Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/S1677-54492007000400010
Jornal Vascular Brasileiro
Original Article

A variabilidade hemodinâmica venosa detectada pelos parâmetros da pletismografia a ar nas classes clínicas da classificação CEAP

Variability of venous hemodynamics detected by air plethysmography in CEAP clinical classes

Ricardo de Ávila Oliveira; Newton de Barros Jr.; Fausto Miranda Jr.

http://dx.doi.org/10.1590/S1677-54492007000400010 J Vasc Bras, vol.6, n4, p.359-365, 2007
PDF Português
PDF English
SciELO
Downloads: 0
Views: 853

Resumo

CONTEXTO: A variabilidade hemodinâmica da pletismografia a ar é conhecida, mas o exato papel dessa variabilidade no cotidiano clínico não foi investigado, podendo ter algum significado clínico ainda não explorado. Sabe-se que há sobreposição entre as classes clínicas (C0 a C6) da classificação CEAP e mesmo entre membros inferiores de uma mesma classe clínica. OBJETIVO: Avaliar a variabilidade hemodinâmica dos parâmetros da pletismografia a ar nas classes clínicas da classificação CEAP. MÉTODO: Este estudo retrospectivo confronta a doença varicosa de membros inferiores classificada de C0 a C6 pela classificação CEAP com os parâmetros hemodinâmicos venosos obtidos pela pletismografia a ar. Os dados obtidos foram tabulados e analisados em suas classes clínicas pelos testes de variância de Kruskal-Wallys e Barllett. RESULTADOS: Foram realizados 310 exames em 230 pacientes cujas idades variaram entre 19 a 81 anos, com uma média de 46,2 anos. Os parâmetros índice de enchimento venoso e volume venoso funcional mostraram aumento da variabilidade hemodinâmica quando analisados na classe clínica C0 do CEAP, demonstrada por meio do coeficiente de variabilidade que, para o índice de enchimento venoso foi de 28,12% na classe clínica C0 e se manteve acima de 57% nas classes de C2 a C6. A fração de ejeção e a fração de volume residual não aumentaram a variabilidade quando comparados com a classe clínica C0 do CEAP. CONCLUSÃO: O índice de enchimento venoso foi o melhor parâmetro para avaliação e triagem de pacientes com insuficiência venosa crônica, mas tem grande variabilidade nas classes clínicas C2 a C6 do CEAP.

Palavras-chave

Varizes, insuficiência venosa, pletismografia

Abstract

BACKGROUND: The hemodynamic variability of air plethysmography is known in the literature, but the clinical significance of this event has not been investigated yet, and there may be some unexplored clinical meaning. There is known superpositioning of CEAP clinical classes (C0-C6) and even in lower limbs of the same clinical classes. OBJECTIVE: To evaluate hemodynamic variability of air plethysmography parameters in CEAP clinical classes. METHODS: This retrospective study compares lower limb varicose disease between C0 and C6 CEAP clinical classes with venous hemodynamic parameters obtained by air plethysmography. Data were tabled and analyzed according to their clinical classes by Kruskal-Wallys and Barllet variance tests. RESULTS: A total of 310 examinations were performed in 230 patients, aged between 19-81 years (mean = 46.2 years). Venous filling index and functional venous volume increased hemodynamic variability when compared with CEAP C0. This was demonstrated by the variability coefficient, which was 28.12% for venous filling index in C0 and higher than 57% between clinical classes C2 and C6. Ejection fraction and residual venous fraction had no increase in variability when compared with CEAP C0. CONCLUSION: Venous filling index is the best parameter for assessment and screening patients with chronic venous insufficiency, but has great variability in C2 to C6 CEAP clinical classes.

Keywords

Varicose veins, venous insufficiency, plethysmography

References

Neglén 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;16:687-93.

DePalma RG, Hart MT, Zanin L, Massarin EH. Physical examination, Doppler ultrasound and color flow duplex scanning: guides to therapy for primary varicose veins. Phlebology. 1993;8:7-11.

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.

Pierik EG, Toonder IM, van Urk H, Wittens CH. Validation of duplex ultrasonography in detecting competent and incompetent perforating veins in patients with venous ulceration of the lower leg. J Vasc Surg. 1997;26:49-52.

Depalma RG, Kowallek DL, Barcia TC, Cafferata HT. Target selection for surgical intervention in severe chronic venous insufficiency: Comparison of duplex scanning and phlebography. J Vasc Surg. 2000;32:913-20.

Neglén P, Raju S. A rational approach to detection of significant reflux with duplex Doppler scanning and air plethysmography. J Vasc Surg. 1993;17:590-5.

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(1):148-59.

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

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

Barros MV, Labropoulos N, Ribeiro AL, Okawa RY, Machado FS. Clinical significance of ostial great saphenous vein reflux. Eur J Vasc Endovasc Surg. 2006;31:320-4.

Criado E, Farber MA, Marston WA, Daniel PF, Burnham CB, Keagy BA. The role of air plethysmography in the diagnosis of chronic venous insufficiency. J Vasc Surg. 1998;27:660-70.

Porter JM, Moneta GL. Reporting standards in venous disease: an update. J Vasc Surg. 1995;21:635-45.

Campos H. Estatística experimental não-paramétrica. 1983.

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

Moneta GL. Regarding "the 'C' of CEAP: Suggested definitions and refinements: an International Union of Phlebology conference of experts". . .

Browse NL. Is the vascular laboratory necessary in the management of venous disease?. J Vasc Surg. 1986;3:481-5.

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.

McDaniel HB, Marston WA, Farber MA. Recurrence of chronic venous ulcers on the basis of clinical, etiologic, anatomic, and pathophysiologic criteria and air plethysmography. J Vasc Surg. 2002;35:723-8.

Labropoulos N, Wierks C, Golts E. Microcirculatory changes parallel the clinical deterioration of chronic venous insufficiency. Phlebology. 2004;19(2):81-6.

Browse NL. The cause of venous ulceration. Lancet. 1982;2:243-5.

Dezotti NR, Joviliano EE, Toma MK. Uso da pletismografia a ar para correlacionar o índice de enchimento venoso com a gravidade da doença venosa crônica. J Vasc Bras. 2005;4(3^s1):S174.

Cordts PR, Hartono C, LaMorte WW, Menzoian JO. Physiologic similarities between extremities with varicose veins and with chronic venous insufficiency utilizing air plethysmography. Am J Surg. 1992;164:260-4.

Swinscow TDV. Data display and summary. Statistics at square one. 1997.

Spence RK, Cahall E. Inelastic versus elastic leg compression in chronic venous insufficiency: A comparison of limb size and venous hemodynamics. J Vasc Surg. 1996;24:783-7.

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.

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

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

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
5ddeba400e8825427e7279a2 jvb Articles
1677-7301 (Electronic)
J Vasc Bras ©2024 All rights reserved.

J Vasc Bras

Share this page
Page Sections