Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/S1677-54492006000400007
Jornal Vascular Brasileiro
Original Article

Comparação entre o laser endovenoso e a fleboextração total da veia safena interna: resultados em médio prazo

Comparison of endovenous laser therapy vs. conventional stripping of the great saphenous vein: midterm results

Charles Angotti Furtado de Medeiros

http://dx.doi.org/10.1590/S1677-54492006000400007 J Vasc Bras, vol.5, n4, p.277-287, 2006
PDF
Downloads: 0
Views: 1175

Resumo

OBJETIVO: Comparar a fotocoagulação endovenosa com laser diodo e a fleboextração total da veia safena interna. MÉTODOS: Trata-se de um estudo prospectivo, controlado e cego de 20 pacientes com varizes sintomáticas e insuficiência bilateral da veia safena interna que foram operados entre março de 2002 e fevereiro de 2004. Para cada caso, foram realizadas aleatoriamente (sorteio) as duas técnicas, sendo uma em cada lado. A avaliação pós-operatória consistiu na aplicação de questionários, exame físico e fotografia digital em todos os pacientes desde o 7º dia de pós-operatório. Também foi realizado controle ultra-sonográfico no 30º dia de pós-operatório e pletismografia a ar no 60º dia após a cirurgia. Este projeto foi aprovado pela comissão de ética, e os pacientes foram incluídos ao assinarem o consentimento pós-informação. Os dados foram submetidos a análise estatística com os programas SPSS e SAS. RESULTADOS: A técnica que utilizou o laser endovenoso apresentou dor semelhante, mas menos edema e menos hematoma durante o pós-operatório. O índice de melhora estética e de satisfação com a cirurgia foi de 100% para as duas técnicas, mas a maioria dos pacientes respondeu que o membro operado com o laser foi o mais beneficiado. Houve melhora do tempo de enchimento venoso nos dois grupos, mas sem diferença significativa entre eles. Durante o seguimento (média de 26 meses), houve um caso de parestesia leve e transitória do lado convencional e somente uma recanalização do lado laser. CONCLUSÃO: A fotocoagulação endovenosa para o tratamento da veia safena interna em pacientes com varizes de membros inferiores é segura e apresenta resultados comparáveis aos da fleboextração convencional.

Palavras-chave

Varizes, veia safena, insuficiência venosa, fotocoagulação a laser

Abstract

OBJECTIVE: To compare endovenous diode laser photocoagulation and conventional stripping of the great saphenous vein. METHODS: A controlled and blind prospective study of 20 patients with symptomatic varicose veins and bilateral great saphenous vein insufficiency who underwent surgery between March 2002 and February 2004. For each case, both techniques were randomly performed, one at each side. The postoperative assessment consisted of questionnaires, physical examination and digital photography of all patients since the 7th postoperative day. Patients also underwent examination with duplex scan at the 30th postoperative day and air plethysmography 60 days after the surgery. This project was approved by the ethics committee, and the patients were included after signing the consent form. All data were submitted to statistical analysis using the software SPSS and SAS. RESULTS:: The endovenous laser technique presented similar pain, but less edema and less hematoma during the postoperative period. The index of esthetic improvement and satisfaction with the surgery was 100% for both techniques, but a minority of patients reported that the limb operated with the laser had better results. There was improvement in venous filling time in both groups, but with no significant difference. During the follow-up (average of 26 months), there was one case of mild and transient paresthesia at the conventional side and only one recanalization at the laser side. CONCLUSION: The endovenous photocoagulation for the treatment of the great saphenous vein in patients with lower limb varicose veins is safe and presents results comparable with the conventional stripping.

Keywords

Varicose vein, saphenous vein, venous insufficiency, laser photocoagulation

References

Labropoulos N, Delis K, Nicolaides AN, Leon M, Ramaswami G. The role of the distribution and anatomic extent of reflux in the development of signs and symptoms in chronic venous insufficiency. J Vasc Surg.. 1996;23:504-10.

