BACKGROUND:This was a prospective study of radiofrequency segmental thermal ablation (RFA) for the treatment of incompetent varicose great saphenous veins (GSVs). The present report describes long-term follow-up at 5 years.METHODS:The 5-year follow-up of this multicentre European study included assessment of the Venous Clinical Severity Score (VCSS), and GSV occlusion and reflux on duplex imaging.RESULTS:A total of 225 patients had 295 GSVs treated by RFA, achieving an initial vein occlusion rate of 100 per cent. With 80·0 per cent compliance, Kaplan-Meier analyses showed a GSV occlusion rate of 91·9 per cent and a reflux-free rate of 94·9 per cent at 5 years. Among the 15 GSVs noted with reflux during follow-up, only three showed full recanalization of the GSV at 1 week, 6 months and 3 years. Of the 12 legs with partial recanalization, reflux originated at the saphenofemoral junction in ten, with a mean length of the patent segment of 5·8 (range 3·2-10) cm; only six patients were symptomatic. Mean(s.d.) VCSS scores improved from 3·9(2·1) at baseline to 0·6(1·2), 0·9(1·3) and 1·3(1·7) at 1, 3 and 5 years.CONCLUSION:At 5 years RFA proved to be an efficient endovenous treatment for incompetent GSVs in terms of sustained clinical and anatomical success for the vast majority of treated patients.

