Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/S1677-54492007000100005
Jornal Vascular Brasileiro
Original Article

Avaliação da bomba muscular da panturrilha em pacientes portadores de varizes primárias dos membros inferiores através da pletismografia a ar

Assessment of calf muscle pump in patients with primary varicose veins of the lower limbs by air plethysmography

André de Araújo Sacchi; Aldemar Araújo Castro; Guilherme Benjamin Brandão Pitta; Fausto Miranda Junior

Downloads: 1
Views: 1338

Resumo

OBJETIVO:Avaliar a influência do refluxo das veias musculares da panturrilha (surais e geniculares) na função da bomba muscular da panturrilha em pacientes com varizes primárias nos membros inferiores. MÉTODOS: Estudo transversal prospectivo, no qual os pacientes foram avaliados por meio de exame físico, mapeamento dúplexe pletismografia a ar. Foram selecionados 120 pacientes divididos em dois grupos (60 indivíduos em cada). O primeiro grupo apresentava refluxo das veias musculares da panturrilha e o segundo grupo apresentava ausência de refluxo. Cada grupo foi analisado com pletismografia a ar para estudo da função da bomba da panturrilha. As variáveis estudadas foram fração de ejeção, fração do volume residual, volume ejetado e índice de enchimento venoso para membro inferior direito e esquerdo. RESULTADOS: No grupo com refluxo, índices de fração de ejeção abaixo de 60% (com p < 0,001) foram encontrados em 82,3% (em perna esquerda) e em 74,6% (em perna direita) dos casos. Índices de fração do volume residual acima de 60% foram identificados em 62,5% (em perna esquerda, p = 0,015) e em 86,7% (em perna direita, p = 0,014) dos casos avaliados. Não houve variação estatisticamente significativa para o índice de enchimento venoso entre os grupos com e sem refluxo, com p = 0,140 e p = 0,140 para pernas esquerda e direita, respectivamente. Foram encontrados 63,6% dos pacientes com refluxo das veias da panturrilha (em perna esquerda), e 61,8% (em perna direita) com volume ejetado acima de 150 mL (p = 0,001). CONCLUSÕES: Houve alteração da bomba muscular da panturrilha, levando a uma diminuição de sua função, em ambos os membros inferiores por conseqüência da presença do refluxo das veias musculares da panturrilha (geniculares e surais).

Palavras-chave

Pletismografia a ar, bomba muscular da panturrilha, varizes, veias gastrocnêmias e soleares, mapeamento dúplex

Abstract

OBJECTIVE: This article aims at assessing the influence of calf muscle vein reflux (suraland genicular veins) on calf muscle pump function in patients with primary varicose veins of the lower limbs. METHODS: Cross-sectional and prospective study assessing 120 patients divided into two groups (60 subjects each) by physical examination, duplex scan and air plethysmography. The first group showed calf muscle venous reflux, whereas the second group presented absence of reflux. Both groups were examined by air plethysmography to verify calf pump function through measurement of ejection fraction, residual volume fraction, ejected volume and venous filling index in both limbs. RESULTS: In the group of patients with reflux, ejection fraction indexes lower than 60% (p < 0.001) were found in 82.3% (left leg) and 74.6% (right leg) of cases. Levels of residual volume fraction greater than 60% were identified in 62.5% (left leg, p= 0.015) and in 86.7% (right leg, p = 0.014) of assessed cases. There was no statistically significant variation concerning the venous filling index between groups with or without reflux, with p= 0.140 in both legs. Of all patients, 63.6% had calf vein reflux (left leg) and 61.8% (right leg) had ejection volume greater than 150 mL (p = 0.001). CONCLUSIONS: The calf pump function decreased in both lower limbs, due to presence of calf muscle vein reflux (genicular and sural veins).

Keywords

Air plethysmography, calf pump function, varicose veins, gastrocnemius and soleal veins, duplex scan

References

Ruckley CV, Evans CJ, Allan PL, Lee AJ, Fowkes FG. Chronic venous insufficiency: clinical and duplex correlations. The Edinburgh Vein Study of venous disorders in the general population. J Vasc Surg. 2002;36:520-5.

