Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/1677-5449.202200192
Jornal Vascular Brasileiro
Original Article

Patterns of flow drainage from varicose veins originating in the incompetent great saphenous vein

Padrões de drenagem do fluxo das varizes oriundas da veia safena magna incompetente

Felipe Coelho Neto; Maria Isabel Sarti Benatti; Mariana Cavalaro Ricciardi; Nicole Dorneli de Carvalho; Sergio Quilici Belczak; Walter Júnior Boim de Araújo; Rodrigo Gomes de Oliveira

Downloads: 3
Views: 501

Abstract

Abstract: Background: Chronic venous insufficiency affects the lives of many people and therefore constitutes a public health problem. Knowledge of the drainage patterns of reflux from varicose veins secondary to incompetent saphenous veins is essential to define the best therapeutic management.

Objectives: To determine the reflux drainage patterns from varicose veins originating in incompetent GSV, the prevalence of perforating veins (PV), and their relationships with symptoms.

Methods: 55 ultrasound reports were analyzed to determine the drainage patterns of reflux from the GSV, location and diameter of PV drainage, and staging of symptoms.

Results: In 64% of the sample, reflux from varicose veins drained to PVs, in 4% reflux drained to the GSV itself, in another 4% drainage was to the small saphenous vein, and in 29% drainage was to varicose trunk veins in which no direct communication with the deep system could be identified. No associations were observed between symptoms and reflux drainage patterns or PV diameters.

Conclusions: For this sample, PVs were responsible for draining flow from varicose veins in 64% of cases. Neither PV diameters nor GSV reflux patterns were associated with severity of symptoms.

Keywords

varicose veins, saphenous vein, venous insufficiency, ultrasonography

Resumo

Resumo: Introdução: A insuficiência venosa crônica impacta a vida de muitas pessoas, constituindo-se, assim, como um problema de saúde pública. Conhecer o padrão de drenagem do refluxo das varizes associadas à veia safena incompetente é fundamental para definir a melhor programação terapêutica.

Objetivos: Determinar os padrões de drenagem do refluxo de varizes originadas da veia safena magna incompetente, a prevalência de veias perfurantes e a relação com os sintomas.

Métodos: Foram analisados 55 registros ultrassonográficos de pacientes com refluxo da veia safena magna para determinar padrões de drenagem do refluxo dessa veia, pontos de refluxo das varizes, localização e diâmetro das perfurantes de drenagem e graduação dos sintomas.

Resultados: O principal padrão de refluxo encontrado foi originado da junção safenofemoral com comprometimento proximal da veia safena magna. Em 64% dos pacientes, o refluxo das varizes drenou para veias perfurantes - 4% drenavam para a própria veia safena magna; em outros 4%, a drenagem era para a veia safena parva; e, em 29%, a drenavam destinava-se para varizes tronculares em que não se identificou comunicação direta com o sistema venoso profundo. Não foi observada associação dos sintomas com os padrões de drenagem do refluxo ou diâmetro das perfurantes.

Conclusão: Para essa amostra, as veias perfurantes foram responsáveis pelo escoamento do fluxo oriundo das varizes em 64% dos casos. O diâmetro das veias perfurantes e o padrão de refluxo da veia safena não estiveram associados à gravidade dos sintomas.
 

Palavras-chave

varizes, veia safena, insuficiência venosa, ultrassonografia

References

1 Kalra M, Gloviczki P. Surgical treatment of venous ulcers: role of subfascial endoscopic perforator vein ligation. Surg Clin North Am. 2003;83(3):671-705. http://dx.doi.org/10.1016/S0039-6109(02)00198-6. PMid:12822732.

2 Chwala M, Szczeklik W, Szczeklik M, Aleksiejew-Kleszczyński T, Jagielska-Chwała M. Varicose veins of lower extremities, hemodynamics and treatment methods. Adv Clin Exp Med. 2015;24(1):5-14. http://dx.doi.org/10.17219/acem/31880. PMid:25923081.

3 Meissner MH. Lower extremity venous anatomy. Semin Intervent Radiol. 2005;22(3):147-56. http://dx.doi.org/10.1055/s-2005-921948. PMid:21326687.

4 Engelhorn AL, Engelhorn CA, Filho DM, Barros FS, Coelho NA. Ultrassonografia vascular na avaliação de varizes dos membros inferiores. In: Engelhorn AL, Engelhorn CA, Filho DM, Barros FS, Coelho NA, editors. Guia prático de ultrassonografia vascular. 4rd ed. Rio de Janeiro: DiLivros Editora, 2019, pp. 555-579.

5 Labropoulos N, Mansour MA, Kang SS, Gloviczki P, Baker WH. New insights into perforator vein incompetence. Eur J Vasc Endovasc Surg. 1999;18(3):228-34. http://dx.doi.org/10.1053/ejvs.1999.0812. PMid:10479629.

6 Engelhorn CA, Manetti R, Baviera MM, et al. Progression of reflux patterns in saphenous veins of women with chronic venous valvular insufficiency. Phlebology. 2012;27(1):25-32. http://dx.doi.org/10.1258/phleb.2011.010077. PMid:21903684.