BackgroundEndothermal saphenous ablation requires the use of perivenous tumescent anesthesia and postinterventional compression stockings, moreover causing paresthesia in 5% to 10% of patients. An embolization technique lacking these needs and complications would significantly improve treatment. The primary endpoint of the study was evaluation of closure of the great saphenous vein GSV at 6 months; however, all patients will be followed to 2 years. We report herein 1-year follow-up.MethodsA prospective multicenter cohort study was conducted in seven European centers between 12/2011 and 07/2012. Incompetent GSVs received endovenous embolization with a unique endovenous cyanoacrylate adhesive implant. Neither tumescent anesthesia nor postinterventional compression stockings were used. Varicose tributaries remained untreated for 3 months. Duplex ultrasound and clinical examination were performed at 2 days and after 1, 3, 6, and 12 months.ResultsSeventy GSVs in 70 patients were treated, follow-up to 1 year was completed in 60 (86%) patients. All treatments were successful. Partial recanalization with open vein segments longer than 10 cm on duplex ultrasound occurred in one patient at 24 hours, in two patients at 3 months, and in one additional patient at 6 months. No additional late recanalization was observed at 12-month follow-up. Life-table occlusion rates were 98.6% at 2 days (95% confidence interval [CI], 95.8%-100%), 95.7% at 3 months (95% CI, 91.1%-100%), and 94.3% at 6 months (95% CI, 89.0%-99.9%). Phlebitis occurred in six cases (8.7%), five of whom received nonsteroidal anti-inflammatory drugs for an average of 7 days, no serious adverse events were observed. Average Venous Clinical Severity Score improved from 4.3 ± 0.3 at baseline to 0.96 ± 1.18 at month 6 (n = 70) and 1.13 ± 1.27 at month 12 (n = 62; P < .0001 for all postprocedure time points compared with baseline).ConclusionsTranscatheter endovenous cyanoacrylate adhesive for closure of insufficient GSVs proved to be feasible, safe, and effective without the use of sedation, tumescent anesthesia, or compression stockings. Side effects were mild; in particular, paresthesia was not observed. Long-term effectiveness appears high, with no late failures between months 6 and 12. BackgroundEndothermal saphenous ablation requires the use of perivenous tumescent anesthesia and postinterventional compression stockings, moreover causing paresthesia in 5% to 10% of patients. An embolization technique lacking these needs and complications would significantly improve treatment. The primary endpoint of the study was evaluation of closure of the great saphenous vein GSV at 6 months; however, all patients will be followed to 2 years. We report herein 1-year follow-up. Endothermal saphenous ablation requires the use of perivenous tumescent anesthesia and postinterventional compression stockings, moreover causing paresthesia in 5% to 10% of patients. An embolization technique lacking these needs and complications would significantly improve treatment. The primary endpoint of the study was evaluation of closure of the great saphenous vein GSV at 6 months; however, all patients will be followed to 2 years. We report herein 1-year follow-up. MethodsA prospective multicenter cohort study was conducted in seven European centers between 12/2011 and 07/2012. Incompetent GSVs received endovenous embolization with a unique endovenous cyanoacrylate adhesive implant. Neither tumescent anesthesia nor postinterventional compression stockings were used. Varicose tributaries remained untreated for 3 months. Duplex ultrasound and clinical examination were performed at 2 days and after 1, 3, 6, and 12 months. A prospective multicenter cohort study was conducted in seven European centers between 12/2011 and 07/2012. Incompetent GSVs received endovenous embolization with a unique endovenous cyanoacrylate adhesive implant. Neither tumescent anesthesia nor postinterventional compression stockings were used. Varicose tributaries remained untreated for 3 months. Duplex ultrasound and clinical examination were performed at 2 days and after 1, 3, 6, and 12 months. ResultsSeventy GSVs in 70 patients were treated, follow-up to 1 year was completed in 60 (86%) patients. All treatments were successful. Partial recanalization with open vein segments longer than 10 cm on duplex ultrasound occurred in one patient at 24 hours, in two patients at 3 months, and in one additional patient at 6 months. No additional late recanalization was observed at 12-month follow-up. Life-table occlusion rates were 98.6% at 2 days (95% confidence interval [CI], 95.8%-100%), 95.7% at 3 months (95% CI, 91.1%-100%), and 94.3% at 6 months (95% CI, 89.0%-99.9%). Phlebitis occurred in six cases (8.7%), five of whom received nonsteroidal anti-inflammatory drugs for an average of 7 days, no serious adverse events were observed. Average Venous Clinical Severity Score improved from 4.3 ± 0.3 at baseline to 0.96 ± 1.18 at month 6 (n = 70) and 1.13 ± 1.27 at month 12 (n = 62; P < .0001 for all postprocedure time points compared with baseline). Seventy GSVs in 70 patients were treated, follow-up to 1 year was completed in 60 (86%) patients. All treatments were successful. Partial recanalization with open vein segments longer than 10 cm on duplex ultrasound occurred in one patient at 24 hours, in two patients at 3 months, and in one additional patient at 6 months. No additional late recanalization was observed at 12-month follow-up. Life-table occlusion rates were 98.6% at 2 days (95% confidence interval [CI], 95.8%-100%), 95.7% at 3 months (95% CI, 91.1%-100%), and 94.3% at 6 months (95% CI, 89.0%-99.9%). Phlebitis occurred in six cases (8.7%), five of whom received nonsteroidal anti-inflammatory drugs for an average of 7 days, no serious adverse events were observed. Average Venous Clinical Severity Score improved from 4.3 ± 0.3 at baseline to 0.96 ± 1.18 at month 6 (n = 70) and 1.13 ± 1.27 at month 12 (n = 62; P < .0001 for all postprocedure time points compared with baseline). ConclusionsTranscatheter endovenous cyanoacrylate adhesive for closure of insufficient GSVs proved to be feasible, safe, and effective without the use of sedation, tumescent anesthesia, or compression stockings. Side effects were mild; in particular, paresthesia was not observed. Long-term effectiveness appears high, with no late failures between months 6 and 12. Transcatheter endovenous cyanoacrylate adhesive for closure of insufficient GSVs proved to be feasible, safe, and effective without the use of sedation, tumescent anesthesia, or compression stockings. Side effects were mild; in particular, paresthesia was not observed. Long-term effectiveness appears high, with no late failures between months 6 and 12.