Labropoulos N, Giannoukas AD, Delis K. Where does venous reflux start?. J Vasc Surg.. 1997;26:736-42.

Evans CJ, Allan PL, Lee AJ, Bradbury AW, Ruckley CV, Fowkes FG. Prevalence of venous reflux in the general population on duplex scanning: the Edinburgh vein study. J Vasc Surg.. 1998;28:767-76.

Proebstle TM, Lehr HA, Kargl A. Endovenous treatment of the greater saphenous vein with a 940-nm diode laser: thrombotic occlusion after endoluminal thermal damage by laser-generated steam bubbles. J Vasc Surg.. 2002;35:729-36.

Proebstle TM, Sandhofer M, Kargl A. Thermal damage of the inner vein wall during endovenous laser treatment: key role of energy absorption by intravascular blood. Dermatol Surg.. 2002;28:596-600.

Sybrandy JEM, Wittens CH. Initial experiences in endovenous treatment of saphenous vein reflux. J Vasc Surg.. 2002;36:1207-12.

Perkowski P, Ravi R, Gowda RC. Endovenous laser ablation of the saphenous vein for treatment of venous insufficiency and varicose veins: early results from a large single-center experience. J Endovasc Ther.. 2004;11:132-8.

Holme JB, Holme K, Sorensen LS. The anatomic relationship between the long saphenous vein and the saphenous nerve: Relevance for radical varicose vein surgery. Acta Chir Scand.. 1988;154:631-3.

Holme JB, Skajaa K, Holme K. Incidence of lesions of the saphenous nerve after partial or complete stripping of the long saphenous vein. Acta Chir Scand.. 1990;156:145-8.

MacKenzie RK, Paisley A, Allan PL, Lee AJ, Ruckley CV, Bradbury AW. The effect of long saphenous vein stripping on quality of life. J Vasc Surg.. 2002;35:1197-203.

Garde C. Cryosurgery of varicose veins. J Dermatol Surg Oncol.. 1994;20:56-8.

Cheatle TR, Kayombo B, Perrin M. Cryostripping the long and short saphenous veins. Br J Surg.. 1993;80:1283.

Etienne G, Constantin JM, Hevia M. Cryo-stripping: an advance in the treatment of varicose veins. 3811 operated limbs. Press Med.. 1995;24:1017-20.

Constantin JM, Etienne G, Hevia M. Technique and results of cryo-stripping in the treatment of varicose veins of the lower limbs. Ann Chir.. 1997;51:745-8.

Weiss RA, Goldman MP. Controlled RF-mediated endovenous shrinkage and occlusion. Varicose veins & telangiectasias: diagnosis and management. 1999.

Chandler JG, Pichot O, Sessa C, Schuller-Petrovic S, Kabnick LS, Bergan JJ. Treatment of primary venous insufficiency by endovenous saphenous vein obliteration. J Vasc Surg.. 2000;34:201-14.

Goldman MP. Closure of the greater saphenous vein with endoluminal radiofrequency thermal heating of the vein wall in combination with ambulatory phlebectomy: preliminary 6-month follow-up. Dermatol Surg.. 2000;26:452-6.

Bergan JJ, Kumins NH, Owens EL, Sparks SR. Surgical and endovascular treatment of lower extremity venous insufficiency. J Vasc Interv Radiol.. 2002;13:563-8.

Cabrera J, Redondo P, Becerra A. Ultrasound-guided injection of polidocanol microfoam in the management of venous leg ulcers. Arch Dermatol.. 2004;140:667-73.

Boné C. Tratamiento endoluminal de las varices com láser de diodo: Estudio preliminar. Rev Patol Vasc.. 1999;5:35-46.

Navarro L, Min RJ, Boné C. Endovenous laser: a new minimally invasive method of treatment for varicose veins - preliminary observations using an 810 nm diode laser. Dermatol Surg.. 2001;27:117-22.

