Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/S1677-54492007000300010
Jornal Vascular Brasileiro
Review Article

Métodos de diagnóstico não-invasivos para avaliação da insuficiência venosa dos membros inferiores

Noninvasive diagnostic methods to evaluate venous insufficiency of the lower limbs

Orlando Adas Saliba Jr.; Mariangela Giannini; Hamilton Almeida Rollo

Downloads: 1
Views: 1340

Resumo

A avaliação clínica dos membros inferiores na insuficiência venosa por si só não identifica os sistemas envolvidos ou os níveis anatômicos, sendo necessários exames complementares. Esses exames podem ser invasivos ou não-invasivos. Os invasivos, como flebografia e pressão venosa ambulatória, apesar de terem boa acurácia, trazem desconforto e complicações. Dentre os não-invasivos, destacam-se: Doppler ultra-som de ondas contínuas, fotopletismografia, pletismografia a ar e mapeamento dúplex. O Doppler ultra-som avalia a velocidade do fluxo sangüíneo de maneira indireta. A fotopletismografia avalia o tempo de reenchimento venoso, fornecendo um parâmetro objetivo de quantificação do refluxo venoso. A pletismografia a ar permite quantificar a redução ou não da capacitância, o refluxo e o desempenho da bomba muscular da panturrilha. O dúplex é considerado padrão-ouro dentre os não-invasivos, porque permite uma avaliação quantitativa e qualitativa, fornecendo informações anatômicas e funcionais, dando avaliação mais completa e detalhada dos sistemas venosos profundo e superficial.

Palavras-chave

Diagnóstico, insuficiência venosa, ultra-som, pletismografia

Abstract

Clinical evaluation of lower limbs of patients with venous insufficiency alone may not identify involved systems or anatomical sites, thus complementary tests are needed. These tests can be invasive or noninvasive. Invasive tests, such as phlebography and ambulatory venous pressure, despite being accurate, may produce discomfort and complications. Some of the most used noninvasive tests are continuous wave Doppler ultrasound, photoplethysmography, air plethysmography and duplex scanning. Doppler ultrasound assesses blood flow velocity indirectly. Photoplethysmography assesses venous refilling time, providing an objective parameter of venous reflux quantification. Air plethysmography allows quantification of reduction in venous capacitance, reflux and performance of the calf muscle pump. Duplex is considered a gold standard among noninvasive methods, because it allows quantitative and qualitative evaluation, supplying anatomical and functional information, thus providing a more complete and detailed evaluation of both deep and superficial venous system.

Keywords

Diagnosis, venous insufficiency, ultrasonics, plethysmography

References

Maffei FHA. Insuficiência venosa crônica: conceito, prevalência, etiopatogenia e fisiopatologia. Doenças vasculares periféricas. 2002:1581-90.

Nicolaides NA. Consenso de classification de las enfermidades venosas crônicas. Patol Nasc.. 1994;1:75-85.

Eklöf B, Rutherford RB, Bergan JJ. Revision of the CEAP classification for chronic venous disorders: Consensus statement. J Vasc Surg.. 2004;40(6):1248-52.

Maffei FH, Magaldi C, Pinho SZ. Varicose veins and chronic venous insufficiency in Brazil: prevalence among 1755 inhabitants of a country. Int J Epidemiol.. 1986;15(2):210-7.

Gonzales-Fajardo JA, Rodriguez-Camarero SJ, Mareno P. Valoración mediante fotopletismografía del efecto de una medicación venotônica. Angiologia. 1990;42(5):167-71.

Barros Jr N. Doença varicosa dos membros inferiores na gestação: Prevalencia, fatores de risco e sintomatologia. 1995.

Scuderi A, Raskin B, Al Assal F. The incidence of venous disease in Braszil based on the CEAP classification. Int Angiol.. 2002;21(4):316-21.

Maffei FHA. Diagnóstico clínico das doenças venosas periférica. Doenças vasculares periféricas. 2002;1:457-69.

Darke SG, Andress MR. The value of venography in the management of chronic venous disorders of the lower limb. Diagnostic techniques and assessment procedures in vascular surgery. 1985:421-46.

McEnroe CS, O'Donnell TF, Mackey WC. Correlation of clinical finding with venous hemodynamics in 386 patients with chronic venous insufficiency. Am J Surg.. 1998;156(2):148-52.

Welch HJ, Faliakou EC, McLaughlin RL, Umphrey SE, Belkin M, O'Donnell Jr TF. Comparison of descending phlebography with quantitative photoplethysmography, air plethysmography, and duplex quantitative valve closure time in assessing deep venous reflux. J Vasc Surg.. 1992;16(6):913-9.

Abramowitz HB, Queral LA, Finn WR. The use of photoplethysmography in the assessment of venous insufficiency: a comparison to venous pressure measurements. Surgery. 1979;86(3):434-41.

Van Bemmelen PS, Mattos MA, Hodgson KJ. Does air plethysmography correlate with duplex scanning in patients with chronic venous insufficiency?. J Vasc Surg.. 1993;18(5):796-807.

