Es bestehen keine Interessenskonflikte zum dargestellten ThemaEs bestehen keine Interessenskonflikte zum dargestellten Thema

Weil er Beschwerden hat? Weil er Beschwerden hat?

Weil das Bein ohne Beschwerden anschwillt? Weil das Bein ohne Beschwerden anschwillt?

Weil ihn die Optik stört Weil ihn die Optik stört

Weil er vom Hausarzt geschickt wurde? Weil er vom Hausarzt geschickt wurde? Weil er vom Hausarzt geschickt wurde?

Dazu gibt es übrigens keine Statistiken!Dazu gibt es übrigens keine Statistiken!

RundRund13.40013.400EingriffeEingriffenur AOK-nur AOK-BW in 1 J.BW in 1 J.BW in 1 J.

1000010000N= 17269

9000

1000051,3% N= 17269

8000

9000N= 17269

8000

700018,7%

6000

700018,7%

5000

6000

5000

4000

5000

3000

4000

11,7%

2000

3000 11,7%

2000

1000

20000,2% 1,2% 1,4%

0,9%

0

1000 0,2% 1,2% 1,4%0,9% 0,8%

C0 C1 C2 C3 C4a C4b C5 C60

C0 C1 C2 C3 C4a C4b C5 C6

OP/Intervention 36 209 8868 5623 2023 239 119 152OP/Intervention 36 209 8868 5623 2023 239 119 152OP/Intervention 36 209 8868 5623 2023 239 119 152

Dr. med. AndreasDr. med. AndreasHildebrandtHildebrandt

Peter J. Pappas: JVS venous and lymphatic disorders 2018; 6:13-24Peter J. Pappas: JVS venous and lymphatic disorders 2018; 6:13-24

PsySoVDQ (no signs)PsySoVDQ (no signs)

Somatic 328 (41%)Somatic 328 (41%)Somatic 328 (41%)Psychic 475 (59%)Psychic 475 (59%)

Somatic 346 (59%)Somatic 346 (59%)Psychic 241 (42%)Psychic 241 (42%)Psychic 241 (42%)

Amsler F, Rabe E, Blättler W, Eur J Vasc Endvasc Surg, 2013; 46:255.262Amsler F, Rabe E, Blättler W, Eur J Vasc Endvasc Surg, 2013; 46:255.262

Blacek C, Amsler F, Blättler W. et al. Phlebology 2013; 28:239-247Blacek C, Amsler F, Blättler W. et al. Phlebology 2013; 28:239-247Blacek C, Amsler F, Blättler W. et al. Phlebology 2013; 28:239-247

Blacek C, Amsler F, Blättler W. et al. Phlebology 2013; 28:239-247Blacek C, Amsler F, Blättler W. et al. Phlebology 2013; 28:239-247Blacek C, Amsler F, Blättler W. et al. Phlebology 2013; 28:239-247

Zitiert aus: Peter J. Pappas: JVS venous and lymphatic disorders 2018; 6:13-24Zitiert aus: Peter J. Pappas: JVS venous and lymphatic disorders 2018; 6:13-24

Blätter W et al, J Vasc Surg: Venous and Lym Dis 2016;4:455-62Blätter W et al, J Vasc Surg: Venous and Lym Dis 2016;4:455-62

(N = 127 patients)(N = 127 patients)(N = 127 patients)

Xavier Kurz, MD, Donna L. Lamping, PhD, Susan R. Kahn, MD, Ugo Baccaglini, MD, FrançoisXavier Kurz, MD, Donna L. Lamping, PhD, Susan R. Kahn, MD, Ugo Baccaglini, MD, FrançoisZuccarelli, MD, Giorgio Spreafico, MD and Lucien Abenhaim, MD, for the VEINES Study Group,Zuccarelli, MD, Giorgio Spreafico, MD and Lucien Abenhaim, MD, for the VEINES Study Group,

( J Vasc Surg 2001;34:641-8)( J Vasc Surg 2001;34:641-8)

Purpose: This study assessed the impact of varicose veins (VV) on quality of life (QOL)Purpose: This study assessed the impact of varicose veins (VV) on quality of life (QOL)and patient-reported sytnptoms.and patient-reported sytnptoms.

