Padrões de refluxo nas veias safenas em homens com insuficiência venosa crônica
Patterns of saphenous reflux in men with chronic venous insufficiency
Carlos Alberto Engelhorn, Francisco Eduardo Coral, Isabela Chaves Monteiro Soares, Gabriel Fernando de Araújo Corrêa, Jaqueline Pozzolo Ogeda, Larissa Yuri Hara, Luisa Saemi Murasse
Resumo
Contexto: A insuficiência venosa crônica (IVCr) é frequente e predomina nas mulheres, mas ainda há poucas informações sobre o refluxo nas veias safenas na população masculina. Objetivos: Identificar os diferentes padrões de refluxo nas veias safenas magnas (VSMs) e parvas (VSPs) em homens, correlacionando esses dados com a apresentação clínica conforme a classificação Clínica, Etiológica, Anatômica e Fisiopatológica (CEAP). Métodos: Foram avaliados 369 membros inferiores de 207 homens pela ultrassonografia vascular (UV) com diagnóstico clínico de IVCr primária. As variáveis analisadas foram a classificação CEAP, o padrão de refluxo nas VSMs e VSPs e a correlação entre os dois. Resultados: Nos 369 membros avaliados, 72,9% das VSMs apresentaram refluxo com predominância do padrão segmentar (33,8%). Nas VSPs, 16% dos membros inferiores analisados apresentaram refluxo, sendo o mais frequente o padrão distal (33,9%). Dos membros classificados como C4, C5 e C6, 100% apresentaram refluxo na VSM com predominância do refluxo proximal (25,64%), e 38,46% apresentaram refluxo na VSP com equivalência entre os padrões distal e proximal (33,3%). Refluxo na junção safeno-femoral (JSF) foi detectado em 7,1% dos membros nas classes C0 e C1, 35,6% nas classes C2 e C3, e 64,1% nas classes C4 a C6. Conclusões: O padrão de refluxo segmentar é predominante na VSM, e o padrão de refluxo distal é predominante na VSP. A ocorrência de refluxo na JSF é maior em pacientes com IVCr mais avançada.
Palavras-chave
Abstract
Background: Chronic venous insufficiency (CVI) is frequent and predominantly affects women, but there is a lack of information about saphenous vein reflux in the male population. Objective: To identify different patterns of reflux in the great and small saphenous veins of men and correlate them with clinical presentation graded according to the Clinical-Etiology-Anatomy-Pathophysiology (CEAP) classification. Methods: A total of 369 lower limbs in 207 men with a clinical diagnosis of primary CVI of the lower limbs were evaluated using vascular ultrasound (VU). The variables analyzed were CEAP clinical classification, patterns of reflux in the great and small saphenous veins, and the correlations between them. Results: A total of 369 limbs were evaluated and in 72.9% of them the great saphenous vein (GSV) had reflux, predominantly the segmental pattern (33.8%), while in 16% of the lower limbs analyzed the small saphenous vein (SSV) had reflux, among which the most frequent pattern was distal (33.9%). All limbs classified as C4, C5, or C6 had GSV reflux, predominantly proximal (25.64%), while 38.46% had SSV reflux compatible with distal and proximal reflux patterns (33.3%). Reflux was detected at the saphenofemoral junction (SFJ) in 7.1% of limbs graded C0 and C1, in 35.6% of C2 and C3 limbs and in 64.1% of C4 to C6 limbs. Conclusion: The predominant reflux patterns are segmental at the GSV and distal at the SSV. The frequency of SFJ reflux is higher in patients with more advanced CVI.
Keywords
References
1. Scuderi A, Raskin B, Al Assal F, et al. The incidence of venous disease in Brazil based on the CEAP classification. Int Angiol. 2002;21(4):316-21. PMid:12518109.
2. Evans CJ, Fowkes FGR, Ruckley CV, Lee AJ. Prevalence of varicose veins and chronic venous insuficiency in men and women in the general population : Edinburgh Vein Study. J Epidemiol Community Health. 1999;53(3):149-53. PMid:10396491. http://dx.doi.org/10.1136/jech.53.3.149.
