Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/S1677-54492012000300004
Jornal Vascular Brasileiro
Artigo Original

Avaliação da insuficiência da veia safena magna com classificação C2 e C3 (CEAP) pela pletismografia a ar e pelo eco-Doppler colorido

Evaluation of the greater saphenous vein with classification C2 e C3 (CEAP) by air plethysmography and color Doppler ultrasonography

Amélia Cristina Seidel; Leandro Pablos Rossetti; Yara Juliano; Neil Ferreira Novo; Fausto Miranda Jr

http://dx.doi.org/10.1590/S1677-54492012000300004 J Vasc Bras, vol.11, n3, p.187-193, 2012
PDF
SciELO
Downloads: 0
Views: 1518

Resumo

CONTEXTO: Com a presença de refluxo venoso, há necessidade de avaliar a gravidade clínica da doença pela quantificação do efeito hemodinâmico da incompetência venosa e definição de sua distribuição anatômica. OBJETIVO: Determinar a correlação da pletismografia a ar com o grau de refluxo pelo eco-Doppler na insuficiência da veia safena magna no quadro clínico C2 e C3 da CEAP. MÉTODOS: Foram examinados, prospectivamente, 87 membros com refluxo da veia safena magna determinado pelo eco-Doppler e 32 membros sem sinais ou sintomas de doença venosa. Todos foram submetidos ao exame clínico, pletismografia e eco-Doppler de membros inferiores. Do eco-Doppler foram utilizados os parâmetros: diâmetro da veia safena em sete níveis, velocidade e tempo de refluxo. Da pletismografia foram considerados o índice de enchimento venoso, a fração de ejeção e a fração de volume residual. RESULTADOS: Dos 119 membros, 61 pertenciam à classe C2. Na comparação do diâmetro da veia nos grupos controle e estudo houve diferença estatisticamente significante, exceto ao nível do maléolo. Utilizando-se a Correlação de Spearman para análise dos índices da pletismografia e eco-Doppler foram observadas algumas significâncias, porém o coeficiente de explicação (r²) mostrou que foram fracas. CONCLUSÕES: Os parâmetros da pletismografia não se correlacionam com o grau de refluxo na veia safena magna, pois houve uma correlação muito fraca entre seus valores e o tempo e a velocidade do refluxo. Somente o índice de enchimento venoso tem correlação com refluxo venoso. A fração de ejeção e de volume residual não se mostraram importantes na discriminação da gravidade clínica.

Palavras-chave

veia safena, ultrassonografia Doppler, pletismografia, varizes

Abstract

BACKGROUND: With the presence of venous reflux, there is need evaluate the clinical severity by quantifying the hemodynamic effect of venous incompetence and definition of their anatomical distribution. OBJECTIVE: To determine and correlate the degree of reflux of the greater saphenous vein (insufficiency) in a clinical CEAP C2/C3 by air plethysmography and color Doppler ultrasonography. METHODS: We prospectively investigated 87 limbs with reflux of the greater saphenous vein as ascertained by Doppler ultrasound and 32 limbs without signs or symptoms of the venous disease. All patients underwent clinical examinations using air plethysmography and Doppler ultrasound of the lower limbs. The parameters used with the Doppler ultrasound were: the diameter of the saphenous vein (seven levels) and the speed and time of reflux. In the plethysmography, the venous filling index, ejection fraction and residual volume fraction were also considered. RESULTS: Of the 119 limbs, 61 were class C2. In comparing the diameters of the vein of the control group with the study group there were statistically significant differences. There was an exception at the malleolus level. Using the Spearman correlation to analyze the indices for the plethysmography and Doppler ultrasound it showed some difference, but the coefficient of determination (r²) showed that they were weak. CONCLUSIONS: The parameters of the plethysmography did not correlate with the degree of reflux in the greater saphenous vein. There was a very weak correlation between their values, time and speed of reflux. Only the venous filling index correlated with venous reflux. The ejection fraction and residual volume fraction were not important for discrimination of clinical severity.

Keywords

saphenous vein, Ultrasonography, Doppler, plethysmography, varicose veins

References

França LHG, Tavares V. Insuficiência venosa crônica: uma atualização. J Vasc Bras. 2003;2(4):318-28.

Castro e Silva M, Cabral ALS, Barros Jr N, Castro AA, Santos MERC. Diagnóstico e tratamento da doença venosa crônica. J Vasc Bras. 2005;4(3):S185-94.

Vasdekis SN, Clarke GH, Nicolaides AN. Quantification of venous reflux by means of duplex scanning. J Vasc Surg. 1989;10(6):670-7.

Ting AC, Cheng SW, Wu LL, Cheung GC. Air plethysmography in chronic venous insufficiency: clinical diagnosis and quantitative assessment. Angiology. 1999;50(10):831-6.

Seidel AC, Mangolim AS, Rossetti LP, Gomes JR, Miranda Jr F. Prevalência de insuficiência venosa superficial dos membros inferiores em pacientes obesos e não obesos. J Vasc Bras. 2011;10(2):124-30.

Antignani PL. Classification of chronic venous insufficiency: a review. Angiology. 2001;52(^s1):S17-26.

Christopoulos D, Nicolaides AN, Szendro G. Venous reflux: quantification and correlation with the clinical severity of chronic venous disease. Br J Surg. 1988;75(4):352-6.

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(4):660-70.

