Consensus Paper 1st. NEEF
NEEF Consensus: Chronic venous disease is a very common disorder of the blood vessels. Untreated it leads to a significant reduction in quality of life. When advancing to stage C6 it leads to very high costs for the health systems. At present time over 95% of these patients are untreated.
Within the framework of the scientific program and the content – related discussion and also through many discussions on the experiences presented of the NEEF Forum, a consensus has emerged.
Following the ESVS – guidelines indications for therapy of varicose veins we are in consensus, that endovenous therapy should be preferred over open radical surgery in most cases and is the therapy of first choice for treatment of varicose veins. This is also in line with suggestions of The NICE guidelines and also The American Venous Forum.
At present time endovenous techniques have evolved to be the new gold standard. With proven efficacy even on long they should be prefered over open surgery as treatment of choice in general cases. Short treatment time, low rate of procedure failures and side effects they can be performed without need of operation theater and general anesthesia. In general cases they should be preferred over open surgery as treatment of choice.
Beside radio frequency and laser ablation the non-thermal non-tumescent cyanoacrylate therapy (VenaSeal) proved to be as least as effective and safe. Truncal varicose veins show long time closure rate between 95 and 97% as shown in different centers and also provides a lower rate of side effects.
Our summary is based on up to 75 month follow – up of using glue for sealing veins. The six vein center results in treatment of over 2000 patients and over 3000 truncal varicose veins are showing a closure rate of between 97,7% after 3 years to 97,3% after 6 years.
Non thermal therapy of sealing veins results in lower postprocedure downtime and hospitalization and lower peri- and postoperative pain compared to thermal ablation and open surgery. Obviously there is no risk of nerval injury.
The venous super glue 2 butyl-cyanoacrylate is biocompatible and bioresorbed over time, so it is not a lifetime implant, no mutagenic or carcinogenic effect is known.
The non thermal, non anaesthesia non tumescent sealing therapy is now accepted throughout Europe and worldwide.
Sealing veins is a gentle alternative method of endovenous therapy – equally effective as endovenous radio frequency and laser.
More information on venous diseases should be given to general public to raise the level of awareness. Thus progression to ulcer state C6 could be reduced.
Dr. Carl Henrik Schelp, Dr. Ints Üdris, Dr. Ulf Th.Zierau
Dr. Joachim Thum, Dr. Kimmo Mäkinen, Dr. Adam Wegrzynowski,
Dr. Giuseppe Serpieri,