Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/S1677-54492012000300007
Jornal Vascular Brasileiro
Artigo Original

Resultados do tratamento da Insuficiência Venosa Crônica grave com espuma de polidocanol guiada por ultrassom

Results of treatment of severe chronic venous insufficiency with ultrasound-guided polidocanol foam

Melissa Andreia de Moraes Silva; Marcelo Calil Burihan; Orlando da Costa Barros; Felipe Nasser; José Carlos Ingrund; Adnan Neser

http://dx.doi.org/10.1590/S1677-54492012000300007 J Vasc Bras, vol.11, n3, p.206-211, 2012
PDF
SciELO
Downloads: 1
Views: 1206

Resumo

CONTEXTO: A insuficiência venosa crônica (IVC) em suas formas mais graves, com ulceração e lesões inflamatórias, associa-se a um tratamento cirúrgico convencional de difícil execução. A escleroterapia de veias tronculares com espuma de polidocanol é considerada uma alternativa terapêutica com resultados satisfatórios. OBJETIVO: Relatar os resultados da escleroterapia com espuma de polidocanol no tratamento de pacientes com IVC de membros inferiores com úlcera ativa. MÉTODOS: Em um período de 48 meses, 71 pacientes (76 membros) foram submetidos à escleroterapia de veias tronculares com espuma de polidocanol a 3% guiada por ultrassom. O seguimento pós-procedimento foi feito por meio de questionário clínico, exame físico e ultrassom Doppler, realizados em sete dias, um e seis meses e, a partir de então, semestralmente. Analisou-se tempo de cicatrização da úlcera, melhora de sintomas clínicos, recanalização, recidiva dos sintomas e complicações. RESULTADOS: O sexo feminino correspondeu a 61% dos casos, e a idade variou de 25 a 85 anos (média de 59 anos). O tempo médio de acompanhamento foi de 460 dias. O refluxo do sistema venoso profundo foi observado em 53,4% dos membros. A cicatrização das úlceras ocorreu em 84,2% dos casos, com um tempo médio de cicatrização de 37 dias. A recanalização ocorreu em 31,5%, porém a recidiva de sintomas, com ressurgimento de úlcera, foi de 11,8%. CONCLUSÃO: A esclerose com espuma é efetiva e apresenta altas taxas de cicatrização de úlceras, com baixos índices de complicações, em pacientes com IVC grave.

Palavras-chave

veia safena, insuficiência venosa, úlcera varicosa, escleroterapia, ultrassonografia de intervenção

Abstract

BACKGROUND: Chronic Venous Insufficiency (CVI) in its most severe forms, with ulceration and inflammatory lesions, is associated with a conventional surgical treatment of difficult execution. Polidocanol foam sclerotherapy of saphenous veins is considered an alternative therapy with satisfactory results. OBJECTIVE: To report the results of polidocanol foam sclerotherapy in the treatment of patients with lower limb CVI with active ulcer. METHODS: Over a period of 48 months, 71 patients (76 limbs) underwent 3% polidocanol foam ultrasound-guided sclerotherapy of saphenous vein. Follow-up was performed by means of clinical questionnaire, physical examination and Doppler ultrasound, in seven days, one and six months, and every six months thereafter. We analyzed time to ulcer healing, improvement of clinical symptoms, recanalization, recurrence of symptoms and complications. RESULTS: Females accounted for 61% of cases, and the age ranged from 25 to 85 years (mean 59 years). The mean follow-up was 460 days. Reflux of the deep venous system was observed in 53% of the limbs. Ulcer healing occurred in 84,2% of cases, with a mean healing time of 37 days. Recanalization occurred in 31,5%, but recurrence of symptoms, with recurrence of ulcer, was 11,8%. CONCLUSION: Foam sclerotherapy is effective and presents high rates of ulcer healing, with low rates of complications, in patients with severe CVI.

Keywords

saphenous vein, venous insufficiency, varicose ulcer, sclerotherapy, ultrasonography, interventional

References

Cornwall JV, Doré CJ, Lewis JD. Leg ulcers: epidemiology and aetiology. Br J Surg. 1986;73(9):693-6.

Kurz X, Kahn SR, Abenhaim L. Chronic venous disorders of the leg: epidemiology, outcomes, diagnosis and management. Summary of an evidence-based report of the VEINES task force. Venous Insufficiency Epidemiologic and Economic Studies. Int Angiol. 1999;18(2):83-102.

Chronic venous disease of the leg. 1992:24-33.

