Escleroterapia com espuma de polidocanol em veias safenas magnas e suas tributárias bilateralmente em tempo único
Bilateral foam polidocanol sclerotherapy of great saphenous veins and their tributaries in synchronous procedure
Luiz Antonio Miranda; Rachel Cristina do Carmo; Cláudia Carvalho Sathler-Melo; Guilherme de Castro-Santos
Resumo
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Abstract
Background: Chronic venous insufficiency is a highly prevalent disease. Advanced cases have high morbidity. Objectives: To evaluate the risks and benefits of foam sclerotherapy in patients who underwent bilateral treatment of the great saphenous veins in a single procedure, in selected cases of advanced venous insufficiency. Methods: We retrospectively reviewed 55 patients (110 limbs) with bilateral incompetence of the great saphenous veins who had undergone foam sclerotherapy treatment bilaterally, using a maximum dose of 20 ml of foam per patient and inelastic compression. Results: In 81 (73.6%) of the 110 saphenous veins analyzed, occlusion was obtained in the first session. After a second session this figure rose to 106 (96.3%) and all 110 (100%) veins were occluded after three sessions. Bilateral occlusion of the great saphenous veins was achieved in 27 patients (50%) in one session, in 34 (62%) patients in two sessions, and in 55 (100%) patients in three sessions. At 42 days after sclerotherapy, there was complete ulcer healing in seven (63%) of the 11 patients with ulcers and partial healing in 3 (27%) of these patients. One patient (1.8%) had self-limited lipothymia and visual scotomas, 3 patients (5.45%) had skin spots, and 19 patients (34.5%) developed retained intravascular coagulum. Conclusions: Bilateral foam sclerotherapy in a synchronous procedure is an option to be considered for treatment of varicose veins of the lower limbs.
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References
1 Radhakrishnan N, Jayakrishnan R, Deepu G. Microfoam sclerotherapy for varicose veins: a retrospective analysis of a modified technique. Indian J Surg. 2015;77(Suppl 3):816-21.
2 Kafejian O, Oliveira GA, Takayanagi T. Inovações técnicas na cirurgia de varizes visando a resultados estéticos. AMB Rev Assoc Med Bras. 1976;22(8):296-7. PMid:1086493.
3 Orbach EJ. Contributions to the therapy of the varicose complex. J Int Coll Surg. 1950;13(6):765-71. PMid:15428675.
4 Tessari L, Cavezzi A, Frullini A. Preliminary experience with a new sclerosing foam in the treatment of varicose veins. Dermatol Surg. 2001;27(1):58-60. PMid:11231246.
5 Frullini A, Cavezzi A. Sclerosing foam in the treatment of varicose veins and telangiectases: history and analysis of safety and complications. Dermatol Surg. 2002;28(1):11-5.
6 Bastos FR, Oliveira CCA, Paiva ACO. A história da escleroterapia. Rev Med Minas Gerais 2016.26:e1807.
7 Evangelista SSM. Ecoescleroterapia com microespuma em varizes tronculares primárias. J Vasc Bras. 2006;5(3):167-8.
8 Bastos FR, de Lima AE, Assumpção AC. Ecoescleroterapia de varizes com espuma: revisão de literatura. Rev Assoc Med Minas Gerais. 2009;19:38-43.
9 Hsu TS, Weiss RA. Foam sclerotherapy: a new era. Arch Dermatol. 2003;139(11):1494-6. PMid:14623712.
10 Couto-Junior EB. Abordagem não-paramétrica para cálculo do tamanho da amostra com base em questionários ou escalas de avaliação na área de saúde [tese]. São Paulo: Faculdade de Medicina, Universidade de São Paulo; 2009. http://dx.doi.org/10.11606/T.5.2009.tde-22022010-175431.
11 Bhogal RH, Moffat CE, Coney P, Nyamekye IK. Can foam sclerotherapy be used to safely treat bilateral varicose veins? Phlebology. 2012;27(1):19-24.
12 Rabe E, Breu FX, Cavezzi A, et al. European guidelines for sclerotherapy in chronic venous disorders. Phlebology. 2014;29(6):338-54.
13 Rabe E, Pannier-Fischer F, Gerlach H, Breu FX, Guggenbichler S, Zabel M. Guidelines for sclerotherapy of varicose veins (ICD 10: I83.0, I83.1, I83.2, and I83.9). Dermatol Surg. 2004;30(5):687-93, discussion 693. PMid:15099309.