Endovenous thermal ablation is a highly effective technology for the treatment of incompetent great saphenous veins (GSVs). However, the treatment requires painful transcutaneous injection of perivenous anesthetic fluids. Graduated compression hose are required postprocedure to help mitigate the inflammatory side-effects of thermal delivery. This study was conducted to demonstrate the safety and efficacy of the Sapheon Closure System for chemical ablation of duplex proven incompetent great saphenous veins. Two series of patients were treated (n=8 and n=30 follow-up of 180 and 30 days, respectively). After venous access and placement of a novel delivery system, the vein was sealed with a proprietary cyanoacrylate (CA) formulation. Perivenous tumescent anesthesia and post-procedure compression stockings were omitted. Thirty-eight patients (29 female) with a median age of 51 years (range, 26-77) and an average VCSS score of 6.0 +/−2.7 (range, 2-17) received study treatment. Average maximum saphenofemoral junction (SFJ) diameter was 8.0 +/− 2.2 cm (range, 4.1 - 12.0) before treatment. The mean length of ablated GSV segments was 33cm (range, 15-52), average treatment duration was 20.3 minutes (range, 11 - 33). The mean volume of CA delivered was a total of 1.3 ml (range, 0.63 - 2.25). Immediately postprocedure, and at 24-72 hours, 100% (38 of 38) were closed. At 30 days follow-up 97% (35 of 36) of treated GSV segments were completely closed; one limb had a 1cm segment of incomplete ablation. VCSS scores improved to a mean of 1.9 +/−2.1 (range, 0-11; P<.001 compared to baseline) at 30 days in 37 patients. Of the eight patients followed for 180 days, average VCSS improved to 1.1 +/− 1.0 (range, 0 - 3) Thirty-one of 37 patients reported no pain during the 30 days after treatment; the remaining six were successfully treated with NSAIDs. No significant side effects or complications were observed. Endovenous ablation of incompetent GSVs with a CA-based glue is feasible. Procedure times are short, tumescent anesthesia is unnecessary as are postprocedure compression stockings. Lack of significant side-effects and an initial success rate of 100% with significant, long-standing, improvement of clinical symptoms support further clinical studies.

Cellulite is a condition affecting the dermal and subdermal compartment and developing on thighs and buttocks of almost every woman. Macroscopically, cellulite is characterized by dimpling, visible either spontaneously or after provoking maneuvers. While published concepts on the pathophysiology of cellulite are in parts inconclusive or contradictory, there are at least some recent studies describing or confirming structural and anatomic changes on dermal and subdermal tissues: (1) A gender specific dimorphism with subdermal septae oriented orthogonally towards the skin surface as well as protrusion of fat tissue into the dermis. (2) These intradermal fat protrusions additionally correlate with the presence of cellulite. (3) There is also a correlation between the thickness of the subdermal fat layer and the presence of cellulite. (4) Cellulite also correlates with focal hypertrophic subcutaneous septae and a reduced density of septae in general. Treatment of cellulite aims at (1) the reduction of the subcutaneous fat layer, (2) increase in dermal thickness and elasticity and (3) dissection of hypertrophic connective tissue septae, responsible for the most pronounced dermal indentions. A variety of treatment options have evolved ranging from topical retinol to interstitial laser.

Background. If ablation of otherwise competent accessoric saphenous veins should be performed concurrently to endothermal ablation of incompetent great saphenous veins (GSVs) or not is still a matter of debate.Methods. During 2-year follow-up of a prospective trial on segmental thermal ablation of incompetent GSVs, duplex ultrasound data was collected on diameters and pathological refluxes of eventually detectable accessoric saphenous veins.Results. Initially, of N=93 limbs which received ablation of the GSV showed accessoric anterior saphenous veins (AASVs) in n=43 cases (48%). Their average diameter was 2.6 +/- 1.0 mm, only n=2 veins with a diameters of 2.2 mm and 4.8 mm showed reflux. At 2-year follow-up with n=90 legs, accessoric anterior saphenous veins (AASVs) were detected in n=53 cases (59%) with an average diameter of 3.0 +/- 1.2 mm. The proportion of AASVs with pathological reflux increased to n=16 (30%), the average diameter of the incompetent veins was 3.2 +/- 1.7 mm. Accessoric posterior saphenous veins (APSVs) were detected at baseline in 7% (n=6) and at 2-year follow-up in 10% (n=9) of legs, however, without presenting pathological reflux.

