Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/S1677-54492006000300005
Jornal Vascular Brasileiro
Original Article

Ecoescleroterapia com microespuma em varizes tronculares primárias

Microfoam ultrasound-guided sclerotherapy in primary trunk varicose veins

Marcondes Figueiredo; Salustiano Pereira de Araújo; Nilson Penha-Silva

Downloads: 0
Views: 27

Resumo

OBJETIVO: Avaliar o tratamento de varizes tronculares primárias por ecoescleroterapia com microespuma. MÉTODOS: A amostra foi constituída de 25 membros de seis pacientes do sexo masculino e 19 do sexo feminino, com incompetência das veias safenas magna (21 membros) ou parva (quatro membros). Eles foram avaliados de acordo com a classificação clínica, etiológica, anatômica e fisiopatológica (CEAP) e classificados nos graus C³ (10 membros), C4 (seis membros), C5 (cinco membros) e C6 (quatro membros). A microespuma (5 ml), preparada pela mistura de 1 ml de polidocanol a 3% e 5 ml de ar, era injetada na veia do paciente, em posição de Trendelenburg, com monitoração por ultra-sonografia com Doppler colorido. Os membros eram enfaixados com atadura inelástica por 3 dias; depois disso, os pacientes usavam meias elásticas, 30-40 mmHg, 3/4 ou 7/8, durante 3 meses. A eficiência do tratamento foi avaliada pelo escore clínico da classificação CEAP para dor, edema e claudicação e pelas alterações ultra-sonográficas 12 meses depois. Os escores clínicos antes e depois do tratamento foram comparados pelo teste de Wilcoxon. RESULTADOS: Houve diminuição significante nos escores clínicos (P < 0,05) e sucesso terapêutico, com oclusão total e recanalização parcial sem refluxo, em 84% dos casos. Do total, 16% dos casos apresentaram recanalização parcial, com refluxo, ou recanalização completa. CONCLUSÃO: A ecoescleroterapia, método simples, de baixo custo, que dispensa internação e anestesia, mostrou ser promissora no tratamento de varizes tronculares primárias.

Palavras-chave

Escleroterapia, varizes, polidocanol, ultra-sonografia por Doppler colorido

Abstract

OBJECTIVE: To evaluate the treatment of primary trunk varicose veins by microfoam ultrasound-guided sclerotherapy. METHODS: The sample was composed of 25 members of six male and 19 female patients, with incompetence of great saphenous vein (21) and short saphenous vein (4). Patients were assessed according to the clinical, etiologic, anatomical and pathophysiological (CEAP) classification and divided into degrees C³ (10), C4 (6), C5 (5) and C6 (4). With the patients in the Trendelenburg position, microfoam (5 ml), prepared by mixture of 1 ml polidocanol at 3% and 5 ml of air, was injected in their vein and monitored by color-flow Doppler ultrasonography. The members were then swaddled with inelastic bandage for 3 days; afterward, the patients used 30-40 mmHg, 3/4 or 7/8, elastic socks, during 3 months. Treatment efficiency was evaluated based on the CEAP classification for pain, edema and claudication, and on color-flow Doppler ultrasonographic changes 12 months later. Clinical scores, before and after treatment, were compared using the Wilcoxon test. RESULTS: There was a significant decrease in the clinical scores (p < 0.05). Therapeutic success was achieved, with total occlusion and partial recanalization without reflux in 84% of the cases. The remaining 16% of the cases presented partial recanalization with reflux or complete recanalization. CONCLUSION: Ultrasound-guided sclerotherapy, which is an easy and low-cost method that does not require hospitalization and anesthesia, proved to be promising for the treatment of primary trunk varicose veins.

Keywords

Sclerotherapy, varicose veins, polidocanol, color-flow Doppler ultrasonography

References

Maffei FHA. Varizes dos membros inferiores: epidemiologia, etiopatogenia e fisiopatologia. Doenças vasculares periféri-cas. 2001:1499-510.

Kostas T, Ioannou CV, Touloupakis E. Recurrent varicose veins after surgery: a new appraisal of a common and complex problem in vascular surgery. Eur J Vasc Endovasc Surg.. 2004;27:275-82.

Orbach EJ. Sclerotherapy of varicose veins: utilization of intravenous air block. Am J Surg.. 1944:362-6.

Cabrera Garrido J, Cabrera Garcia-Olmedo JR. Nuevo método de esclerosis en las varices tronculares. Patol Vasc.. 1995;4:55-73.

Cavezzi A, Frullini A, Ricci S, Tessari L. Treatment of varicose veins by foam sclerother-apy: two clinical series. Phlebology. 2002;17:13-8.

Frullini A. Foam sclerotherapy: a review. Phlebolymphology. 2003;40:125-9.

Breu FX, Guggenbichler S. European consensus meeting on foam sclerotherapy. Dermatol Surg.. Apri;30:709-17.

Partsch B. Die Schaumverödung: eine Renaissance der Sklerotherapie. Phlebologie. 2004;33:30-6.

Rossi GG. Escleroterapia eco-guiada com microespuma. Tratado de flebologia e linfologia. 2006:189-94.

Tessari L, Cavezzi A, Frullini A. Preliminary experience with a new sclerosing foam in the treatment of varicose veins. Dermatol Surg.. 2001;27:58-60.

Nicolaides AN. Investigation of chronic venous insufficiency: a consensus statement (France, March 5-9, 1997). Circulation. 2000;102:E126-63.

Yamaki T, Nozaki M, Iwasaka S. Comparative study of duplex-guided foam sclerotherapy and duplex-guided liquid sclerotherapy for the treatment of superficial venous insufficiency. Dermatol Surg.. 2004;30:718-22.

Rabe E, Pannier-Fischer F, Gerlach H. Guidelines for sclerotherapy of varicose veins (ICD 10: I83.0, I83.1, I83.2, and I83.9). Dermatol Surg.. 2004;30:687-93.

Agus GB, Allegra C, Antignani PL. Guidelines for the diagnosis and therapy of the vein and lymphatic disorders. Int Angiol.. 2005;24:107-68.

Interventional procedures overview of ultrasound guided foam sclerotherapy for varicose veins. 2004.

Guex JJ. Foam sclerotherapy: an overview of use for primary venous insufficiency. Semin Vasc Surg.. 2005;18:25-9.

Critchley G, Handa A, Maw A, Harvey A, Harvey MR, Corbett CR. Complications of vari-cose vein surgery. Ann R Coll Surg Engl.. 1997;79:105-10.

Bountouroglou D, Geroulakos G. Ultrasound-guided foam sclerotherapy for the treatment of primary varicose veins. Phlebology. 2004;19:107-8.

Belcaro G, Cesarone MR, Di Renzo A. Foam-sclerotherapy, surgery, sclerotherapy, and combined treatment for varicose veins: a 10-year, prospective, randomized, controlled, trial (VEDICO trial). Angiology. 2003;54:307-15.

Forlee MV, Grouden M, Moore DJ, Shanik G. Stroke after varicose vein foam injection sclerotherapy. J Vasc Surg.. 2006;43:162-4.

5de960ee0e88259676e31d42 jvb Articles
Links & Downloads

J Vasc Bras

Share this page
Page Sections