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Rezidivvarikose — Pathomechanismen — Therapie

Recurrent varicosis — Pathomechanisms — Therapy

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Zusammenfassung

Grundlagen: Trotz verbesserter Diagnostik und standardisierten Operationsverfahren ist die Rezidivvarikose nach wie vor ein Problem des chirurgischen Alltags.

Methodik: Anhand einer Literaturübersicht mit Einbeziehung der eigenen Erfahrung wird die Pathogenese der Rezidivvarikose und ihre chirurgische Therapie dargestellt.

Ergebnisse: Ursache der Rezidivvarikose ist in einem Großteil der Fälle eine übersehene oder bei der Erstoperation nicht behobene insuffiziente Verbindung zwischen oberflächlichem und tiefem Venensystem. Diese ist in absteigender Häufigkeit in der Leiste, an Perforansvenen oder in der Kniekehle lokalisiert.

Nach duplexsonographischer Lokalisation müssen die Insuffizienzpunkte ausgeschaltet werden, wobei sich in der Leiste und der Fossa poplitea ein chirurgisches Vorgehen, das narbig verändertes Gewebe primär umgeht, bewährt hat.

Schlußfolgerungen: Die chirurgische Therapie der Rezidivvarikose erfordert subtile Diagnostik und exaktes chirurgisches Vorgehen und muß in der Hand des Erfahrenen verbleiben.

Summary

Background: Despite of improvements in diagnostic workup and operative technique, recurrent varicose veins remain a common problem in surgical practice.

Methods: The objective of this paper is giving an overview of the pathomechanism and operative treatment of recurrent varicose veins.

Results: Recurrent varicose veins mostly result from recurrent or residual valve incompetence with consecutive reflux.

These sites of reflux are the groin, perforating veins in the calf and the popliteal region. Preoperative assessment should include duplex ultrasound examination of these regions. The technical difficulty of re-exploration of the groin and popliteal region can be reduced by approaching the sapheno-femoral junction through unoperated tissue.

Conclusions: Treatment of recurrent varicose veins demands correct preoperative diagnostic work-up and subtile surgical technique and cannot be delegated to inexperienced surgeons.

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Correspondence to W. Hofmann.

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Hofmann, W., Magometschnigg, H. Rezidivvarikose — Pathomechanismen — Therapie. Acta Chir. Austriaca 32, 14–16 (2000). https://doi.org/10.1007/BF02950346

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Schlüsselwörter

  • Rezidivaarizen
  • Pathomechanismus
  • chirurgische Technik

Keywords

  • Recurrent varicose veins
  • pathomechanism
  • surgical technique