This prospective and multicenter study shows the results at 1 year of radiofrequency-powered segmental thermal obliteration (RSTO) carried out with the ClosureFast procedure. The RSTO clinical and duplex ultrasound imaging results were evaluated at 3 days, 3 months, 6 months, and 1 year. All procedures were carried out on outpatients under tumescent local anesthesia. Among the 295 members who were treated, 289 were reexamined at 3 days, 290 at 3 months, 289 at 6 months, and 220 at 1 year. Occlusion scores were 99.7%, 99.3%, 98.6%, and 96.9% at, respectively, 3 days, 3 months, 6 months, and 1 year. At 3 cm below the saphenofemoral junction, before the procedure, the greater saphenous vein (GSV) diameter was 5.4+/-2 mm (range 2-18). It decreased to 4.5+/-1.7 mm at 3 days, 2.4+/-1.5 mm at 6 months, and 1.3+/-0.9 mm at 1 year. In members reexamined at 1 year, the decrease in diameter of the treated vein compared with the preprocedural measurement was 79% (p<0.001, t-test). At 1 year, in 58% of the cases, duplex ultrasound imaging at mid-thigh level could not show the GSV trunk. Preprocedural pain that was present in 57.5% of the cases decreased to 10.8% of the cases at 3 days and 2% of the cases at 1 year (p<0.001, chi2 test). Among the treated limbs, 70.1% did not present with any postprocedural pain at any time of the follow-up. On the third day, the patients evaluated the mean pain intensity at 0.7+/-1.6 on a visual analog scale of 0-10. During the follow-up, no painful indurations were noticed in 67.7% of the legs. No thromboembolic complications were reported. Paresthesias were observed in 3.4% of the cases. Invalidity clinical score, evaluated at 3.9+/-2 before the procedure, decreased to 3.5+/-1.2 on the third day, 0.9+/-1.5 at 3 months, 0.7+/-1.2 at 6 months, and 0.5+/-1.1 at 1 year. This study confirms the efficacy of RSTO when using ClosureFast, which allows obliteration of the GSV trunk in 97% of cases at 1 year with few side effects and almost no postprocedural pain.

Ce travail rapporte les résultats à un an de l’Oblitération par Segments par Radio Fréquence (OSRF) réalisée avec le dispositif ClosureFast®. C’est une étude prospective, multicentrique. Les résultats cliniques et écho-Doppler de l’OSRF ont été évalués à 3 jours, 3 mois, 6 mois et un an. Toutes les procédures ont été réalisées sous anesthésie locale tumescente en ambulatoire. Parmi les 295 membres traités, 289 ont été revus à 3 jours, 290 à 3 mois, 289 à 6 mois et 220 à 1 an. Les taux d’occlusion ont été de 99,7 %, 99,3 %, 98,6 % et 96,9 % à respectivement 3 jours, 3 mois, 6 mois et 1 an. Le diamètre de la grande veine saphène (GVS) 3 cm avant la jonction saphéno-fémorale (JSF) est passé de 5,4±2 mm (2-18 mm) en préopératoire à 4,5 ±1,7 mm à 3 jours, 2,4±1,5 mm à 6 mois et 1,3±0,9 mm à 1 an. Pour les membres revus à 1 an, la réduction du diamètre de la veine traitée par rapport à la mesure préopératoire a été de 79% (p < 0,001, test t). A 1 an, le tronc de la GVS n’était pas discernable en échographie à mi-cuisse dans 58% des cas. La douleur présente en préopératoire chez 57,5 % des patients traités, a été rapportée en post opératoire par 10,8 % des patients au 3ème jour et par 2% des patients à 1 an (P < 0,001, test X2). Parmi les membres traités 70,1 % n’ont présenté en postopératoire aucune douleur à aucun moment du suivi. L’intensité moyenne de douleur a été évaluée par les patients à 0,7±1,6 au 3ème jour sur une échelle analogique graduée de 0 à 10. Aucune induration douloureuse n’a été constatée sur 67,7 % des membres au cours du suivi. Aucune complication thromboembolique n’a été rapportée. Des paresthésies ont été observées dans 3,4 % des cas. Le score clinique d’invalidité, évalué à 3.9±2 en préopératoire, est passé à 3,5±1,2 au 3ème jour, 0,9±1,5 à 3 mois, 0,7±1,2 à 6 mois et 0,5±1,1 à 1 an. Cette étude confirme l’efficacité de l’OSRF utilisant ClosureFast®, qui permet d’obtenir une oblitération du tronc de la GVS dans 97 % des cas à 1 an avec peu d’effets secondaires et une absence presque totale de douleurs postopératoires.

Anamnese und klinischer Befund: Klinisch-chemische Untersuchungen: Therapie und Verlauf: Folgerung: History and clinical findings: Laboratory investigations: Treatment and course: Conclusion:

HISTORY AND CLINICAL FINDINGS A 52-year-old man had been in terminal renal failure for 6 years. On haemodialysis under heparin without complications, acral skin necroses occurred. Even with low-molecular heparin anticoagulation further lesions developed. Within 12 weeks of haemodialysis being performed without heparin the necroses healed, but they recurred when heparin was again added for dialysis. On admission the patient was in poor general condition, with a weight of 55 kg (height 175 cm). LABORATORY INVESTIGATIONS: The heparin-induced platelet aggregation (HIPA) test was positive in the absence of thrombocytopenia. Na-heparin reacted positively in three out of four tests, but Danaparoid did not react. TREATMENT AND COURSE The skin necroses once again healed after the heparinoid Danaparoid, which had not reacted in the HIPA test, had been substituted for heparin. CONCLUSION This case illustrates that skin necroses, thrombocytopenia and thromboembolism can be independent signs of immunologically induced platelet aggregation.

