Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/S1677-54492007000300007
Jornal Vascular Brasileiro
Original Article

Probabilidade de refluxo nas veias safenas de mulheres com diferentes graus de insuficiência venosa crônica

Reflux probability in saphenous veins of women with different degrees of chronic venous insufficiency

Maria Fernanda Cassou; Patrícia Carla Zanelatto Gonçalves; Carlos Alberto Engelhorn

http://dx.doi.org/10.1590/S1677-54492007000300007 J Vasc Bras, vol.6, n3, p.238-245, 2007
PDF Português
PDF English
SciELO
Downloads: 0
Views: 1645

Resumo

CONTEXTO: A presença de refluxo nas junções safeno-femoral e safeno-poplítea é um dado importante para programação da cirurgia de varizes. Estudos mostraram que, na maioria dos pacientes com insuficiência venosa crônica, as junções estão competentes, e o refluxo está presente ao longo do trajeto das veias safenas. OBJETIVOS: Identificar probabilidade de diferentes padrões de refluxo nas veias safenas de mulheres com vários graus de insuficiência venosa crônica e avaliar se o comprometimento das junções das safenas está associado com gravidade da insuficiência venosa. MÉTODOS: Um total de 1.184 membros inferiores de 672 mulheres foram estudados pela ultra-sonografia vascular com Doppler colorido e avaliados pela classificação clínica, etiológica, anatômica e patológica (CEAP). As extremidades foram agrupadas de acordo com a gravidade da insuficiência venosa em graus leve (CEAP C1-C2), moderado (CEAP C3) e grave (CEAP C4-C6). Para avaliar a classificação clínica CEAP na predição do padrão de refluxo, utilizou-se o Teorema de Bayers. Para avaliar associação entre classificação clínica CEAP e padrões de refluxo com ou sem comprometimento das junções das safenas, utilizou-se o teste qui-quadrado (p < 0,05). RESULTADOS: Das 1.184 extremidades avaliadas, 50,2% apresentavam varizes sem edema (CEAP C2). O padrão de refluxo segmentar foi o mais freqüente nas veias safenas magna (35,14%) e parva (8%), independente da gravidade da insuficiência venosa. As junções safeno-femoral e safeno-poplítea foram fontes de refluxo em 12 e 6% das extremidades, respectivamente. Considerando a associação entre classificação clínica CEAP e insuficiência das junções das safenas, foi observada diferença significativa entre presença de refluxo nas junções safeno-femoral (p = 0,0009) e safeno-poplítea (p = 0,0006) na doença avançada. CONCLUSÕES: O refluxo inicia-se predominantemente em segmentos no trajeto das veias safenas. As junções das safenas não são as principais fontes causadoras do refluxo no sistema venoso superficial. À medida que piora a apresentação clínica da insuficiência venosa, aumenta a probabilidade de refluxo nas junções das safenas.

Palavras-chave

Insuficiência venosa, varizes, veia safena, ultra-som, Doppler

Abstract

BACKGROUND: Presence of reflux in saphenofemoral and saphenopopliteal junctions represents important data for indication of varicose vein surgery. Studies demonstrated that in most patients with chronic venous insufficiency junctions are competent and reflux is present in segments in the course of saphenous veins. OBJECTIVES: To identify the probability of different reflux patterns in the saphenous veins of women with various degrees of chronic venous insufficiency and to evaluate whether junction impairment is associated with severity of venous insufficiency. METHODS: A total of 1,184 lower limbs of 672 women were evaluated by color-flow Doppler ultrasonography and classified according to clinical, etiologic, anatomic and pathophysiological classification (CEAP). The extremities were divided according to severity of venous insufficiency into three groups: mild (CEAP C1-C2), moderate (CEAP C3) and severe (CEAP C4-C6). Bayes' theorem was used to evaluate CEAP classification as a predictor of reflux patterns. The association between CEAP clinical classification and reflux patterns with or without saphenofemoral and saphenopopliteal insufficiency was analyzed using chi-square test (p < 0.05). RESULTS: Out of 1,184 lower limbs, 50.2% had varicose veins without edema (CEAP C2). The most common reflux pattern was the segmental in both great (35.14%) and small (8%) saphenous vein, regardless of severity of venous insufficiency. Saphenofemoral and saphenopopliteal junctions were the source of reflux in 12 and 6% of lower limbs, respectively. Considering the association between CEAP clinical class and saphenous vein insufficiency, there was significant difference between presence of reflux in saphenofemoral (p = 0.0009) and saphenopopliteal (p = 0.0006) junctions in advanced disease. CONCLUSIONS: Venous reflux begins mainly in saphenous vein segments. Saphenous vein junctions are not the main sources of reflux in the superficial venous system. Risk of reflux in saphenous vein junctions increases with clinical severity of chronic venous insufficiency.

Keywords

Venous insufficiency, varicose veins, saphenous vein, ultrasonics, Doppler

References

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

Yamaki T, Nozaki M, Fujiwara O, Yoshida E. Comparative evaluation of duplex-derived parameters in patients with chronic venous insufficiency: correlation with clinical manifestations. J Am Coll Surg.. 2002;195:822-30.

Salles-Cunha SX. Lower extremity mapping of venous reflux. Vasc US Today. 2000;5(1):1-20.

Engelhorn CA, Engelhorn AL, Cassou MF, Zanoni CC, Gosalan CJ, Ribas E. Classificação anátomofuncional 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.

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

Jutley RS, Cadle I, Cross KS. Preoperative assessment of primary varicose veins: a duplex study of venous incompetence. Eur J Vasc Endovasc Surg.. 2001;21:370-3.

Engelhorn CA, Engelhorn AL, Cassou MF, Salles-Cunha SX. Patterns of saphenous reflux in women with primary varicose veins. J Vasc Surg.. 2005;41:645-51.

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

van Bemmelen PS, Bedford G, Beach K, Strandness DE. Quantitative segmental evaluation of venous valvular reflux with duplex ultrasound scanning. J Vasc Surg.. 1989;10:425-31.

Ruckley CV. Socioeconomic impact of chronic venous insufficiency and leg ulcers. Angiology. 1997;48:67-9.

Santos MERC. Insuficiência venosa crônica: conceito, classificação e fisiopatologia. Cirurgia vascular. 2002:1002-11.

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.

Labropoulos N, Kang SS, Mansour MA, Giannoukas AD, Buckman J, Baker WH. Primary superficial vein reflux with competent saphenous trunk. Eur J Vasc Endovasc Surg.. 1999;18:201-6.

Seidel AC, Miranda Jr. F, Juliano Y, Novo NF, dos Santos JH, de Souza DF. Prevalence of varicose veins and venous anatomy in patients without truncal saphenous reflux. Eur J Vasc Endovasc Surg.. 2004;28:387-90.

Wills V, Moylan D, Chambers J. The use of routine duplex scanning in the assessment of varicose veins. Aust NZ J Surg.. 1998;68:41-4.

Abu-Own A, Scurr JH, Coleridge Smith PD. Saphenous vein reflux without incompetence at the saphenofemoral junction. Br J Surg.. 1994;81:1452-4.

Cooper DG, Hillman-Cooper CS, Barker SG, Hollingsworth SJ. Primary varicose veins: the sapheno-femoral junction, distribution of varicosities and patterns of incompetence. Eur J Vasc Endovasc Surg.. 2003;25:53-9.

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
5ddebfca0e8825ec127279a1 jvb Articles
1677-7301 (Electronic)
J Vasc Bras ©2024 All rights reserved.

J Vasc Bras

Share this page
Page Sections