewiesen[23] und eine einheitliche Rezidivdefinition gefordert. Der secundary outcome wird in endoluminalen Arbeiten wie folgt definiert: Technischer Erfolg = Fehlen eines technischen Fehlers und Durchführung der OP wie geplant und duplexsonographisch fehlender Reflux in der Zielvene.…”