Stücker Markus
Klinik für Dermatologie, Venerologie und Allergologie, Venenzentrum der Dermatologischen und Gefäßchirurgischen Kliniken, Kliniken der Ruhr-Universität Bochum, St. Maria-Hilf-Krankenhaus, Hiltroper Landwehr 11-13, 44805, Bochum, Deutschland.
Inn Med (Heidelb). 2022 Jun;63(6):612-618. doi: 10.1007/s00108-022-01341-9. Epub 2022 May 3.
Venous disorders affect a large proportion of the German population (varicose veins 13.3%, chronic venous insufficiency 40.8%).
Based on current literature, a practically oriented update on superficial venous thrombosis, varicosis, and chronic venous insufficiency is provided.
Superficial vein thrombosis of the legs requires comprehensive duplex ultrasonography of the superficial and deep leg veins. Only superficial vein thrombosis less than 5 cm in length and more than 3 cm from the saphenofemoral or saphenopopliteal junction can be treated conservatively with compression, cooling, and relative immobilization. Superficial vein thrombosis greater than 5 cm in length with more than 3 cm distance to the deep venous system is treated pharmacologically with fondaparinux for 45 days (approved for 30-45 days). If the surface thrombus reaches the saphenofemoral or saphenopopliteal junction at a distance of less than 3 cm, therapy analogous to deep vein thrombosis is required for 3 months. The most effective therapy for varicose veins is invasive removal. In this regard, endovenous thermal ablation has become particularly important in recent years, given that its effectiveness is of a similar order of magnitude to that of crossectomy and stripping surgery, but the complication rates are significantly lower. Invasive removal of varicose veins not only improves patients' quality of life, but also significantly reduces the risk of deep vein thrombosis. Recent epidemiological data demonstrate an increased risk of cardiovascular disease in patients with chronic venous insufficiency. There is preliminary evidence that this risk of cardiovascular disease in varicose vein patients can be lowered by varicose vein therapy.
静脉疾病影响着很大一部分德国人口（静脉曲张占13.3%，慢性静脉功能不全占40.8%）。
基于当前文献，提供一份关于浅静脉血栓形成、静脉曲张和慢性静脉功能不全的实用更新内容。
腿部浅静脉血栓形成需要对浅静脉和深静脉进行全面的双功超声检查。只有长度小于5厘米且距离隐股或隐腘静脉交界处超过3厘米的浅静脉血栓形成可以通过加压、冷敷和相对制动进行保守治疗。长度大于5厘米且距离深静脉系统超过3厘米的浅静脉血栓形成采用磺达肝癸钠进行45天的药物治疗（批准治疗时间为30 - 45天）。如果表面血栓距离隐股或隐腘静脉交界处小于3厘米，则需要进行类似于深静脉血栓形成的治疗，为期3个月。治疗静脉曲张最有效的方法是侵入性切除。在这方面，近年来静脉内热消融变得尤为重要，因为其有效性与静脉切除术和剥脱手术相当，但并发症发生率显著更低。侵入性切除静脉曲张不仅能改善患者的生活质量，还能显著降低深静脉血栓形成的风险。近期的流行病学数据表明，慢性静脉功能不全患者患心血管疾病的风险增加。有初步证据表明，静脉曲张治疗可以降低静脉曲张患者患心血管疾病的风险。
