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

http://dx.doi.org/10.1590/S1677-54492006000300005 J Vasc Bras, vol.5, n3, p.177-183, 2006
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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

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