Two months after the onset of mainly frontal headaches a 25-year-old man of Turkish descent additionally developed double vision. Fundoscopy revealed bilateral choked discs and right trochlear paralysis. Computed tomography and digital subtraction angiography demonstrated thrombosis of the superior sagittal sinus. On admission to hospital the patient was fully conscious but had marked meningism, bilaterally positive Lasègue's sign (painful straight leg raising) at a 50 degree angle, and multiple oral aphthous ulcers. The sinus thrombosis suggested a chronic inflammatory process, while the oral ulcers pointed to Behçet's syndrome.Inflammatory parameters (erythrocyte sedimentation rate, C-reactive protein and white blood cell count) were increased and the HLA-B27 test was positive. Other laboratory tests, cerebrospinal fluid, chest radiogram and ECG were unremarkable.Despite intravenous administration of heparin nad cefuroxim for one week the sagittal sinus thrombosis spread to the straight sinus. In the third week scrotal ulcerations were noted and taken to confirm Behçet's syndrome. Immunosuppressive treatment with methylprednisolone (initially 80 mg daily) and 2 weeks later together with chlorambucil (0.1 mg/kg daily) was started. Four weeks later the patient was free of symptoms and discharged.Neurological signs are not adequately stressed by the International Study Group for Behçet's Disease among its listed diagnostic criteria.

6 months before admission a 21-year-old woman had developed anogenital condylomata acuminata (CA). Since early childhood she had been treated for primary hypoparathyroidism (PHPT) and recurrent mucocutaneous candidiasis. 5 years before admission corneal clouding had caused visual impairment. Recently, mainly truncal vitiligo with occipital poliosis had developed.PHPT was confirmed (parathormone level 7.7 mg/l). In addition, liver transaminases were raised (GOT 105.8 U/l, GPT 145.6 U/l, gamma-GT 56.8 U/l), pointing to noninfectious hepatitis. An ACTH stress test could not exclude manifest adrenocortical insufficiency, and thyroid function was also normal. The Merieux Multitest indicated an anergy.The constellation of test results suggested autoimmune polyglandular syndrome type I. The condylomata were treated by electrocautery and the intestinal candidiasis with amphotericin B suspension. Calcitriol capsules, 0.5 microgram, and calcium gluconate or lactate, 500 and 300 mg respectively, 3 times daily each, were given for the PHPT.This case demonstrates a complex syndrome which can be recognized early by simple clinical tests. Early diagnosis prevents possible life-threatening complications.

BACKGROUND:Limited data are available about treatment-related side effects with respect to laser wavelength in endovenous laser treatment (ELT) of the great saphenous vein (GSV).OBJECTIVE:To compare the results and side effects of a 940 nm diode and a 1,320 nm neodymium:yttium-aluminum-garnet (Nd:YAG) laser.METHODS:Three patient cohorts (A, B, and C) received ELT of the GSV using a 940 nm diode laser at 15 W (group A) or 30 W (group B) or using a 1,320 nm laser at 8 W (group C). In all cases, energy was administered continuously with constant pullback of the laser fiber under perivenous tumescent local anesthesia.RESULTS:The GSVs of group A (n = 113), group B (n = 136), and group C (n = 33) received ELT. An average linear endovenous energy density of 24, 63, and 62 J/cm and an average endovenous fluence equivalent of 12, 30, and 33 J/cm2 were administered to the vein. Occlusion rates were 95% (group A), 100% (group B), and 100% (group C) at day 1 after ELT and 90.3% (group A), 100% (group B), and 97% (group C) at 3 months after ELT. With the 1,320 nm laser ELT (group C), treatment-related pain (50%) and the need for analgesics (36%) were significantly reduced (p < .005) in comparison with treatment-related pain (81%) and the need for analgesics (67%) after the 30 W 940 nm laser ELT (group B). Ecchymosis was also significantly reduced (p < .05) in group C (1,320 nm) compared with group B (30 W, 940 nm).CONCLUSION:ELT of the GSV using a 1,320 nm Nd:YAG laser causes fewer side effects compared with 940 nm diode laser ELT.

