Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/S1677-54492011000300003
Jornal Vascular Brasileiro
Original Article

Estudo comparativo entre os achados do exame físico, do mapeamento com eco-color Doppler e da exploração cirúrgica na recidiva das varizes de membros inferiores a partir da junção safeno-femoral

Comparative study among the physical examination, echo-color Doppler mapping and operative approaching in the recurrent lower extremity varicose veins from the saphenofemoral junction

Gilberto Narchi Rabahie; Daniel Reis Waisberg; Lourdes Conceição Martins; Mariane Martins Manso; Newton Eiji Kitamura; Jaques Waisberg

http://dx.doi.org/10.1590/S1677-54492011000300003 J Vasc Bras, vol.10, n3, p.198-204, 2011
PDF Português
PDF English
SciELO
Downloads: 0
Views: 1129

Resumo

CONTEXTO: A recidiva de varizes em membros inferiores é complicação frequente da safenectomia e sua incidência atinge até 80% dos casos. OBJETIVO: Avaliar a sensibilidade do exame físico e do mapeamento com eco-color Doppler no diagnóstico da insuficiência do coto da veia safena magna, em doentes previamente operados, comparando-os com os achados da exploração operatória da junção safeno-femoral. MÉTODOS: Foram estudados prospectivamente 30 doentes envolvendo 37 membros submetidos previamente à safenectomia magna para tratamento de varizes e que foram reoperados por recidiva de varizes na região inguinal ou em face anterossuperior da coxa. Todos os doentes foram submetidos ao mapeamento com eco-color Doppler. Os dados foram comparados com os achados da exploração da crossa da veia safena magna na reoperação. RESULTADOS: A sensibilidade do mapeamento com eco-color Doppler para a presença de insuficiência do coto da veia safena magna foi de 70,3% (26 concordâncias dentre os 37 membros) e resultados falsos negativos ocorreram em 29,7% (11) membros avaliados (p=0,03). A sensibilidade do achado de varizes na região inguinal e na face anteromedial da coxa com a presença de insuficiência do coto da veia safena magna foi de 100% (37 concordâncias dentre os 37 membros) e não houve resultados falsos negativos. CONCLUSÕES: No doente já submetido à safenectomia magna, a presença no exame físico de varizes recidivadas em região inguinal e na face anteromedial da coxa é sugestivo de insuficiência do coto da veia safena magna, devendo-se realizar o mapeamento com eco color Doppler para o adequado planejamento da reexploração da crossa da veia safena magna.

Palavras-chave

veia safena, varizes, recidiva, ultrassonografia, ultrassonografia Doppler em cores

Abstract

BACKGROUND: Recurrent varicose veins of the lower limbs are a frequent complication of saphenous vein stripping and their incidence may reach 80% of the cases. OBJECTIVE: To evaluate the sensitivity of physical examination and color-Doppler flow mapping for the diagnosis of insufficiency in the greater saphenous vein stump in patients who had previously undergone saphenous vein stripping, comparing the results with the findings at reoperation of the saphenofemoral junction. METHODS: This prospective study included 37 limbs of 30 patients who had been previously submitted to saphenous vein stripping to treat varicose veins. Color-Doppler flow mapping was performed in all patients. Results were compared with findings at reoperation of the saphenofemoral junction. RESULTS: The sensitivity of color-Doppler flow mapping was 70.3% (26 limbs out of 37 limbs) and false negative results occurred in 11 (29.7%) limbs (p=0.03). The sensitivity of finding varicose veins in the groin and/or in the anteromedial aspect of the upper thigh was 100% (37 limbs out of 37 limbs), without false-negatives. CONCLUSIONS: In patients previously submitted to saphenous vein stripping, recurrent varicose veins found at physical examination in the groin or anteromedial aspect of the upper thigh are suggestive of greater saphenous vein stump insufficiency. Color-Doppler flow mapping should be performed for an adequate saphenofemoral junction reoperation.

References

Darke SG. The morphology of recurrent varicose veins. Eur J Vasc Surg.. 1992;6(5):512-7.

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(9):889-93.

Bradbury AW, Stonebridge PA, Ruckley CV. Recurrent varicose veins: correlation between preoperative clinical and hand-held Doppler ultrasonographic examination, and anatomical findings at surgery. Br J Surg.. 1993;80(7):849-51.

Perrin MR, Guex JJ, Ruckley CV. Recurrent varices after surgery (REVAS), a consensus document. REVAS group. Cardiovasc Surg.. 2000;8(4):233-45.

De Maeseneer MG, Van Schil PE, Philippe MM. Is recurrence of varicose veins after surgery unavoidable?. Acta Chir Belg.. 1995;95(1):21-6.

Luccas GC, Menezes FH, Barel EV. Varizes dos membros inferiores - tratamento. Cirurgia Vascular. 2002:1034-51.

Franco G, Nguyen KAC G, Lefebvre-Villardebo M. Apport de l´echo doppler couleue dans les récidives variqueuses post-opèratoires au niveau de la region inguinale. Phlebologie. 1995;48(2):241-50.

Rivlin S. The surgical cure of primary varicose veins. Br J Surg.. 1975;62(11):913-7.

Negus D. Recurrent varicose veins: a national problem. Br J Surg.. 1993;80(7):823-4.

Geier B, Stücker M, Hummel T. Residual stumps associated with inguinal varicose vein recurrences: a multicenter study. Eur J Vasc Endovasc Surg.. 2008;36(2):207-10.