Weingarten MS, Czeredarczuk M, Scovell S, Branas CC, Mignogna GM, Wolferth CC. A correlation of air plethysmography and color-flow-assisted duplex scanning in the quantification of chronic venous insufficiency. J Vasc Surg.. 1996;24(5):750-4.

Christopoulos D, Nicolaides AN. Air plethysmography. Surgical management of venous disease. 1997:86-96.

Satomura S, Kaneko Z. Ultrasonic blood rheograph. :254-8.

Barnes RW, Vitti MJ. Diagnóstico não invasivo de doença venosa. Cirurgia vascular. 1999:1153-70.

Fonseca FP. Doppler ultra-som nas doenças venosas. Doenças vasculares periféricas. 2002;1:471-7.

Menezes RE, Sales EA. Avaliação dos pacientes portadores de varizes e de insuficiência venosa crônica através do Doppler Ultra-Som. Cir Vasc Angiol.. 1990;6(1):11-4.

Gaylis H. Some observations on peripheral venous pressure using a non-invasive technique: a preliminary report. Br J Surg.. 1975;62(4):259-63.

Barnes RW, Collicott PE, Mozersky DJ, Sumner DS, Strandness Jr DE. Noninvasive quantitation of venous reflux in the postphlebitic syndrome. Surg Gynecol Obstet.. 1973;136(5):769-73.

Barnes RW, Collicott PE, Sumner DS, Strandness Jr DE. Noninvasive quantitation of venous hemodinamics in the postphlebitic syndrome. Arch Surg.. 1973;107(5):807-14.

Luccas GC, Kauffman P, Lane JC. Método de avaliação do estado funcional da veia safena interna. Cir Vasc Angiol.. 1985;1(3):22-8.

Bartolo M, Antignani PL, Nicosia PM, Tidini AR. Noninvasive venous pressure measurement and its validation. Int Angiol.. 1988;7(2):182-9.

Cheng SWK, Wong J. Chronic venous insuffiency in a chinese population: an anatomic and funcional study by continuous-wave Doppler and photoplethysmography. Ann Vasc Surg.. 1995;9(3):274-9.

Rollo HA. Avaliação do refluxo venoso profundo. Ultra-sonografia vascular. 2000:209-17.

Barnes RW, Garret WV, Hummel BA, Siamaker EE, Maixner W, Reinertson JE. Photoplethysmographic assessement of altered cutaneous circulation in the postphebitic syndrome. :25.

Evangelista SSM, Fonseca FP. O valor da fotopletismografia no pré e pós-operatório das varizes tronculares primárias dos MMII. Cir Vasc Angiol.. 1996;12(^s4):59-62.

Gerlock AJ, Giyanani VL, Krebs C. Applications of noninvasive vascular techniques. 1988:181-205.

Sarin S, Shields DA, Farrah J, Scurr JH, Cobridge - Smith PD. Does venous function deteriorate in patients waiting for varicose vein surgery?. J R Soc Med.. 1993;86(1):21-3.

Scriven JM, Bianchi V, Hartshorne T, Bell PR, Naylor AR, London NJ. A clinical and haemodynamic investigation into the role of calf perforating vein surgery in patients with venous ulceration and deep venous incompetence. Eur J Vasc Endovasc Surg.. 1998;16(2):148-52.

Alvarez Sánchez JA, Vega Gómez ME. Nuevos critérios en el diagnostico de la insuficiencia venosa mediante fotopletismografia. Rev Cuba Invest Biomed.. 1991;10(2):123-5.

Sakurai T, Matsushita M, Nishikimi N, Nimura Y. Hemodynamic assessment of femoropopliteal venous reflux in patients with primary varicose veins. J Vasc Surg.. 1997;26(2):260-4.

Rutgers PH, Kitslaar PJ, Ermers EJ. Photoplethysmography in the diagnosis of superficial venous valvular incompetence. Br J Surg.. 1993;80(3):351-3.

Evangelista SSM. Pletismografia no estudo das doenças venosas. Doenças vasculares periféricas. 2002;1:479-92.

Guillot B. Techniques used to evaluate the cutaneous microcirculation: application of photoplethysmography to the assessment of a phlebotropic agent in the treatment of leg ulcers. Angiology. 1994;45(6):542-8.

Iafrati MD, Welch H, O'Donnell TF, Belkin M, Umphrey S, McLaughlin R. Correlation of venous noninvasive with the Society for Vascular Surgery/ International Society for Cardiovascular Surgery clinical classification of chronic venous insufficiency. J Vasc Surg.. 1994;19(6):1001-7.

Tucker EA, Lamb LE, Callicott C, Cooke SD, Cooke ED. Measurements of calf muscle pump efficiency during simulated ambulation. Int Angiol.. 1998;17(4):255-9.

Fronek A, Minn C, Kim R. Venous outflow and inflow resistance in health and venous disease. J Vasc Surg.. 2000;31(3):472-6.