PURPOSE:To assess the prognostic value of serial reverse transcriptase polymerase chain reaction (RT-PCR) -based measurements of tyrosinase mRNA in peripheral blood of stage II and III melanoma patients.PATIENTS AND METHODS:During routine follow-up of American Joint Committee on Cancer stage II and III melanoma patients, serial testing for tyrosinase transcripts in peripheral blood was performed by RT-PCR. The PCR results were compared with the clinical data collected during the follow-up.RESULTS:Over a period of 3 years, 111 patients (78 stage II and 33 stage III patients) were enrolled, and tyrosinase determinations were carried out. The 6-year disease-specific survival probability was 97% for patients always showing negative RT-PCR results and 67% for patients who tested positive at least once. In a Cox proportional hazards model, the prognostic value of sex, age, site of primary tumor, histologic subtype, stage, Breslow's tumor thickness, Clark level, and the time-dependent variable PCR result was assessed. Patients with a positive RT-PCR test had a distinctly higher risk of dying from melanoma, with a hazard ratio of 12.6 (95% CI, 3.4 to 46.3; P < .001).CONCLUSION:Our study shows a strong association between PCR and disease-specific survival time. Detection of tyrosinase mRNA in peripheral blood may be of similar importance for the clinical course of melanoma as the detection of micrometastatic disease in the sentinel lymph node. Whether a combination of these two factors leads to a better definition of the prognosis of melanoma patients is under investigation in current studies.

BACKGROUNDBased on phase II trial results, chemoimmunotherapy combinations have become the preferred treatment for patients with metastatic melanoma in many institutions. This study was performed to determine whether interleukin-2 (IL-2) as a component of chemoimmunotherapy influences survival of patients with metastatic melanoma.PATIENTS AND METHODSPatients with advanced metastatic melanoma were randomly assigned to receive dacarbazine 250 mg/m2 and cisplatin 30 mg/m2 on days 1 to 3 combined with interferon-alfa-2b 10 x 10(6) U/m2 subcutaneously on days 1 through 5 without (arm A) or with (arm B) a high-dose intravenous decrescendo regimen of IL-2 on days 5 through 10 (18 x 10(6) U/m2/6 hours, 18 x 10(6) U/m2/12 hours, 18 x 10(6) U/m2/24 hours, and 4.5 x 10(6) U/m2 for 3 x 24 hours). Treatment cycles were repeated in the absence of disease progression every 28 days to a maximum of four cycles.RESULTSThree hundred sixty-three patients with advanced metastatic melanoma were accrued. The median survival was 9 months in both arms, with a 2-year survival rate of 12.9% and 17.6% in arms A and B, respectively (P = .32; hazard ratio, 0.90; 95% CI, 0.72 to 1.11). There was also no statistically significant difference regarding progression-free survival (median, 3.0 v 3.9 months) and response rate (22.8% v 20.8%).CONCLUSIONDespite its activity in melanoma as a single agent or in combination with interferon-alfa-2b, the chosen schedule of IL-2 added to the chemoimmunotherapy combination had no clinically relevant activity.

Endovenous laser treatment (ELT) is the planned elimination of subcutaneously and intrafascially located varicose veins by intraluminal loser administration. ELT should only be applied by physicians with specialized phlebological knowledge and skills, who are capable to master and, furthermore, regularly perform phlebological diagnostics as well as indication of phlebological treatments. The physician additionally should be able to perform additional treatments with respect to follow-up and be familiar with alternative treatment options.

ZusammenfassungDie endovenöse Lasertherapie (ELT) ist die planvolle Ausschaltung von subkutanen und intrafaszial gelegenen Varizen durch intraluminale Laseranwendung. Nur Ärzte sollen die ELT anwenden, die über phlebologische Spezialkenntnisse und -fertigkeiten verfügen, d. h. sie beherrschen sowohl die Methode als auch die Diagnose- und Indikationsstellung sowie die Therapieplanung phlebologischer Krankheitsbilder und üben dies regelmäßig aus. Der Therapeut muss außerdem ggf. ergänzende Nachbehandlungen durchführen können und mit alternativen Therapieverfahren vertraut sein.