Jornal Vascular Brasileiro
https://www.jvascbras.org/article/5e20511e0e8825962911f7b5
Jornal Vascular Brasileiro
Original Article

Classificação anatomofuncional da insuficiência das veias safenas baseada no eco-Doppler colorido, dirigida para o planejamento da cirurgia de varizes

Functional anatomic classification of saphenous vein insufficiency in the planning for varicose vein surgery based on color Doppler ultrasound

Carlos Alberto Engelhorn, Ana Luiza Engelhorn, Maria Fernanda Cassou, Cassiana Casagrande Zanoni, Carlos José Gosalan, Emerson Ribas

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Resumo

Objetivo: Os objetivos deste estudo são apresentar uma classificação funcional ampliada dos padrões de refluxo nas safenas baseada no eco- Doppler colorido e determinar seus pontos de refluxo e escoamento, a fim de orientar o cirurgião quanto à programação cirúrgica. População e método: No período de junho a dezembro de 2002, foram estudados prospectivamente pelo eco-Doppler colorido 1.740 membros inferiores de 910 pacientes com queixas de insuficiência venosa crônica. O grupo de pacientes era constituído de 128 homens e 782 mulheres, com média de idade de 41 anos. Dos 1.740 membros, 324 foram excluídos por apresentarem trombose venosa profunda antiga ou por terem sido submetidos a cirurgia prévia de varizes. De acordo com as fontes causadoras e os pontos de drenagem do refluxo, foram estabelecidos padrões de refluxo para as safenas interna e externa. Das 1.416 extremidades incluídas no estudo, 718 foram do membro inferior direito e 692 do membro inferior esquerdo. Resultados: As safenas internas não apresentaram refluxo em 398 membros inferiores (28,11%). Foram identificados seis padrões de refluxo na safena interna, com maior incidência do refluxo segmentar isolado (33,54%). As principais fontes causadoras e os pontos de drenagem do refluxo na safena interna foram as veias tributárias colaterais da perna (44,78 e 33,97%, respectivamente). As safenas externas não apresentaram refluxo em 1.132 extremidades (79,94%). Foram identificados seis padrões de refluxo na veia safena externa, com maior incidência de refluxo segmentar (8,47%). As principais fontes causadoras e os pontos de drenagem do refluxo na safena externa foram as veias tributárias colaterais (70,24 e 83,33%, respectivamente). A junção safeno-poplítea localizava- se principalmente na prega poplítea (54,6%). O refluxo do sistema venoso profundo estava presente em 3,53% dos membros inferiores. Conclusão: A classificação apresentada ressalta as diferentes formas de apresentação do refluxo nas safenas e a importância do planejamento cirúrgico das varizes de membros inferiores, a fim de evitar recidivas ou retiradas desnecessárias das safenas.

Palavras-chave

ultra-som, veia safena, ultra-sonografia Doppler em cores

Abstract

Objective: The objective of this study is to present a functional classification of reflux patterns in saphenous veins based on color Doppler ultrasound, and to determine the sites of reflux and drainage in order to guide the surgeon in the surgical planning. Patients and Methods: From June to December 2002, color Doppler ultrasound was used to study prospectively 1,740 lower extremities from 910 patients complaining of chronic venous insufficiency. There were 128 male and 782 female patients, with average age of 41 years. Of these 1,740 limbs, 324 were excluded because they presented past chronic deep venous thrombosis or underwent previous varicose vein surgery. The patterns of reflux for the great and short saphenous veins were established according to the sources of reflux and sites of drainage. From the 1,416 extremities included in the study, 718 were right lower limbs and 692 were left lower limbs. Results: The great saphenous vein had no reflux in 398 lower limbs (28.11%). A total of six different patterns of reflux were identified to the great saphenous vein, and the isolated segmental reflux was the most common (33.54%) of them. The main sources of reflux and sites of drainage in the great saphenous vein were the tributaries of the leg (44.78% and 33.97%, respectively). The short saphenous vein was normal in 1,132 extremities (79.94%). A total of six different patterns of reflux were identified to the short saphenous vein, and the isolated segmental reflux was the most common (8.47%) of them. The main sources of reflux and sites of drainage in the short saphenous vein were also the tributaries (70.24% and 83.33%, respectively). The most common place of the saphenofemoral junction was at the popliteal fold (54.6%). Deep venous reflux occurred in 3.53% of the lower limbs. Conclusion: The classification proposed gives salience to the different types of reflux in long and short saphenous veins and to the importance of the surgical planning in the treatment of lower limb varicose veins in order to avoid recurrent varicose veins or unnecessary removal of saphenous veins.

Keywords

ultrasonography, saphenous vein, color Doppler ultrasonography
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