Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/S1677-54492006000300006
Jornal Vascular Brasileiro
Artigo Original

Tratamento de varizes com laser endovenoso: estudo prospectivo com seguimento de 39 meses

Treatment of varicose veins with endovenous laser: a prospective 39-month follow-up study

Luiz Marcelo Aiello Viarengo; Guilherme Vieira Meirelles; João Potério Filho

http://dx.doi.org/10.1590/S1677-54492006000300006 J Vasc Bras, vol.5, n3, p.184-193, 2006
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Resumo

OBJETIVO: Avaliar os resultados da terapêutica endovenosa com laser no tratamento de varizes primárias. PACIENTES E MÉTODO: No período compreendido entre julho de 2001 e setembro de 2004 (39 meses), 253 pacientes (417 membros) foram tratados ambulatorialmente com laser de diodo de 810 e 980-nm, com energia liberada endovenosamente através de fibra óptica introduzida por punção guiada por eco-Doppler. Foi utilizada anestesia por infiltração intumescente perivasal com solução de lidocaína a 0,2% (50-150 ml). A potência e duração do pulso foram determinadas pelo diâmetro da veia. Os controles foram realizados com eco-Doppler aos 7 dias, 1 mês, 3 meses, 6 meses, 1 ano e, a seguir, anualmente, para avaliar a eficácia do tratamento e os efeitos adversos. RESULTADOS: A oclusão primária da veia safena magna foi obtida em 405 dos 417 membros (97,1%) tratados. Houve reintervenção em 12 casos (2,9%), com sucesso. O tempo médio de observação foi de 18 meses, e, nesse período, a taxa de recidiva global de varizes foi de 7,4%, sendo 6,3% (26 membros) veias colaterais tributárias da crossa e 1,2% (cinco membros) com recanalização da safena magna. Todas as recorrências ocorreram entre o terceiro e o 12º mês. Os efeitos indesejáveis mais freqüentes foram: equimoses (60,6%); dor suportável durante o procedimento (16,1%); hematomas (5,5%); flebite em colaterais não-tratadas (3,4%); hiperpigmentação (2,9%); e parestesia transitória (3,4%). Nenhum caso de tromboflebite da safena magna foi observado. Não houve nenhum caso de trombose venosa profunda ou embolia pulmonar. CONCLUSÃO: O tratamento endovenoso de varizes com laser, conforme descrito, foi eficaz para ocluir a safena magna e seus principais ramos, com efeitos adversos autolimitados e com recorrência inferior a 8% no período de seguimento.

Palavras-chave

Varizes, cirurgia a laser, lasers

Abstract

OBJETIVE: To evaluate results of endovenous laser treatment for primary varicose veins. PATIENTS AND METHOD: From July 2001 to September 2004 (39 months), 253 outpatients (417 limbs) were treated with 810 and 980 nm diode laser energy delivered percutaneously using optical fiber introduced by puncture under ultrasound guidance. Tumescent anesthesia (50-150 ml of 0.2% lidocaine) was delivered perivenously. Power and duration of the pulse were determined by vein diameter. Duplex control was performed at 7 days, 1 month, 3 months, 6 months, 1 year and yearly thereafter to assess treatment efficacy and adverse effects. RESULTS: Primary great saphenous vein occlusion was obtained in 405 of 417 members (97.1%). Twelve recurrent cases (2.9%) were successfully treated. Mean follow-up time was 18 months. During this period, global recurrence rate of varicose veins was 7.4%; 6.3% (26 limbs) related to tributary and collateral veins of the saphenofemoral junction, and 1.2% (five limbs) with great saphenous vein recanalization. All recurrences occurred between 3 and 12 months. Ecchymosis was the most common adverse effect (60.6%). Other complications were: moderate pain during the procedure (16.1%); hematoma (5.5%), superficial phlebitis of varicose tributaries (3.4%), hyperpigmentation (2.9%), transient paresthesia (3.4%). There were no cases of great saphenous vein thrombophlebitis, deep vein thrombosis or pulmonary emboli. CONCLUSION: Varicose vein treatment with endovenous laser technique was successful in occluding great saphenous vein and its branches, with self-limited adverse effects and recurrence rate lower than 8% in the follow-up period.

Keywords

Varicose veins, laser surgery, lasers

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