Methode: A cross-sectional population-based study was held in 166 general practices and 116Methode: A cross-sectional population-based study was held in 166 general practices and 116specialist clinics for venous disorders of the leg in Belgium, Canada (Quebec ), France, and Italy.specialist clinics for venous disorders of the leg in Belgium, Canada (Quebec ), France, and Italy.

259 reference patients without VV (CEAP class 0 or 1) 259 reference patients without VV (CEAP class 0 or 1)

1054 patients with VV who were classified as having1054 patients with VV who were classified as having

VV alone (367; 34.8%) VV alone (367; 34.8%)

VV with edema (l25; 11,9%) VV with edema (l25; 11,9%)

VV with skin changes (431; 40.9%) VV with skin changes (431; 40.9%)

VV with healed ulcer (l00; 9.5%) VV with healed ulcer (l00; 9.5%)

VV with active ulcer ( 31; 2.9%) VV with active ulcer ( 31; 2.9%)

The main outcome measure was generic and disease-specific QOL, as measured by meansThe main outcome measure was generic and disease-specific QOL, as measured by means

of the Short-Form Health Survey-36 (SF-36) and the VEINES-QOL scale, and patient-reportedsyrnptorns as measured by the VEINES-SYM scale.syrnptorns as measured by the VEINES-SYM scale.

Xavier Kurz, MD, Donna L. Lamping, PhD, Susan R. Kahn, MD, Ugo Baccaglini, MD, FrançoisXavier Kurz, MD, Donna L. Lamping, PhD, Susan R. Kahn, MD, Ugo Baccaglini, MD, FrançoisZuccarelli, MD, Giorgio Spreafico, MD and Lucien Abenhaim, MD, for the VEINES Study Group,Zuccarelli, MD, Giorgio Spreafico, MD and Lucien Abenhaim, MD, for the VEINES Study Group,

( J Vasc Surg 2001;34:641-8)( J Vasc Surg 2001;34:641-8)

The high prevalençe of major symptoms of venous disorders in patients inThe high prevalençe of major symptoms of venous disorders in patients inCEAP class 0 or 1 being treated for venous disorders (76,1% of patients hadCEAP class 0 or 1 being treated for venous disorders (76,1% of patients hadheaviness, aching legs, or swelling) might have contributed to theheaviness, aching legs, or swelling) might have contributed to theimpairment of QOL in the reference group.impairment of QOL in the reference group.

Conclusion:Conclusion:

Results indicate that impairment in physical QOL in patients with VV isResults indicate that impairment in physical QOL in patients with VV isassociated with concomitant venous disease, rather than the presence of VVassociated with concomitant venous disease, rather than the presence of VVper se.per se.

Findings concerning QOL in patients with VV can only be reliablyFindings concerning QOL in patients with VV can only be reliablyinterpreted when concomitant venous disease is taken into account. Ininterpreted when concomitant venous disease is taken into account. Inpatients with VV alone, the objectives of cosmetic improvement and thepatients with VV alone, the objectives of cosmetic improvement and theimprovement of QOL should be considered separatly.improvement of QOL should be considered separatly.

1.

2.2.

3.3.

1.2 Referral to a vascular service1.2 Referral to a vascular service

1.2.1 Refer people with bleeding varicose veins to a vascular service [ 3 ]1.2.1 Refer people with bleeding varicose veins to a vascular service [ 3 ]immediately.immediately.

1.2.2 Refer people to a vascular service if they have any of the following:1.2.2 Refer people to a vascular service if they have any of the following:

Symptomatic (Cx s) primary or symptomatic recurrent varicose veins.Symptomatic (Cx s) primary or symptomatic recurrent varicose veins.