7 Coelho F No, de Oliveira RG, Gregorio EP, Belczak SQ, de Araujo WJB. Saphenous reflux patterns in C2 patients: a record of 1196 ultrasound reports. Phlebology. 2020;35(6):409-15. http://dx.doi.org/10.1177/0268355519889868. PMid:31830425.

8 Engelhorn CA, Engelhorn AL, Cassou MF, et al. Classificação anatomofuncional da insuficiência das veias safenas baseada no eco-Doppler colorido, dirigida para o planejamento da cirurgia de varizes. J Vasc Bras. 2004;3:13-9.

9 Callam MJ. Epidemiology of varicose veins. Br J Surg. 1994;81(2):167-73. http://dx.doi.org/10.1002/bjs.1800810204. PMid:8156326.

10 Zamboni P, Cappelli M, Marcellino MG, Murgia AP, Pisano L, Fabi P. Does a saphenous varicose vein exist? Phlebology. 1997;12(2):74-7. http://dx.doi.org/10.1177/026835559701200207.

11 Engelhorn CA, Escorsin JKS, Costa KCO, Miyashiro L, Silvério MM, Costa RCG. Localização e papel hemodinâmico das veias perfurantes independentes das veias safenas. J Vasc Bras. 2018;17(2):104-8. http://dx.doi.org/10.1590/1677-5449.009117. PMid:30377418.

12 Chiesa R, Marone EM, Limoni C, Volontè M, Petrini O. Chronic venous disorders: correlation between visible signs, symptoms, and presence of functional disease. J Vasc Surg. 2007;46(2):322-30. http://dx.doi.org/10.1016/j.jvs.2007.04.030. PMid:17600668.

13 Castro e Silva M, Cabral ALS, Barros JRN, et al. Diagnóstico e tratamento da doença venosa crônica. J Vasc Bras. 2005;4(Suppl 2):185-94.

14 Higginson IJ, Carr AJ. Measuring quality of life: using quality of life measures in the clinical setting. BMJ. 2001;322(7297):1297-300. http://dx.doi.org/10.1136/bmj.322.7297.1297. PMid:11375237.

15 Seidl EMF, Zannon CMLC. Qualidade de vida e saúde: aspectos conceituais e metodológicos. Cad Saude Publica. 2004;20(2):580-8. http://dx.doi.org/10.1590/S0102-311X2004000200027. PMid:15073639.

16 Lamping DL, Schroter S, Kurz X, Kahn SR, Abenhaim L. Evaluation of outcomes in chronic venous disorders of the leg: development of a scientifically rigorous, patient-reported measure of symptoms and quality of life. J Vasc Surg. 2003;37(2):410-9. http://dx.doi.org/10.1067/mva.2003.152. PMid:12563215.

17 Kahn SR, M’Lan CE, Lamping DL, Kurz X, Bérard A, Abenhaim LA. Relationship between clinical classification of chronic venous disease and patient-reported quality of life: results from an international cohort study. J Vasc Surg. 2004;39(4):823-8. http://dx.doi.org/10.1016/j.jvs.2003.12.007. PMid:15071450.

18 Kurz X, Lamping DL, Kahn SR, et al. Do varicose veins affect quality of life? Results of an international population-based study. J Vasc Surg. 2001;34(4):641-8. http://dx.doi.org/10.1067/mva.2001.117333. PMid:11668318.

19 Sandri JL, Barros FS, Pontes S, Jacques C, Salles-Cunha SX. Diameter-reflux relationship in perforating veins of patients with varicose veins. J Vasc Surg. 1999;30(5):867-74. http://dx.doi.org/10.1016/S0741-5214(99)70011-X. PMid:10550184.

20 Recek C. Competent and incompetent calf perforators in primary varicose veins: a resistant myth. Phlebology. 2016;31(8):532-40. http://dx.doi.org/10.1177/0268355515610041. PMid:26450850.

21 Stuart WP, Adam DJ, Allan PL, Ruckley CV, Bradbury AW. Saphenous surgery does not correct perforator incompetence in the presence of deep venous reflux. J Vasc Surg. 1998;28(5):834-8. http://dx.doi.org/10.1016/S0741-5214(98)70058-8. PMid:9808850.

22 Gohel MS, Barwell JR, Wakely C, et al. The influence of superficial venous surgery and compression on incompetent calf perforators in chronic venous leg ulceration. Eur J Vasc Endovasc Surg. 2005;29(1):78-82. http://dx.doi.org/10.1016/j.ejvs.2004.09.016. PMid:15570276.

23 Al-Mulhim AS, El-Hoseiny H, Al-Mulhim FM, et al. Surgical correction of main stem reflux in the superficial venous system: does it improve the blood flow of incompetent perforating veins? World J Surg. 2003;27(7):793-6. http://dx.doi.org/10.1007/s00268-003-6751-z. PMid:14509507.

24 Recek C, Karisch E, Gruber J. Diameter alterations of calf perforators and deep veins in the lower leg after abolition of saphenous reflux (German). Phlebologie. 2000;29:37-40.
 


Submitted date:
02/25/2022

Accepted date:
06/27/2023

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
63b4692ea953957b4d3592c4 jvb Articles
Links & Downloads

J Vasc Bras

Share this page
Page Sections