Ruckley CV. Socioeconomic impact of chronic venous insufficiency and leg ulcers. Angiology. 1997;48(1):67-9.

Phillips T, Stanton B, Provan A, Lew R. A study of the impact of leg ulcers on quality of life: financial, social, and psychologic implications. J Am Acad Dermatol. 1994;31(1):49-53.

Cabrera J, Redondo P, Becerra A. Ultrasound-guided injection of polidocanol microfoam in the management of venous leg ulcers. Arch Dermatol. 2004;140(6):667-73.

Orbach EJ. Contributions to the therapy of the varicose complex. J Int Coll Surg. 1950;13(6):765-71.

Tessari L. Nouvelle technique d'obtention de la sclera mousse. Phlebologie. 2000;53:129-33.

Labropoulos N, Tiongson J, Pryor L. Definition of venous reflux in lower-extremity veins. J Vasc Surg. 2003;38(4):793-8.

Yamaki T, Nozaki M, Iwasaka S. Comparative study of duplex-guided foam sclerotherapy and duplex-guided liquid sclerotherapy for the treatment of superficial venous insufficiency. Dermatol Surg. 2004;30(5):718-22.

Bergan J, Pascarella L, Mekenas L. Venous disorders: treatment with sclerosant foam. J Cardiovasc Surg. 2006;47(1):9-18.

Nicolaides A, Hussein MK, Szendro G, Christopoulos D, Vasdekis S, Clarke H. The relation of venous ulceration with ambulatory venous pressure measurements. J Vasc Surg. 1993;17(2):414-9.

Barwell JR, Davies CE, Deacon J. Comparison of surgery and compression with compression alone in chronic venous ulceration (ESCHAR study): randomised controlled trial. Lancet. 2004;363(9424):1854-9.

Ceulen RPM, Bullens-Goessens YIJM, Pi-Van De Venne SJA, Nele-mans PJ, Veraart JC, Sommer A. Outcomes and side effects of duplex: guided sclerotherapy in the treatment of great saphenous veins with 1% versus 3% polidocanol foam: results of a randomized controlled trial with 1-year follow-up. Dermatol Surg. 2007;33(3):276-81.

Guex JJ, Allaert FA, Gillet JL, Chleir F. Immediate and midterm complications of sclerotherapy: Report of a prospective multicenter registry of 12,173 sclerotherapy sessions. Dermatol Surg. 2005;31(2):123-8.

Myers KA, Jolley D. Factors affecting the risk of deep venous occlusion after ultrasound-guided sclerotherapy for varicose veins. Eur J Vasc Endovasc Surg. 2008;36(5):602-5.

Jia X, Mowatt G, Burr JM, Cassar K, Cook J, Fraser C. Systematic review of foam sclerotherapy for varicose veins. Br J Surg. 2007;94(8):925-36.

Myers KA, Jolley D, Clough A, Kirwan J. Outcome of ultrasound: guided sclerotherapy for varicose veins: medium-term results assessed by ultrasound surveillance. Eur J Vasc Endovasc Surg. 2007;33(1):116-21.

Coleridge Smith PD. Chronic venous disease treated by ultrasound guided foam sclerotherapy. Eur J Vasc Endovasc Surg. 2006;32(5):577-83.

Hamada T, El Hamid MA. Foam treatment for varicose veins; efficacy and safety. Sci Med J ESCME. 2006;18(1):25-40.

Kakkos SK, Bountouroglou DG, Azzam M, Kalodiki E, Daskalopoulos M, Geroulakos G. Effectiveness and safety of ultrasound-guided foam sclerotherapy for recurrent varicose veins: immediate results. J Endovasc Ther. 2006;13(3):357-64.

Breu FX, Guggenbichler S, Wollmann JC. 2nd European Consensus Meeting on Foam Sclerotherapy 2006, Tegernsee, Germany. VASA. 2008;37(^s71):1-29.

Figueiredo M, Araújo SP, Penha-Silva N. Ecoescleroterapia com microespuma em Varizes Tronculares Primárias. J Vasc Bras. 2006;5(3):177-83.

O'Hare JL, Earnshaw JJ. Randomised clinical trial of foam sclerotherapy for patients with a venous leg ulcer. Eur J Vasc Endovasc Surg. 2010;39(4):495-9.

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
5ddd2e3a0e88250e671da3e9 jvb Articles
Links & Downloads
1677-7301 (Electronic)
J Vasc Bras ©2024 All rights reserved.

J Vasc Bras

Share this page
Page Sections