Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/1677-5449.202301421
Jornal Vascular Brasileiro
Case Report

Tratamento de veia safena parva e de veias tributárias com endolaser associado a espuma ecoguiada em paciente com síndrome pós-trombótica: apresentando a técnica TEThA

Treatment of the small saphenous vein and tributary veins with endolaser associated with ultrasound-guided foam in a patient with post-thrombotic syndrome: presenting the TEThA technique

Nara Medeiros Cunha de Melo Vasconcelos; Harue Santiago Kumakura; Marcelo Halfen Grill; Marília de Castro e Silva

Downloads: 0
Views: 61

Resumo

A doença venosa crônica dos membros inferiores possui alta prevalência, com termoablação endovenosa como técnica de escolha para o tratamento de veias safenas insuficientes. Porém, ainda há controvérsia sobre a melhor conduta para as veias tributárias varicosas. Este artigo relata um caso de tratamento ambulatorial de refluxo de veia safena parva e de veias tributárias em paciente do sexo feminino, de 52 anos, com síndrome pós-trombótica e queixa de dor e edema em membro inferior direito. Realizamos a técnica transfixing endovenous thermal ablation (TEThA) com termoablação da veia safena parva e de veias varicosas, combinada com espuma ecoguiada de polidocanol a 2%. Após 30 dias, no eco-Doppler de controle, havia oclusão de veia safena parva e ausência de sinais ecográficos de varizes em face posterior de perna direita e de trombose. O tratamento combinado endovenoso e perivenoso das varizes dos membros inferiores tem se mostrado seguro, rápido e eficaz.

Palavras-chave

varizes; veia safena; insuficiência venosa crônica; laser endovenoso; estética

Abstract

Chronic venous disease of the lower limbs is a highly prevalent pathology and endovenous thermoablation is the technique of choice for treatment of insufficient saphenous veins. However, there is still controversy about the best management for varicose tributaries. This article reports a case of outpatient treatment of reflux of the small saphenous vein and tributary veins in a 52-year-old female patient with post-thrombotic syndrome complaining of pain and edema in the right lower limb. We performed the Transfixing Endovenous Thermal Ablation (TEThA) technique with thermoablation of the small saphenous vein and varicose veins combined with ultrasound-guided administration of 2% polidocanol foam. After 30 days, the control Doppler ultrasound showed occlusion of the short saphenous vein and absence of ultrasound signs of varicose veins and thrombosis. The combined endovenous and perivenous treatment of lower limb varicose veins proved to be safe, fast, and effective.

Keywords

varicose veins; saphenous vein; chronic venous insufficiency; endovenous laser therapy; esthetics

References

1 Salim S, Machin M, Patterson BO, Onida S, Davies AH. Global epidemiology of chronic venous disease: a systematic review with pooled prevalence analysis. Ann Surg. 2021;274(6):971-6. http://doi.org/10.1097/SLA.0000000000004631. PMid:33214466.

2 Lurie F, Passman M, Meisner M, et al. The 2020 update of the CEAP classification system and reporting standards. J Vasc Surg Venous Lymphat Disord. 2020;8(3):342-52. http://doi.org/10.1016/j.jvsv.2019.12.075. PMid:32113854.

3 De Maeseneer MG, Kakkos SK, Aherne T, et al. Editor’s Choice - European Society for Vascular Surgery (ESVS) 2022 Clinical practice guidelines on the management of chronic venous disease of the lower limbs. Eur J Vasc Endovasc Surg. 2022;63(2):184-267. http://doi.org/10.1016/j.ejvs.2021.12.024. PMid:35027279.

4 Mowatt-Larssen E. Management of secondary varicosities. Semin Vasc Surg. 2010;23(2):107-12. http://doi.org/10.1053/j.semvascsurg.2010.01.006. PMid:20685565.

5 Gibson K, Minjarez R, Gunderson K, Ferris B. Need for adjunctive procedures following cyanoacrylate closure of incompetent great, small and accessory saphenous veins without the use of postprocedure compression: three-month data from a postmarket evaluation of the VenaSeal System (the WAVES Study). Phlebology. 2019;34(4):231-7. http://doi.org/10.1177/0268355518801641. PMid:30227791.

6 Utoh J, Tsukamoto Y. Ultrasound-guided percutaneous laser ablation of tributary varicose veins using a slim-type radial fiber. Phlebology. 2023;38(6):404-9. http://doi.org/10.1177/02683555231179821. PMid:37261956.

7 Myers KA, Clough A, Tilli H. Endovenous laser ablation for major varicose tributaries. Phlebology. 2013;28(4):180-3. http://doi.org/10.1258/phleb.2011.011088. PMid:22490724.

8 Fehm TF, Deán-Ben XL, Schaur P, Sroka R, Razansky D. Volumetric optoacoustic imaging feedback during endovenous laser therapy: an ex vivo investigation. J Biophotonics. 2016;9(9):934-41. http://doi.org/10.1002/jbio.201500210. PMid:26572505.

9 Wang JC, Li Y, Li GY, et al. A comparison of concomitant tributary laser ablation and foam sclerotherapy in patients undergoing truncal endovenous laser ablation for lower limb varicose veins. J Vasc Interv Radiol. 2018;29(6):781-9. http://doi.org/10.1016/j.jvir.2018.01.774. PMid:29705225.

10 Amatuzi D, Drummond DAB, Poschinger-Figueiredo D, Barbosa-Silva L, Oliveira JCP, Marques MA. Assisted total thermal ablation: presentation of the ATTA technique. J Vasc Bras. 2022;21:e20220048. http://doi.org/10.1590/1677-5449.202200481. PMid:36452404.

11 Lu X, Ye K, Li W, Lu M, Huang X, Jiang M. Endovenous ablation with laser for great saphenous vein insufficiency and tributary varices: a retrospective evaluation. J Vasc Surg. 2008;48(3):675-9. http://doi.org/10.1016/j.jvs.2008.04.017. PMid:18586448.

12 Prüfer M. Nouvelle technique de mise en place d’un introducteur veineux sans utiliser de guide. Resultats à 5 ans. Phlebologie. 2020;73:55-65.

13 Bugiantella W, Bovani B, Zini F. Endovenous and perivenous 808-nm laser treatment of lower limb collateral, reticular and telangiectasic veins. J Cosmet Laser Ther. 2017;19(1):30-5. http://doi.org/10.1080/14764172.2016.1247967. PMid:27911107.


Submitted date:
09/18/2023

Accepted date:
02/19/2024

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
67462ce4a953957fe5399a93 jvb Articles
Links & Downloads

J Vasc Bras

Share this page
Page Sections