3. Maffei FH, Magaldi C, Pinho SZ, et al. Varicose veins and chronic venous insufficiency in Brazil: prevalence among 1755 inhabitants of a country town. Int J Epidemiol. 1986;15(2):210-7. PMid:3721683. http://dx.doi.org/10.1093/ije/15.2.210.
4. Boisseau MR, Eklof B. Chronic venous disease. N Engl J Med. 2006;355(5):488-98. PMID: 16885552. http://dx.doi.org/10.1056/NEJMra055289.
5. Schmid-Schonbein GW, Takase S, Bergan JJ. New advances in the understanding of the pathophysiology of chronic venous insufficiency. Angiology. 2001;52(Suppl 1):S27-34. PMid:11510594. http://dx.doi.org/10.1177/000331970105200104.
6. Wittens C, Davies AH, Bækgaard N, et al. Management of chronic venous disease. clinical practice guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2015;49(6):678-737. PMid:25920631.
7. Eklof B, Rutherford RB, Bergan JJ, et al. Revision of the CEAP classification for chronic venous disorders: consensus statement. J Vasc Surg. 2004;40(6):1248-52. PMid:15622385. http://dx.doi.org/10.1016/j.jvs.2004.09.027.
8. Coleridge-Smith P, Labropoulos N, Partsch H, Myers K, Nicolaides A, Cavezzi A. Duplex ultrasound investigation of the veins in chronic venous disease of the lower limbs −UIP consensus document. Part I basic principles. Eur J Vasc Endovasc Surg. 2006;31(1):83-92. PMid:16226898. http://dx.doi.org/10.1016/j.ejvs.2005.07.019.
9. Engelhorn CA, Engelhorn AL, Cassou MF, Casagrande C, Gosalan CJ, Ribas E. Classificação anátomo-funcional da insuficiência das veias safenas baseada no eco-Doppler colorido, dirigida para o planejamento da cirurgia de varizes. J Vasc Bras. 2004;3(1):13-9.
10. van Bemmelen S, Bedford G, Beach K, Strandness DE Jr. Quantitative segmental evaluation of venous valvular reflux with duplex ultrasound scanning. J Vasc Surg. 1989;10(4):425-31. PMid:2677416. http://dx.doi.org/10.1016/0741-5214(89)90417-5.
11. Labropoulos N, Tiongson J, Pryor L, et al. Definition of venous reflux in lower-extremity veins. J Vasc Surg. 2003;38(4):793-8. PMid:14560232. http://dx.doi.org/10.1016/S0741-5214(03)00424-5.
12. Engelhorn CA, Engelhorn AL, Cassou MF, Salles-Cunha SX. Patterns of saphenous reflux in women with primary varicose veins. J Vasc Surg. 2005;41(4):645-51. PMid:15874929. http://dx.doi.org/10.1016/j.jvs.2004.12.051.
13. Cassou MF, Gonçalves PCZ, Engelhorn CA. Probabilidade de refluxo nas veias safenas de mulheres com diferentes graus de insuficiência venosa crônica. J Vasc Bras. 2007;6(3):238-45. http://dx.doi.org/10.1590/S1677-54492007000300007.
14. Garcia-Gimeno M, Rodriguez-Camarero S, Tagarro-Villalba S, et al. Reflux patterns and risk factors of primary varicose veins’ clinical severity. Phlebol J Venous Dis. 2013;28(3):153-61. PMid:22345327. http://dx.doi.org/10.1258/phleb.2011.011114.
15. Pittaluga P, Chastanet S, Rea B, Barbe R. Classification of saphenous refluxes: implications for treatment. Phlebol J Venous Dis. 2008;1(23):2-9. PMid:18361263. http://dx.doi.org/10.1258/phleb.2007.007042.
16. Labropoulos N, Leon M, Nicolaides AN, Giannoukas AD, Volteas N, Chan P. Superficial venous insufficiency: correlation of anatomic extent of reflux with clinical symptoms and signs. J Vasc Surg. 1994;20(6):953-8. PMid:7990191. http://dx.doi.org/10.1016/0741-5214(94)90233-X.