Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/1677-5449.200172
Jornal Vascular Brasileiro
Original Article

Resultados do tratamento do refluxo de veias safenas com endolaser 1.470 nm e correlação com o grau de insuficiência venosa

Results of venous reflux treatment with 1,470 nm endolaser and correlation with degree of venous insufficiency

Ana Paula Pires Silva; Daniel Mendes Pinto; Vanessa Aline Miranda Vieira Milagres; Leonardo Ghizoni Bez; Júlio César Arantes Maciel; Caetano de Souza Lopes

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Resumo

Resumo: Contexto: Pacientes com doença venosa crônica avançada são mais propensos a exigir outros procedimentos para recidiva de veias varicosas. Ainda não está estabelecido se a gravidade da insuficiência venosa é um fator que influencia a taxa de oclusão de veias safenas tratadas por endolaser.

Objetivos: Analisar a taxa de oclusão dos segmentos venosos tratados com endolaser e correlacionar com o Venous Clinical Severity Score (VCSS) e a classificação Clínica-Etiológica-Anatômica-Patológica (CEAP) dos pacientes.

Métodos: Análise retrospectiva de coorte de pacientes operados com endolaser 1.470 nm entre novembro/2012 a março/2020. Foram realizadas estatística descritiva e curva de sobrevida de Kaplan-Meier com regressão de Cox para grupos de VCSS e CEAP.

Resultados: Foram analisados 170 pacientes e 180 segmentos venosos; a idade média foi de 44,3 ± 9,2, sendo a maioria do sexo feminino (71%). A densidade de energia média utilizada na veia safena magna foi 49,2 ± 8,3 J/cm. As principais complicações foram dor no trajeto da safena (12,2%) e parestesias após 6 meses (17,2%). Não houve diferença na taxa de oclusão venosa entre grupos com VCSS ≤ 7 e VCSS > 7 (p = 0,067). O grupo de pacientes com CEAP agrupada C4-C5-C6 teve taxa de oclusão menor em relação ao grupo C2-C3 [hazard ratio (HR) = 3,22; intervalo de confiança (IC) 1,85, 5,61; p = 0,001].

Conclusões: As taxas de oclusão de segmentos venosos tratados com endolaser foram menores na presença de classificações CEAP avançadas. Nesses pacientes, provavelmente deve-se despender mais energia para o tratamento eficaz das safenas.

Palavras-chave

varizes, laserterapia, veia safena

Abstract

Background: Patients with advanced chronic venous disease are more likely to need additional procedures for relapsed varicose veins. It has not yet been established whether severity of venous insufficiency is a factor that influences the occlusion rate of saphenous veins treated with endolasers. Objectives: To analyze occlusion rate of venous segments treated with endolaser and correlate it with patients’ Venous Clinical Severity Score (VCSS) and Clinical-EtiologicalAnatomical-Pathological (CEAP) classification. Methods: Retrospective analysis of a cohort of patients operated using a 1,470 nm endolaser from November 2012 to March 2020. Descriptive statistics were calculated and Kaplan-Meier survival curves were plotted with Cox regression for groups stratified by VCSS and CEAP. Results: A total of 180 venous segments were analyzed in 170 patients. Mean age was 44.3 ± 9.2 and the majority of patients were female (71%). Mean energy density used in the great saphenous vein was 49.2 ± 8.3 J/cm. The most common complications were pain along the course of the saphenous vein (12.2%) and paresthesias at 6 months (17.2%). There was no difference in venous occlusion rate between groups with VCSS ≤ 7 and VCSS > 7 (p = 0.067). A group of patients classified as CEAP classes C4, C5, or C6 had a lower occlusion rate than a group at classes C2 or C3 (hazard ratio [HR] = 3.22; confidence interval [CI] 1.85, 5.61; p = 0.001]. Conclusions: The occlusion rates of venous segments treated with endolaser were lower in patients with higher CEAP classes. It is probably necessary to use more energy in these patients to achieve effective treatment of saphenous veins.

Keywords

varicose veins; laser therapy; saphenous vein.

References

1 Bendix SD, Peterson EL, Kabbani LS, Weaver MR, Lin JC. Effect of endovenous ablation assessment stratified by great saphenous vein size, gender, clinical severity, and patient-reported outcomes. J Vasc Surg Venous Lymphat Disord. 2021;9(1):128-36. http://dx.doi.org/10.1016/j.jvsv.2020.04.017. PMid:32353593.

2 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. http://dx.doi.org/10.1016/j.ejvs.2015.02.007. PMid:25920631.

3 Gloviczki P, Comerota AJ, Dalsing MC, et al. The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 2011;53(5, Supl.):2S-48S. http://dx.doi.org/10.1016/j.jvs.2011.01.079. PMid:21536172.