Min RJ, Zimmet SE, Isaacs MN, Forestal MD. Endovenous laser treatment of the incompetent greater saphenous vein. J Vasc Interv Radiol.. 2001;12:1167-71.

Porter JM, Moneta GL. Reporting standards in venous disease: an update. International Consensus Committee on Chronic Venous Disease. J Vasc Surg.. 1995;21:635-45.

Gloviczki P, Yao JST. Classification and grading of chronic venous disease in the lower limbs: a consensus statement. Handbook of Venous Disorders: Guidelines of the American Venous Forum. 1996:652-60.

Min RJ, Khilnani N, Zimmet SE. Endovenous laser treatment of saphenous vein reflux: long-term results. J Vasc Interv Radiol.. 2003;14:991-6.

Munn SR, Morton JB, Macbeth WA, Mcleish AR. To strip or not to strip the long saphenous vein?: A varicose vein trial. Br J Surg.. 1981;68:426-8.

Katz ML, Comerota AJ, Kerr R. Air plethysmograph (APG™): a new technique to evaluate patients with chronic venous insufficiency. J Vasc Tech.. 1991;15:23-7.

Conover WJ. Practical nonparametric statistics. 1971.

Fleiss JL. Statistical methods for rates and proportions. 1981.

Hulley SB, Cummings SR. Designing clinical research. 1988.

Lurie F, Creton D, Eklof B. Prospective randomized study of endovenous radiofrequency obliteration (closure procedure) versus ligation and stripping in a selected patient population (EVOLVeS Study). J Vasc Surg.. 2003;38:207-14.

Lurie F, Creton D, Eklof B. Prospective randomized study of endovenous radiofrequency obliteration (closure) versus ligation and vein stripping (EVOLVeS Study): two-year follow-up. Eur J Vasc Endovasc Surg.. 2005;29:67-73.

Manfrini S, Gasbarro V, Danielsson G. Endovenous management of saphenous vein reflux. J Vasc Surg.. 2000;32:330-42.

Zimmet SE, Min RJ. Temperature changes in perivenous tissue during endovenous laser treatment in a swine model. J Vasc Interv Radiol.. 2003;14:911-5.

Kabnick LS, Merchant RF. Twelve and twenty-four month follow-up after endovascular obliteration of saphenous vein reflux: a report from multi-center registry. J Phleb.. 2001;1:17-24.

Morrison C, Dalsing MC. Signs and symptoms of saphenous nerve injury after greater saphenous vein stripping: prevalence, severity, and relevance for modern practice. J Vasc Surg.. 2003;38:886-90.

Gillespie DL, Cordts PR, Hartono C. The role of air plethysmography in monitoring results of venous surgery. J Vasc Surg.. 1992;16:674-8.

Owens LV, Farber MA, Young M. The value of air plethysmography in predicting clinical outcome after surgical treatment of chronic venous insufficiency. J Vasc Surg.. 2000;32:961-8.

Evangelista SSM. Pletismografia no estudo das doenças venosas. Doenças vasculares periféricas. 2002:479-92.

Ibegbuna V, Delis KT, Nicolaides AN, Aina O. Effect of elastic compression stockings on venous hemodynamics during walking. J Vasc Surg.. 2003;37:420-5.

Yang D, Vandongen YK, Stacey MC. Variability and reliability of air plethysmographic measurements for the evaluation of chronic venous disease. J Vasc Surg.. 1997;26:638-42.

Proebstle TM, Krummenauer F, Gül D, Knop J. Nonocclusion and early reopening of the greater saphenous vein after endovenous laser treatment is fluence dependent. Dermatol Surg.. 2004;30:174-8.

Pichot O, Sessa C, Chandler JG, Nuta M, Perrin M. Role for duplex imaging in endovenous obliteration for primary venous insufficiency. J Endovasc Ther.. 2000;7:451-9.

Proebstle TM, Gül D, Lerh HA, Kargl A, Knop J. Infrequent early recanalization of greater saphenous vein after endovenous laser treatment. J Vasc Surg.. 2003;38:511-6.