Lower-limb skin changes, such as pigmentation or eczema, thought to be caused Lower-limb skin changes, such as pigmentation or eczema, thought to be causedby chronic venous insufficiency (C4)by chronic venous insufficiency (C4)

Superficial vein thrombosis (characterised by the appearance of hard, painful Superficial vein thrombosis (characterised by the appearance of hard, painfulveins) and suspected venous incompetence.veins) and suspected venous incompetence.

A venous leg ulcer (a break in the skin below the knee that has not healed A venous leg ulcer (a break in the skin below the knee that has not healedwithin 2 weeks) (C5).within 2 weeks) (C5).

A healed venous leg ulcer (C6). A healed venous leg ulcer (C6).

1.3 Assessment and treatment in a vascular service1.3 Assessment and treatment in a vascular service

1.3.1 Use duplex ultrasound to confirm the diagnosis of varicose veins and the1.3.1 Use duplex ultrasound to confirm the diagnosis of varicose veins and theextent of truncal reflux, and to plan treatment for people with suspected primary orextent of truncal reflux, and to plan treatment for people with suspected primary orrecurrent varicose veins.recurrent varicose veins.

Interventional treatmentInterventional treatment

1.3.2 For people with confirmed varicose veins and truncal reflux….1.3.2 For people with confirmed varicose veins and truncal reflux….

Previous local guidance (© NICE) advised GP‘s to refer a patientPrevious local guidance (© NICE) advised GP‘s to refer a patientPrevious local guidance (© NICE) advised GP‘s to refer a patientwith VV to secondary care only in the presence of what waswith VV to secondary care only in the presence of what wasdefined as advanced disease C4-C6.defined as advanced disease C4-C6.

However, venous disease is a progressive disorder; Bonn Vein study showsHowever, venous disease is a progressive disorder; Bonn Vein study showsHowever, venous disease is a progressive disorder; Bonn Vein study showsprogression of disease from C2 to higher C-class in 2% per annum.progression of disease from C2 to higher C-class in 2% per annum.

This change in evidence has led national bodies to change referralThis change in evidence has led national bodies to change referralpathwaya to all symptomatic disease with the aim of preventing higherpathwaya to all symptomatic disease with the aim of preventing higher

C-class stages. Referred by Soc.Vasc.Surgery and Nice InstitutC-class stages. Referred by Soc.Vasc.Surgery and Nice Institut

It is important to consider differential diagnosis. …It is important to consider differential diagnosis. …

In a patient with evidence of reflux on venous duplex, it is important toIn a patient with evidence of reflux on venous duplex, it is important toinform them that intervention may not resolve their symptoms.inform them that intervention may not resolve their symptoms.

Special Topic: A study on varicose vein treatments, Patient Reported Outcome Measures (PROMs) inSpecial Topic: A study on varicose vein treatments, Patient Reported Outcome Measures (PROMs) inEngland, April 2009 to March 2015, © 2016 Health and Social Care Information Centre.England, April 2009 to March 2015, © 2016 Health and Social Care Information Centre.

Ingo Flessenkämper et al: Endovenous laser ablation with and without high ligation compared to highIngo Flessenkämper et al: Endovenous laser ablation with and without high ligation compared to highligation and stripping for treatment of great saphenous varicose veins: Results of a multicentre randomisedcontrolled trial with up to 6 years follow-up. Phlebology 2015 online first doi:10.1177/0268355514555547controlled trial with up to 6 years follow-up. Phlebology 2015 online first doi:10.1177/0268355514555547

Beschreibung was grundsätzlich therapierbar ist (möglichst große Freiheit)Beschreibung was grundsätzlich therapierbar ist (möglichst große Freiheit)

Medizinisch eindeutiger (zwingender?) Indikation unter dem Aspekt derMedizinisch eindeutiger (zwingender?) Indikation unter dem Aspekt derKosteneffizienz (Beschränkung der Anzahl der Eingriffe)Kosteneffizienz (Beschränkung der Anzahl der Eingriffe)