4 Tan MKH, Sutanto SA, Onida S, Davies AH. The relationship between vein diameters, clinical severity, and quality of life: a systematic review. Eur J Vasc Endovasc Surg. 2019;57(6):851-7. http://dx.doi.org/10.1016/j.ejvs.2019.01.024. PMid:30850282.

5 Van der Velden SK, Lawaetz M, De Maeseneer MGR, et al. Predictors of Recanalization of the Great Saphenous Vein in Randomized Controlled Trials 1 Year After Endovenous Thermal Ablation. Eur J Vasc Endovasc Surg. 2016;52(2):234-41. http://dx.doi.org/10.1016/j.ejvs.2016.01.021. PMid:26994834.

6 Bergan JJ, Eklof B, Kistner RL, et al. Classification and grading of chronic venous disease in the lower limbs. A consensus statement. J Cardiovasc Surg. 1997;38(5):437-41. PMid:9358799.

7 Mendes-Pinto D, Bastianetto P, Lyra LCB, Kikuchi R, Kabnick L. Endovenous laser ablation of the great saphenous vein comparing 1920-nm and 1470-nm diode laser. Int Angiol. 2016;35(6):599-604. PMid:26418143.

8 Pfisterer L, König G, Hecker M, Korff T. Pathogenesis of varicose veins: lessons from biomechanics. Vasa. 2014;43(2):88-99. http://dx.doi.org/10.1024/0301-1526/a000335. PMid:24627315.

9 Dogdus M, Akhan O, Ozyasar M, Yilmaz A, Altintas MS. Evaluation of arterial stiffness using pulse wave velocity and augmentation index in patients with chronic venous insufficiency. Int J Vasc Med. 2018;2018:5437678. http://dx.doi.org/10.1155/2018/5437678.

10 Obi AT, Sutzko DC, Almeida JI, et al. First 10-month results of the vascular quality initiative varicose vein registry. J Vasc Surg Venous Lymphat Disord. 2017;5(3):312-320.e2. http://dx.doi.org/10.1016/j.jvsv.2016.12.007. PMid:28411696.

11 Kokkosis AA, Schanzer H. Anatomical and clinical factors favoring the performance of saphenous ablation and microphlebectomy or sclerotherapy as a single-stage procedure. Phlebology. 2015;30(9):627-31. http://dx.doi.org/10.1177/0268355514554023. PMid:25300313.

12 Viarengo LMA, Viarengo G, Martins AM, Mancini MW, Lopes LA. Resultados de médio e longo prazo do tratamento endovenoso de varizes com laser de diodo em 1940 nm: análise crítica e considerações técnicas. J Vasc Bras. 2017;16(1):23-30. http://dx.doi.org/10.1590/1677-5449.010116. PMid:29930619.

13 Viarengo LM, Potério-Filho J, Potério GM, Menezes FH, Meirelles GV. Endovenous laser treatment for varicose veins in patients with active ulcers: measurement of intravenous and perivenous temperatures during the procedure. Dermatol Surg. 2007;33(10):1234-41. http://dx.doi.org/10.1097/00042728-200710000-00014. PMid:17903157.

14 Fernández CF, Roizental M, Carvallo J. Combined endovenous laser therapy and microphlebectomy in the treatment of varicose veins: efficacy and complications of a large single-center experience. J Vasc Surg. 2008;48(4):947-52. http://dx.doi.org/10.1016/j.jvs.2008.05.029. PMid:18692346.

15 Kemaloğlu C. Saphenous vein diameter is a single risk factor for early recanalization after endothermal ablation of incompetent great saphenous vein. Vascular. 2019;27(5):537-41. http://dx.doi.org/10.1177/1708538119837110. PMid:30880609.

16 Yamamoto T, Sakata M. Morphological Comparison of Blood Vessels that were Heated with a Radiofrequency Device or a 1470-nm Laser and a Radial 2Ring Fiber. Ann Vasc Dis. 2016;9(4):272-6. http://dx.doi.org/10.3400/avd.oa.16-00120. PMid:28018497.

17 Malý I, Julínek S, Winkler L. Five years’ experience in endovenous laser therapy of lower extremity varicose veins. Int Surg. 2010;95(3):221-6. PMid:21067000.

18 Wallace T, El-Sheikha J, Nandhra S, et al. Long-term outcomes of endovenous laser ablation and conventional surgery for great saphenous varicose veins. Br J Surg. 2018;105(13):1759-67. http://dx.doi.org/10.1002/bjs.10961. PMid:30132797.
 


Submitted date:
09/23/2020

Accepted date:
12/04/2020

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