Merchant RF, DePalma RG, Kabnick LS. Endovascular obliteration of saphenous reflux: a multicenter study. J Vasc Surg.. 2002;35:1190-6.

Mozes G, Kalra M, Carmo M, Swenson L, Gloviczki P. Extension of saphenous thrombus into the femoral vein: a potential complication of new endovenous ablation techniques. J Vasc Surg.. 2005;41:130-5.

Sarin S, Scurr JH, Coleridge Smith PD. Assessment of stripping the long saphenous vein in the treatment of primary varicose veins. Br J Surg.. 1992;79:889-93.

Chang CJ, Chua JJ. Endovenous laser photocoagulation (EVLP) for varicose veins. lasers. Surg Med.. 2002;31:257-62.

McMullin GM, Smith C, Scurr JH. Objective assessment of high ligation without stripping the long saphenous vein. Br J Surg.. 1991;78:1139-42.

Dwerryhouse S, Davies B, Harradine K, Earnshaw JJ. Stripping the long saphenous vein reduces the rate of reoperation for recurrent varicose veins: five-year results of a randomized trial. J Vasc Surg.. 1999;29:589-92.

Glass GM. Neovascularization in recurrence of the varicose great saphenous vein following transaction. Phlebology. 1987;2:81-91.

Jones L, Braithwaite BD, Selwyn D, Cooke S, Earnshaw JJ. Neovascularisation is the principal cause of varicose vein recurrence: results of a randomised trial of stripping the long saphenous vein. Eur J Vasc Endovasc Surg.. 1996;12:442-5.

Bradbury AW, Stonebridge PA, Callam MJ. Recurrent varicose veins: assessment of the saphenofemoral junction. Br J Surg.. 1994;81:373-5.

Stonebridge PA, Chalmers N, Beggs I, Bradbur AW, Ruckley CV. Recurrent varicose veins: a varicographic analysis leading to a new practical classification. Br J Surg.. 1995;82:60-2.

Oh CK, Jung DS, Jang HS, Kwon KS. Endovenous laser surgery of the incompetent greater saphenous vein with a 980-nm diode laser. Dermatol Surg.. 2003;29:1135-40.

Matsui IA, Menezes FH, Silveira SAF, Luccas GC, Lane JC. Derivações arteriais com veia safena interna autógena varicosa: seguimento com duplex. Cir Vasc Angiol.. 1994;10:126-9.

Barel EV. Estudo quantitativo do refluxo da veia safena interna pelo duplex em pacientes com varizes dos membros inferiores. .

Neglén P, Egger JF, Olivier J, Raju S. Hemodynamic and clinical impact of ultrasound: derived venous reflux parameters. J Vasc Surg.. 2004;40:303-10.

Luccas GC, Parente JBF, Nagase Y, Lane JC. Preservação da veia safena magna em cirurgia de varizes: resultados tardios. Cir Vasc Angiol.. 1995;11:15-8.

Luccas GC, Nagase Y, Silveira SAF, Potério Filho J. Avaliação quantitativa do refluxo na veia safena interna com duplex: aplicação no planejamento cirúrgico das varizes primárias dos membros inferiores. Cir Vasc Angiol.. 1999;15:27S.

Luccas GC, Nagase Y, Silveira SAF, Menezes FG. Medida do diâmetro e refluxo da veia safena interna no pré e pós-operatório da cirurgia de varizes. Cir Vasc Angiol.. 2001;17:24S.

Engelhorn CA, Engelhorn AL, Cassou MF, Casagrande C, Gosalan CJ, Ribas E. Classificação anatomofuncional da insuficiência das veias safenas baseada no Eco-Doppler colorido, dirigida para o planejamento da cirurgia de varizes. J Vasc Bras.. 2004;3:13-9.

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
5de95b900e88258c68e31d42 jvb Articles
Links & Downloads
1677-7301 (Electronic)
J Vasc Bras ©2024 All rights reserved.

J Vasc Bras

Share this page
Page Sections