Dezotti NRA, Joviliano EE, Toma MK, Moriya T, Piccinato CE. Estudo da hemodinâmica venosa por meio da pletismografia a ar no pré e pós-operatório de varizes dos membros inferiores. J Vasc Bras. 2009;8(1):21-8.

Saliba Jr OA, Giannini M, Rollo HA. Métodos de diagnóstico não-invasivos para avaliação da insuficiência venosa dos membros inferiores. J Vasc Bras. 2007;6(3):266-75.

Eklöf B, Rutherford RB, Bergan JJ, Carpentier PH, Gloviczki P, Kistner RL. Revision of the CEAP classification for chronic venous disorders: consensus statement. J Vasc Surg. 2004;40(6):1248-52.

Engelhorn CA, Picheth FS, Castro Jr N, Dabul Jr NM, Gomes CS. Estudo do sistema venoso superficial com o duplex scan a cores. Cir Vasc Angiol. 1996;12:12-4.

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(4):425-31.

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.

Luccas GC, Nagase Y, Menezes FH, Matsui IA, Capri LG, Silveira SAF. Cirurgia de varizes dos membros inferiores: Avaliação pré-operatória do sistema venoso com mapeamento duplex. Cir Vasc Angiol. 1996;12:15-20.

Cavezzi A, Labropoulos N, Partsch H, Ricci S, Gaggiati A, Myers K. Duplex ultrasound investigation of the veins in chronic venous disease of the lower limbs: UIP consensus document. Part II. Anatomy. Eur J Vasc Endovasc Surg. 2006;31(3):288-99.

Labropoulos N, Leon LR Jr. Duplex evalution of venous insufficiency. Semin Vasc Surg. 2005;18(1):5-9.

Delis KT, Ibegbuna V, Nicolaides AN, Lauro A, Hafez H. Prevalence and distribution of incompetent perforating veins in chronic venous insufficiency. J Vasc Surg. 1998;28(5):815-25.

Szendro G, Nicolaides AN, Zukowski AJ, Christopoulos D, Malouf GM, Christodoulou C. Duplex scanning in the assessment of deep venous incompetence. J Vasc Surg. 1986;4(3):237-42.

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.

Welch HJ, Faliakou EC, McLaughlin RL, Umphrey SE, Belkin M, O'Donnell TF Jr. 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.

Yamaki T, Nozaki M, Sasaki K. Quantitative assessment of superficial venous insufficiency using duplex ultrasound and air plethysmography. Dermatol Surg. 2000;26(7):644-8.

Nishibe T, Kudo F, Miyazaki K, Kondo Y, Nishibe M, Dardik A. Relationship between air-plethysmographic venous function and clinical severity in primary varicose veins. Int Angiol. 2006;25(4):352-5.

Oliveira RA, Barros Jr N, Miranda Jr F. A variabilidade hemodinâmica venosa detectada pelos parâmetros da pletismografia a ar nas classes clínicas da classificação CEAP. J Vasc Bras. 2007;6(4):359-65.

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

Iafrati MD, Welch H, O'Donnell TF, Belkin M, Umphrey S, McLaughlin R. Correlation of venous noninvasive tests 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.

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

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

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

Payne SP, Thrush AJ, London NJ, Bell PR, Barrie WW. Venous assessment using air plethysmography: a comparison with clinical examination, ambulatory venous pressure measurement and duplex scanning. Br J Surg. 1993;80(8):967-70.

Araki CT, Back TL, Padberg FT Jr, Thompson PN, Duran WN, Hobson RW. Refinements in the ultrasonic detection of popliteal vein reflux. J Vasc Surg. 1993;18(5):742-8.

Engelhorn CA, Beffa CV, Bochi G, Pullig RC, Cassou MF, Cunha SS. A pletismografia a ar avalia a gravidade da insuficiência venosa crônica?. J Vasc Bras. 2004;3:311-6.

Weingarten MS, Czeredarczuk M, Scovell S, Branas CC, Mignogna GM, Wolferth CC Jr. 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.

Navarro TP, Delis KT, Ribeiro AP. Clinical and hemodynamic significance of the greater saphenous vein diameter in chronic venous insufficiency. Arch Surg. 2002;137(11):1233-7.

Rodriguez AA, Whitehead CM, McLaughlin RL, Umphrey SE, Welch HJ, O'Donnell TF. Duplex-derived valve closure times fail to correlate with reflux flow volumes in patients with chronic venous insufficiency. J Vasc Surg. 1996;23(4):606-10.

Labropoulos N, Tassiopoulos AK, Bhatti AF, Leon L. Development of reflux in the perfurator veins in limbs with primary venous disease. J Vasc Surg. 2006;43(3):558-62.

Krnic A, Vucic N, Sucic Z. Correlation of perforating vein incompetence with extent of great saphenous insufficiency: cross sectional study. Croat Med J. 2005;46(2):245-51.

Hanrahan LM, Araki CT, Fisher JB, Rodriguez AA, Walker TG, Woodson J. Evaluation of the perforating veins of the lower extremity using high resolution duplex imaging. J Cardiovasc Surg. 1991;32(1):87-97.

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
5ddd2d7f0e8825dd641da3ea jvb Articles
Links & Downloads
1677-7301 (Electronic)
J Vasc Bras ©2024 All rights reserved.

J Vasc Bras

Share this page
Page Sections