Zsoter T, Cronin RF. Venous distensibility in patients with varicose veins. Can Med Assoc J. 1966;94:1293-7.

Bollinger A, Leu AJ, Hoffmann U, Franzeck UK. Microvascular changes in venous disease: an update. Angiology. 1997;48:27-32.

Morano JU, Raju S. Chronic venous insufficiency: assessment with descending venography. Radiology. 1990;174:441-4.

Shami SK, Sarin S, Cheatle TR, Scurr JH, Smith PD. Venous ulcers and the superficial venous system. J Vasc Surg. 1993;17:487-90.

Becker F. Mechanisms, epidemiology and clinical evaluation of venous insufficiency of the lower limbs. Rev Prat. 1994;44:726-31.

Christopoulos DG, Nicolaides AN, Szendro G, Irvine AT, Bull ML, Eastcott HH. Air-plethysmography and the effect of elastic compression on venous hemodynamics of the leg. J Vasc Surg. 1987;5:148-59.

Bradbury AW, Stonebridge PA, Ruckley CV, Beggs I. Recurrent varicose veins: correlation between preoperative clinical and hand-held Doppler ultrasonographic examination, and anatomical findings at surgery. Br J Surg. 1993;80:849-51.

Kalodiki E, Calahoras L, Nicholaides AN. Make it easy: duplex examination of the venous system. Phlebology. 1993;8:17-21.

Jiang P, van Rij AM, Christie R, Hill G, Solomon C, Thomson I. Recurrent varicose veins: patterns of reflux and clinical severity. Cardiovasc Surg. 1999;7:332-9.

Jiang P, van Rij AM, Christie RA, Hill GB, Thomson IA. Venous physiology in the different patterns of recurrent varicose veins and the relationship to clinical severity. Cardiovasc Surg. 2000;8:130-6.

Nicolaides AN. Diagnostic evaluation of pacients with cronic venous insufficiency. Vascular surgery. 1989:1583-601.

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

Rutherford RB. Vascular surgery. 1995:1772.

Christopoulos DG, Nicolaides AN, Szendro G, Irvine AT, Bull ML, Eastcott HH. Air-plethysmography and the effect of elastic compression on venous hemodynamics of the leg. J Vasc Surg. 1987;5:148-59.

van Rij AM, Jiang P, Solomon C, Christie RA, Hill GB. Recurrence after varicose vein surgery: A prospective long-term clinical study with duplex ultrasound scanning and air plethysmography. J Vasc Surg. 2003;38:935-43.

Harada RN, Katz ML, Comerota A. A noninvasive screening test to detect "critical": deep venous reflux. J Vasc Surg. 1995;22:532-7.

Christopoulos D, Nicolaides NA. Air plethysmography. Surgical management of venous disease. 1997;93.

Belcaro G, Nicolaides AN, Veller M. Assessment of the venous and lymphatic systems. Venous disorders: a manual of diagnosis and treatment. 1995:41.

Comerota AJ, Harada RN, Eze AR, Katz ML. Air plethysmography: a clinical review. Int Angiol. 1995;14:45-52.

Christopoulos D, Nicolaides AN, Szendro G. Venous reflux: quantification and correlation with the clinical severity of chronic venous disease. Br J Surg. 1988;75:352-6.

Bradbury A, Evans C, Allan P, Lee A, Ruckley CV, Fowkes FG. What are the symptoms of varicose veins?: Edinburgh Vein Study cross sectional population survey. BMJ. 1999;318:353-6.

Evans CJ, Fowkes FG, Ruckley CV, Lee AJ. Prevalence of varicose veins and chronic venous insufficiency in men and women in the general population: Edinburgh Vein Study. J Epidemiol Community Health. 1999;53:149-53.

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.

Nicolaides AN, Summer DS. Investigation of patients with deep vein thrombosis and chronic venous insufficiency. 1991:9-61.

Christopoulos D, Nicolaides AN, Cook A, Irvine A, Galloway JM, Wilkinson A. Pathogenesis of venous ulceration in relation to the calf muscle pump function. Surgery. 1989;106:829-35.

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
5ddfe0810e8825d1364ce1d5 jvb Articles
Links & Downloads

J Vasc Bras

Share this page
Page Sections