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

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
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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.

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