Aita DJ, Kvamme P, Rice JC, Kerstein MD. Venous insufficiency: a late sequelae of four-compartment fasciotomy in lower extremity?. Am Surg.. 1993;59(9):574-7.

Dunn RM, Fudem GM, Walton RL, Anderson Jr FA, Malhotra R. Free flap valvular transplantation for refractory venous ulceration. J Vasc Surg.. 1994;19(3):525-31.

Fonseca FP, Sarkis AL, Evangelista SSM. Surgery for primary troncular varicose veins without stripping the safenous vein pre and pos-operative evaluation by duplex scan and photoplethysmography. Phlebologie. 1995:419-21.

Rodríguez Oliveri O, Mebold P J, Galleguillos Olmedo I. Valvuloplastia externa (banding) en pacientes con úlcera venosa de la pierna. Rev Chil Cír.. 2000;52(1):73-6.

Lane R J, Cuzzilla ML, McMahon CG. Intermediate to long term results of repairing incompetent multiple deep venous valves using external valvular stenting. Anz J Surg.. 2003;73(5):267-74.

Gaitini D, Torem S, Pery M, Kaftori JK. Image directed Doppler ultrasound in the diagnosis of lower-limb venous insufficiency. J Clin Ultrasound.. 1994;22(5):291-7.

Sardinha WE, Miranda Jr F, Francisco Jr J, Pitta GBB, Burihan E. Avaliação da insuficiência venosa crônica pela flotopletismografia. Cir Vasc Angiol.. 1988;4(3):7-11.

Peixoto LHWP, Braga PEG, Zorn WGW, Van Bellen B. Estase venosa e gravidez: Um estudo prospectivo fotopletismográfico. An Paul Med Cir.. 1991;118(2):29-38.

Owens LV, Faber MA, Young ML. The value of air plethysmography in predicting clinical outcome after surgical treatment of chronic venous insufficiency. J Vasc Surg.. 2000;32(5):961-8.

Comerota AJ, Harada RN, Eze AR, Katz ML. Air plethysmography: a clinical review. Int Angiol.. 1995;14(1):45-52.

Sanches PRS. Pletismografias: Considerações básicas. Ultra-sonografia vascular. 2000:24-7.

Kalodiki E, Nicolaides AN. Out of a recent CVI consensus some features of a basic statement. Int Angiol.. 2002;21(^s2):2-11.

Bays RA, Healy DA, Atnip RG, Neumyer M, Thiele BL. Validation of air plethysmography, photoplethysmography, and duplex ultrasonography in the evaluation of severe venous stasis. J Vasc Surg.. 1994;20(5):721-7.

Christopoulos D, 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(1):148-59.

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(5):829-35.

Christopoulos D, Nicolaides AN, Galloway JMD, Wilkinson A. Objective noninvasive evaluation of venous surgical results. J Vasc Surg.. 1988;8(6):683-7.

Gillespie DL, Cordts PR, Hartono C. The role of air plethysmography in monitoring results of venous surgery. J Vasc Surg.. 1992;16(5):674-8.

Kalodiki E, Volteas SK, Nicolaides AN. Air plethysmography versus venography and/or duplex scanning in the diagnosis of acute deep vein thrombosis. Phlebology. 1995:681-3.

Kalodiki E, Calahoras L, Delis KT, Zouzias CP, Nicolaides AN. Air plethysmography: the answer in detecting past deep venous thrombosis. J Vasc Surg.. 2001;33(4):715-20.

Yang D, Vandongen YK, Stacey MC. Variability and reliability of air pletysmographic measurements for the evaluation of chronic venous disease. J Vasc Surg.. 1997;26(4):638-42.

Engelhorn CA, Engelhorn AL, Casagrande C. Classificação da insuficiência venosa superficial baseada no Eco-Doppler colorido. Ultra-sonografia vascular. 2000:173-9.

Seidel AC. Correlação da pletismografia a ar com o quadro clínico (CEAP) e o ultra-som colorido com Doppler na insuficiência da veia safena magna. 2003.

Rollo HA. Mapeamento dúplex no diagnóstico das doenças venosas. Doenças vasculares periféricas. 2002;1:493-505.

Labropoulos N, Delis K, Nicolaides AN, Leon M, Ramaswami G, Volteas N. 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(3):504-10.

Neglen P, Raju S. A comparison between descending phlebography and duplex Doppler investigation in the evaluation of reflux in chronic venous insufficiency: a challenge to phlebography as the "gold standard". J Vasc Surg.. 1992;16(5):687-93.

Baker SR, Burnand KG, Sommerville KM, Thomas ML, Wilson NM, Browse NL. Comparison of venous reflux assessed by duplex scanning and descending phlebography in chronic venous disease. Lancet. 1993;341(8842):400-3.

Delis KT, Husmann M, Kalodiki E, Wolfe JH, Nicolaides A. In situ hemodynamics of perforating veins in chronic venous insufficiency. J Vasc Surg.. 2001;33(4):773-82.

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
5ddec07b0e882545147279a1 jvb Articles

J Vasc Bras

Share this page
Page Sections