[The endovenous laser therapy of varicose veins--substantial innovation or expensive playing?]. / Die endovenöse Lasertherapie der Varicosis--echte Innovation oder teure Spielerei?

INTRODUCTION: The aim of the study was to evaluate the efficiency of the endovenous use of laser for treatment of varicose veins. In particular the influence of laser energy on the perivenous temperature, the postoperative clinical and duplex ultrasound course was taken into account. METHOD: The patients were divided into two groups. In 33 cases the laser therapy was used without perivenous liquid protection. In 30 cases a 0.9 % NaCl solution has been injected around the vein. The laser used was a 980 nm diode laser (Ceralas D 980, Biolitec AG, Bonn). The pulse-mode procedure has been applied for triggering the laser impulse (1.5 s pulse length, 1.5 s pause with a 3 mm withdrawal of the laser fibre. The laser energy was 15 watt. 20 cm distal to the saphenofemoral or saphenopopliteal junction a thermo unit measured continuously the perivenous temperature. Clinical and duplex ultrasound checks were carried out before and on the day of the operation. Further checks followed on the first and tenth day after the operation and 8 weeks and 6 months afterwards. RESULTS: The perivenous temperature prior to ELT was 31.3 degrees C, then dropping after the injection of the NaCl solution by 3.4 degrees C. During the ELT the temperature rose by 10.0 degrees C without and by 5.5 degrees C with infiltration. The rise in temperature happened only 3 cm before the tip of the laser fibre arrived at the thermo unit and fell quite rapidly. 98 % of the veins showed within the time period of 2 to 14 months an effective occlusion controlled by duplex ultrasound without refluxing segments. All operations were out-patient treatments. The patients were able to take up work after 1 to 7 days. CONCLUSION: The endovenous laser treatment is an innovative method for the treatment of varicose veins. Considering the mid-term subjective and objective outcomes this method can not only compete with the conventional surgery but has proved to be superior as regards the recurrence rate and patient's comfort. The study presented here, did not find a risk of damage to surrounding non-target tissue.

[The significance of the pneumatic tourniquet technique for an innovative varicose vein surgery--methods, advantages, risks, danger]. / Die Bedeutung der Blutleere für eine innovative Varizenchirurgie--Methodik, Vorteile, Risiken und Gefahren. Varizenchirurgie und Blutleere.

AIM: The systemic effects of the pneumatic tourniquet technique in varicose vein surgery were studied in order to evaluate possible risks and threats. METHODS: 155 patients were included to look at intraoperative changes of cardiovascular parameters and capillary blood and respiratory gases. RESULTS: Whereas the pulse rate showed only an insignificant rise of 3/min, the systolic and diastolic blood pressure increased significantly by 12 and 6 mm Hg resp., after inducing ischemia by roller cuff. After removal of the roller cuff blood pressure decreased by 14 and 9 mm Hg, resp., again. At releasing of the ischemia, pH values drop by 0.02, and the base excess by 0.3 mval/L with operation on one side and 0.5 mval/L in both sides operation. In comparison, the capillary pCO 2 rose by 3 mm Hg and the pCO 2 of the respiratory air by 1 mm Hg in one side operation and 3 mm Hg, resp. in operation of both sides. The pressure in the roller cuff was in the middle only 55 mm Hg above systemic pressure values. CONCLUSIONS: The systemic effects of the tourniquet technique have no clinical relevance. The use of the pneumatic tourniquet (Loefqvist method) is unrestrictedly recommended due to its advantages, such as no intraoperative blood loss, avoidance of post-op haematoma and pain and good immediate cosmetic results.

[Financing endoluminal stent prostheses in abdominal aortic aneurysms]. / Zur Finanzierbarkeit endoluminaler Stentprothesen beim abdominalen Aortenaneurysma.

Clinical testing of endovascular therapy of aortic aneurysm is at present going on in various hospitals. Because of their restricted budgets, breaking even is not possible for hospitals realising this method of treatment. Amongst technical difficulties, legal questions and the lack of long-term studies, the common use of this expensive method is complicated by unsolved financing. According to section 26 of the "Bundespflegesatzverordnung", a pilot study can be financed by the health insurances for a limited period, to evaluate the type of treatment with respect to its scientific and economic implications. This should result in an inclusion of the costs in the budget of "Sonderentgelte" and "Fallpauschalen". Even in times of low budgets medical progress must be available.

[Peripheral venous pressure in acute and chronic femoral-pelvic vein occlusion--an experimental study]. / Der periphere Venendruck beim akuten und chronischen Bein-Beckenvenenverschluss--eine experimentelle Studie.

The behaviour of the peripheral venous pressure was checked after starvation of the venous main vessel of the pelvic limb in 34 mongrel dogs in long-term course about 40 weeks. The influence of recanalisation processes on the pressure development was excluded by the ligature model. The pressure measurements took place continuously statically and dynamically in horizontal and in oblique posture. They produced a changed pressure characteristic with a chronically increased resting pressure and a decreased drop in pressure with load. The insufficient transport capacity of the spontaneously originated collateral circulation could be pointed out.

[Surgery of leg and pelvic venous thrombosis]. / Die chirurgische Therapie der Bein- und Beckenvenenthrombose. Operative Möglichkeiten und Ergebnisse.

33 patients suffering from crural-pelvic venous thrombosis and having been treated surgically were now followed-up. The late results obtained were satisfactory.

[Leg oedema after surgery of varicose veins (author's transl)]. / Lymphgefässschädigung nach operativer Varizenbehandlung.

Following surgery of varicose veins by stripping we observed leg oedema due to iatrogenic damage of lymphatic vessels. In cases of preexisting swelling of the leg in combination with varicose veins the authors recommend preoperative lymphography. After vein stripping compression therapy for 3 to 6 weeks should be obligatory.