Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/1677-5449.200070
Jornal Vascular Brasileiro
Case Report

Varizes pulsáteis simulando aneurisma de artéria femoral: relato de caso

Pulsatile varicose veins simulating femoral artery aneurysm: case report

Cleilson Almeida Marchesi; Márcia Porto Assis

Downloads: 1
Views: 714

Resumo

Resumo: A regurgitação tricúspide severa é citada como fator associado ao desenvolvimento ou à recidiva de varizes em membros inferiores as quais podem, retrogradamente, apresentar um fluxo pulsátil. O diagnóstico etiológico diferencial desse achado ultrassonográfico deve ser feito com a pesquisa de fístulas arteriovenosas, tendo em vista as diferentes formas de tratamento. Dada a complexidade do estado geral dos pacientes com regurgitação tricúspide, a escolha do tratamento das varizes pulsáteis deve ser individualizada, fruto de uma avaliação multidisciplinar. Fazem parte do arsenal terapêutico todas as técnicas habitualmente empregadas no tratamento de varizes, bem como a associações entre elas a serem escolhidas levando-se em conta a gravidade das manifestações clínicas e o risco cardiovascular envolvido. Relatamos um caso de varizes pulsáteis secundárias a regurgitação tricúspide, diagnosticado durante a suspeita primária de aneurisma de artéria femoral em paciente de 73 anos, com a classificação clínica da doença venosa (CEAP) 4a, oligossintomática, tratada com medidas posturais e elastocompressão.

Palavras-chave

varizes, pulsáteis, regurgitação tricúspide, ultrassonografia vascular

Abstract

Severe tricuspid regurgitation is mentioned as a factor associated with development or recurrence of varicose veins in the lower limbs and may present with retrograde pulsatile flow. Differential etiological diagnosis of this ultrasound finding must include investigation of arteriovenous fistulas, since the treatment methods are different. Given the complexity of the general condition of patients with tricuspid regurgitation, treatment for pulsatile varices should be chosen on a case-by-case basis after multidisciplinary evaluation. All of the techniques commonly used to treat varicose veins are part of the therapeutic arsenal, as well as combinations of them, taking into account the severity of clinical manifestations and the cardiovascular risk involved. We report a case of pulsatile varices secondary to tricuspid regurgitation diagnosed when investigating a primary suspicion of femoral artery aneurysm in a 73-year-old patient, CEAP 4a, oligosymptomatic, who was treated with postural measures and elastic compression.

Keywords

varicose veins; pulsatile; tricuspid regurgitation; vascular ultrasound.

References

1 Bendick PJ. Cardiac effects on peripheral vascular doppler waveforms. JVU. 2011;35(4):237-43. http://dx.doi.org/10.1177/154431671103500407.

2 Chihara S, Sawada K, Tomoeda H, Aoyagi S. Pulsatile varicose veins secondary to severe tricuspid regurgitation: report of case successfully managed by endovenous laser treatment. Ann Vasc Surg. 2017;39:286.e11-14. http://dx.doi.org/10.1016/j.avsg.2016.06.026. PMid:27666801.

3 Kerr WMJ, Warren SL. Peripheral pulsations in the veins in congestive failure of the heart, associated with the pulsaton of the liver and tricuspid regurgitation. Arch Intern Med. 1925;36(5):593-613. http://dx.doi.org/10.1001/archinte.1925.00120170002001.

4 Ribeiro AJA, Ribeiro ACO, Rodrigues MMM, et al. Avaliação da influência de alterações cardíacas na ultrassonografia vascular periférica de idosos. J Vasc Bras. 2016;15(3):205-9. http://dx.doi.org/10.1590/1677-5449.010015. PMid:29930591.

5 Dalla Vestra M, Grolla E, Bonanni L, Dorrucci V, Presotto F, Rigo F. From the veins to the heart: a rare cause of varicose veins. Case Rep Vasc Med. 2015;2015:849408. PMid:26090263.

6 Badger SA, Makar RR, Chew EW, Lee B. Recurrent bilateral varicose veins secondary to tricuspid regurgitation. Ir J Med Sci. 2012;181(3):405-7. http://dx.doi.org/10.1007/s11845-010-0547-6. PMid:20706799.

7 Casian D, Gutsu E, Culiuc V. Surgical treatment of severe chronic venous insufficiency caused by pulsatile varicose veins in a paciente with tricuspid regurgitation. Phlebology. 2009;24(2):79-81. http://dx.doi.org/10.1258/phleb.2008.008043. PMid:19299276.

8 Rispoli P, Varetto G, Santovito D, Castagno C, Tallia C. A severe cause of pulsating varicose vein. Lancet. 2011;378(9809):2138. http://dx.doi.org/10.1016/S0140-6736(11)61578-X. PMid:22177513.

9 Klein HO, Shachor D, Schneider N, David D. Unilateral pulsatile varicose veins from tricuspid regurgitation. Am J Cardiol. 1993;71(7):622-3. http://dx.doi.org/10.1016/0002-9149(93)90528-K. PMid:8438758.

10 Abbas M, Hamilton M, Yahya M, Mwipatayi P, Sieunarine K. Pulsating varicose veins!! The diagnosis lies in the heart. ANZ J Surg. 2006;76(4):264-6. http://dx.doi.org/10.1111/j.1445-2197.2006.03597.x. PMid:16681546.

11 Li X, Feng Y, Liu Y, Zhang F. Varicose veins of the lower extremity secondary of tricuspid regurgitation. Ann Vasc Surg. 2019;60:477.e1-6. http://dx.doi.org/10.1016/j.avsg.2019.02.052. PMid:31075472.
 


Submitted date:
12/20/2020

Accepted date:
02/15/2021

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
60c0cd3ca953950cbf51e933 jvb Articles

J Vasc Bras

Share this page
Page Sections