Felizitas Pannier

Primary chronic venous disorders

Primary chronic venous disorders, which according to the CEAP classification are those not associated with an identifiable mechanism of venous dysfunction, are among the most common in Western populations. Varicose veins without skin changes are present in about 20% of the population while active ulcers may be present in as many as 0.5%. Primary venous disorders are thought to arise from intrinsic structural and biochemical abnormalities of the vein wall. Advanced cases may be associated with skin changes and ulceration arising from extravasation of macromolecules and red blood cells leading to endothelial cell activation, leukocyte diapedesis, and altered tissue remodeling with intense collagen deposition. Laboratory evaluation of patients with primary venous disorders includes venous duplex ultrasonography performed in the upright position, occasionally supplemented with plethysmography and, when deep venous reconstruction is contemplated, ascending and descending venography. Primary venous disease is most often associated with truncal saphenous insufficiency. Although historically treated with stripping of the saphenous vein and interruption and removal of major tributary and perforating veins, a variety of endovenous techniques are now available to ablate the saphenous veins and have generally been demonstrated to be safe and less morbid than traditional procedures. Sclerotherapy also has an important role in the management of telangiectasias; primary, residual, or recurrent varicosities without connection to incompetent venous trunks; and congenital venous malformations. The introduction of ultrasound guided foam sclerotherapy has broadened potential indications to include treatment of the main saphenous trunks, varicose tributaries, and perforating veins. Surgical repair of incompetent deep venous valves has been reported to be an effective procedure in nonrandomized series, but appropriate case selection is critical to successful outcomes.

Therapy with compression stockings in Germany – results from the Bonn Vein Studies

Background: Despite the frequent use of medical compression stockings (MCS), reliable data are lacking on the frequency of MCS use and experience of patients with the treatment.

Sclerotherapy of Varicose Veins with Polidocanol Based on the Guidelines of the German Society of Phlebology

BACKGROUND Sclerotherapy involves the injection of a sclerosing agent for the elimination of intracutaneous, subcutaneous, and transfascial varicose veins. OBJECTIVE To update guidelines for sclerotherapy of varicose veins. METHODS The guidelines for sclerotherapy of varicose veins of the German Society of Phlebology were updated and modified through a review of the available literature. RESULTS Published clinical series and controlled clinical trials provide evidence to support the elimination of intracutaneous and subcutaneous varicose veins using sclerotherapy. Allergic skin reactions occur occasionally as allergic dermatitis, contact urticaria, or erythema. Anaphylaxis is rare. Transient migraine headaches present more frequently in patients treated with foam sclerotherapy than liquid sclerotherapy. CONCLUSION Sclerotherapy is the method of choice for the treatment of small‐caliber varicose veins (reticular varicose veins, spider veins). If performed properly, sclerotherapy is an efficient treatment method with a low incidence of complications. BioForm Medical provided financial support for formal formatting of this manuscript without any influence over the content of the manuscript. The authors have previously participated in two scientific studies with polidocanol (ESAF and EASI study) financed by Kreussler.

Schaumsklerosierung der Varikose

ZusammenfassungDie Sklerosierungstherapie hat ihren festen Stellenwert in der Behandlung von retikulären Varizen und Seitenästen. Durch die Einführung der Sklerosierung mit aufgeschäumten Verödungsmitteln konnte die Effektivität bei großen Varizen und der Stammvarikose deutlich gesteigert werden. Bei niedriger Nebenwirkungsrate und guter Kosten-Nutzen-Relation stellt die Sklerosierung subkutaner Varizen mit aufgeschäumten Verödungsmitteln eine Alternative und eine Ergänzung zu den operativen und endovenösen Verfahren dar.Der Stellenwert der Schaumsklerosierung im Vergleich zu den anderen Therapieverfahren muss in randomisierten Vergleichsstudien überprüft werden.AbstractSclerotherapy is a standardized method in the treatment of reticular veins and tributary varicose veins. The use of foamed sclerosing agents has improved the effectivity of the method also for large subcutaneous veins and saphenous veins. With a low profile of side effects and good cost effectiveness, foam sclerotherapy is an alternative and additional method to operative and endovenous treatment of varicose veins. The position of this method in comparison with the other options has to be defined by randomized comparative studies in the future.