Chapter: Conservative therapy
Article: 1 of 8
Update: Mai 15, 2021
Author(s): Wohlgemuth, Walter A.
The most important basis of what is often life-long therapy for patients with vascular anomalies is the conservative therapy, not the invasive or surgical therapy as is often assumed.
Even with conservative therapy methods, the correct indication and implementation are essential, since even conservative therapy methods can have side effects or undesirable effects and can do more harm than good if used incorrectly.
However, the risk-benefit ratio is generally good, provided that certain special aspects are taken into account, which are covered in the following chapter.
Both phlebedema and lymphedema have a tendency to worsen if left untreated, especially in the lower extremity, and can be effectively and sustainably improved by compression and decongestive therapy measures. Appropriate, mostly custom-made compression products can reduce the progression of the disease and prevent complications.
Compression therapy, which is often necessary throughout life, is the most important and helpful therapeutic measure. Proper fitting of the compression garments is a prerequisite. This is complemented by manual lymphatic drainage/complex combined decongestive therapy.
Pain and functional limitations in joints, muscles and the whole musculoskeletal system can lead to permanent secondary damage, which can be avoided and treated. It is particularly important to maintain the ability to walk and the patient’s mobility. Physiotherapeutic and occupational therapy measures are essential for regaining mobility, reducing pain and maintaining function, especially in the musculoskeletal system, but they are also essential tools in a rehabilitation phase after major interventions or serious phases of illness.
Drug therapy methods also have their place in the conservative treatment of vascular anomalies, and are even gaining in importance as a result of new findings. The most important groups of drugs in this field have proved to be coagulation therapy and anticoagulation, pain therapy, specific anti-angiogenic drugs (especially mTOR inhibitors such as sirolimus), the treatment of infantile hemangiomas with propranolol and erysipelas treatment with antibiotics.