14 Myers K, Hannah P. Australasian college of phlebology. Direct-vision and ultrasound-guided sclerotherapy In: Myers K, Hannah P, Cremonese M, et al., editors. Manual of venous and lymphatic diseases. Boca Raton Florida: CRC Press; 2017. P. 137-147.
15 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.
16 Rutherford RB, Padberg FT Jr, Comerota AJ, Kistner RL, Meissner MH, Moneta GL. Venous severity scoring: An adjunct to venous outcome assessment. J Vasc Surg. 2000;31(6):1307-12.
17 Silva MAM, Araujo ÁZP, Amaral JF, Jesus-Silva SG, Cardoso RS, Miranda F Jr. Impacto da escleroterapia com espuma de polidocanol guiada por ultrassom em pacientes com úlcera venosa. J Vasc Bras. 2017;16(3):239-43. http://dx.doi.org/10.1590/1677-5449.002717. PMid:29930653.
18 Howard JK, Slim FJ, Wakely MC, et al. Recanalisation and ulcer recurrence rates following ultrasound-guided foam sclerotherapy. Phlebology. 2016;31(7):506-13.
19 Coelho F No, de Araújo GR, Kessler IM, de Amorim RFB, Falcão DP. Treatment of severe chronic venous insufficiency with ultrasound-guided foam sclerotherapy: a two-year series in a single center in Brazil. Phlebology. 2015;30(2):113-8.
20 Figueiredo M, Araújo S, Barros N Jr, Miranda F Jr. Results of surgical treatment compared with ultrasound-guided foam sclerotherapy in patients with varicose veins: a prospective randomised study. Eur J Vasc Endovasc Surg. 2009;38(6):758-63.
21 Oliveira RG, Morais D Fo, Engelhorn CA, Kessler IM, Coelho F No. Foam sclerotherapy for lower-limb varicose veins: impact on saphenous vein diameter. Radiol Bras. 2018;51(6):372-6.
22 Khan Kharl RA, Khan NI, Pervaiz HK, et al. Foam sclerotherapy: an emerging, minimally invasive and safe modality of treatment for varicose veins. J Ayub Med Coll Abbottabad. 2019;31(Suppl 1)(4):S641-5. PMID: 31965766.
23 Wright D, Gobin JP, Bradbury AW, et al. Varisolve polidocanol microfoam compared with surgery or sclerotherapy in the management of varicose veins in the presence of trunk vein incompetence: European randomized controlled trial. Phlebology. 2006;21(4):180-90.
24 Ceratti S, Okano FM, Pontes AB, Pontes AL, Nastri R. Ecoescleroterapia com espuma no tratamento da insuficiência venosa crônica. Radiol Bras. 2011;44(3):167-71.
25 Nael R, Rathbun S. Effectiveness of foam sclerotherapy for the treatment of varicose veins. Vasc Med. 2010;15(1):27-32.
26 Kurnicki J, Osęka M, Tworus R, Gałązka Z. Ultrasound-guided foam sclerotherapy of great saphenous vein with 2% polidocanol - one-year follow-up results. Wideochir Inne Tech Malo Inwazyjne. 2016;11(2):67-75.
27 Tremaine AM, Friedmann DP, Goldman MP. Foam sclerotherapy for reticular veins of the dorsal hands: a retrospective review. Dermatol Surg. 2014;40(8):892-8.
28 Gillet JL, Guedes JM, Guex JJ, et al. Side-effects and complications of foam sclerotherapy of the great and small saphenous veins: a controlled multicentre prospective study including 1025 patients. Phlebology. 2009;24(3):131-8.
29 Ma RWL, Pilotelle A, Paraskevas P, Parsi K. Three cases of stroke following peripheral venous interventions. Phlebology. 2011;26(7):280-4.
30 Figueiredo M. A terapia da compressão e sua evidência científica. J Vasc Bras. 2009;8(2):100-2.
31 Hamel-Desnos CM, Guias BJ, Desnos PR, Mesgard A. Foam sclerotherapy of the saphenous veins: randomised controlled trial with or without compression. Eur J Vasc Endovasc Surg. 2010;39(4):500-7.
32 Welsh L. What is the existing evidence supporting the efficacy of compression bandage systems containing both elastic and inelastic components (mixed-component systems)? A systematic review. J Clin Nurs. 2017;26(9-10):1189-203.
Submitted date:
09/30/2020
Accepted date:
01/18/2021