Heim D, Negri M, Schlegel U. Resecting the great saphenous stump with endothelial inversion decreases neither neovascularization nor thigh varicosity recurrence. J Vasc Surg.. 2008;47(5):1028-32.

Donati M, Gandolfo L, Brancato G. Recurrent varicose veins due to neovascularisation: can they be prevented?. Chir Ital.. 2008;60(1):83-90.

van Rij AM, Jones GT, Hill BG. Mechanical inhibition of angiogenesis at the saphenofemoral junction in the surgical treatment of varicose veins: early results of a blinded randomized controlled trial. Circulation. 2008;118(1):66-74.

Moreau PM. Neovascularization is not a major cause of varicose veins recurrence. Int J Angiol. 2002;11(2):99-101.

Bartos Junior J, Bartos J. Causes of recurrencies following procedures for varicose veins of the lower extremities. Rozhl Chir.. 2006;85(6):293-5.

Tong Y, Royle J. Recurrent varicose veins following high ligation of long saphenous vein: a duplex ultrasound study. Cardiovasc Surg.. 1995;3(5):485-7.

Benabou JE, Molnar LJ, Cerri GG. Duplex sonographic evaluation of the sapheno-femoral venous junction in patients with recurrent varicose veins after surgical treatment. J Clin Ultrasound.. 1998;26(8):401-4.

Berni A, Tromba L, Mosti G. La comparsa di varici dopo loro trattamento: Studio multicentrico del Doppler Club Italiano Societá di Clinica e Tecnologia. Minerva Cardioangiol. 1998;46(4):87-90.

Wali MA, Sheehan SJ, Colgan MP. Recurrent varicose veins. East Afr Med J.. 1998;75(3):188-91.

Jiang P, van Rij AM, Christie R. Recurrent varicose veins: patterns of reflux and clinical severity. Cardiovas Surg.. 1999;7(3):332-9.

Roscitano G, Mirenda F, Mandolfino T. Varicose vein recurrence after surgery of the sapheno-femoral junction: color Doppler ultrasonography study. Chir Ital.. 2003;55(6):893-6.

Cerri GG, Molnar LJ, Vezozzo DC. Doppler: Avaliacao duplex do sistema venoso profundo e superficial. 1996:69-89.

Zwiebel W. Introdução à ultrassonagrafia vascular: exame venoso periféricoMódulo IV. 1998:244-349.

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.

Li AK. A technique for re-exploration of the saphenofemoral junction for recurrent varicose veins. Br J Surg.. 1975;62(9):745-6.

Stalker LK, Heyerdale W. Factors in recurrence of varices following treatment. Surg Gynecol Obstet.. 1940;71:723-30.

Glasser ST. An anatomic study of venous variations of the fossa ovalis: The significance of recurrences following ligations. Arch Surg.. 1943;46:289-95.

Luke JC. The management of recurrent varicose veins. Surgery. 1954;35(1):40-4.

Lofgren KA, Ribisi AP, Miyers TT. An evaluation of stripping versus ligation for varicose veins. AMA Arch Surg.. 1958;76(2):310-6.

Morais Filho D, El Hozni Junior RA, Diniz JAM. Uso do duplex ultra-som no planejamento do tratamento cirúrgico de varizes dos membros inferiores. Cir Vasc Angiol.. 1999;15(2):43-9.

Perrin M, Gobin JP, Nicolini P. Les recidives au pli de l'aine après chirurgie des varices. J Mal Vasc.. 1997;22(5):303-12.

Enrici EA, Regalado OE, Enrici A. Várices recidivadas luego de la cirugía venosa de los miembros inferiores. Rev Argent Cir.. 2001;81(3/4):107-16.

França GJ, Timi JR, Vidal EA. O eco-Doppler colorido na avaliação das varizes recidivadas. J Vasc Bras.. 2005;4(2):161-6.

Rodríguez O, Valenzuela R S, Mebold P J. Recurrencia de várices en el Hospital Barros Luco-Trudeau. Rev Chil Cir.. 2004;56(5):470-4.

Labropoulos N, Touloupakis E, Giannoukas AD. Recurrent varicose veins: investigation of the pattern and extent of reflux with color flow Duplex scanning. Surgery.. 1996;119(4):406-9.

van Rij AM, Hill G, Gray C. A prospective study of the fate of venous leg perforators after varicose vein surgery. J Vasc Surg.. 2005;42(6):1156-62.

Egan B, Donnelly M, Bresnihan M. Neovascularization: an "innocent bystander" in recurrent varicose veins. J Vasc Surg.. 2006;44(6):1279-84.

Zaraca F, Ebner H. Causes and treatment of recurrent varices of the lower limbs. Chir Ital.. 2005;57(6):761-5.

Hayden A, Holdsworth J. Complications following re-exploration of the groin for recurrent varicose veins. Ann R Coll Surg Engl.. 2001;83(4):272-3.

De Maeseneer MG, Philipsen TE, Vanderbroeck CP. Closure of the cribriform fascia: an efficient anatomical barrier against postoperative neovascularization at the saphenofemoral junction? A prospective study. Eur J Vasc Endovasc Surg.. 2007;34(3):361-6.

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
5dded2630e8825a7517279a2 jvb Articles
1677-7301 (Electronic)
J Vasc Bras ©2024 All rights reserved.

J Vasc Bras

Share this page
Page Sections