Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/S1677-54492012000400005
Jornal Vascular Brasileiro
Original Article

Avaliação do segmento venoso femoropoplíteo pela ultrassonografia Doppler em pacientes com úlcera varicosa

Doppler ultrasonography of the femoral popliteal segment in patients with venous ulcer

Jesus Antonio de Carvalho Abreu; Guilherme Benjamin Brandão Pitta; Fausto Miranda Júnior

http://dx.doi.org/10.1590/S1677-54492012000400005 J Vasc Bras, vol.11, n4, p.277-285, 2012
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Resumo

CONTEXTO: Como a úlcera é uma grave complicação da insuficiência venosa crônica, é necessário o conhecimento amplo de sua fisiopatologia. A ultrassonografia Doppler venosa é o exame complementar mais adequado, que possibilita o estudo do sistema venoso superficial e profundo, sua anatomia e fisiologia. Trabalhos recentes valorizam o refluxo em Veia Poplítea como importante fator para o desenvolvimento deste quadro clínico. OBJETIVOS: Avaliar o refluxo em segmento venoso femoropoplíteo em pacientes com úlcera varicosa. TIPO DE ESTUDO: Estudo de prevalência. MÉTODOS: Cento e quatro pacientes apresentando 118 membros inferiores com úlcera varicosa. Procedimentos: exame de ultrassonografia Doppler venosa do membro acometido, observado o refluxo no segmento venoso femoropoplíteo e diâmetro da Veia Poplítea. Variáveis: Primária: refluxo no segmento venoso femoropoplíteo. Secundária: diâmetro da Veia Poplítea. RESULTADOS: A presença de refluxo no segmento venoso femoropoplíteo foi observada em 56 (47,45%) dos 118 membros com úlcera varicosa, examinados em 104 pacientes. O diâmetro médio da Veia Poplítea foi de 1,14 cm, sendo o diâmetro médio normal da população 0,6 cm. CONCLUSÃO: O refluxo venoso no segmento venoso femoropoplíteo é um importante fator na avaliação do prognóstico destes pacientes, o aumento de diâmetro da Veia Poplítea reflete a magnitude da insuficiência venosa.

Palavras-chave

úlcera varicosa, ultrassonografia Doppler, Veia Poplítea

Abstract

BACKGROUND: Ulcer is a severe complication from chronic venous insufficiency; thus, its pathophysiology needs to be deeply understood. Venous Doppler ultrasonography is the most appropriate complementary imaging study, enabling the study of the superficial and deep venous system, the diameter and flow of the veins. Recent studies have suggested that popliteal vein reflux is an important factor for the development of ulceration. OBJECTIVE: To evaluate the venous reflux of the femoral popliteal segment in patients with venous ulcers. STUDY DESIGN: Prevalence study. METHODS: Involving 104 patients with 118 lower extremities with venous ulcers. Patients underwent Doppler ultrasonography of the affected limb showing the venous reflux of the femoral popliteal segment and popliteal vein diameter. Primary variable was venous reflux in the femoral popliteal segment; and secondary variable was diameter of the popliteal vein. RESULTS: Venous reflux in the femoral popliteal segment was observed in 56 of the 118 limbs with venous ulcer (47.45%) in 104 patients. The mean diameter of the popliteal vein was 1.14 cm, whereas 0.6 cm was the normal mean diameter of the population. CONCLUSION: Venous reflux in the femoral popliteal segment is a major factor in assessing the prognosis of these patients. Increased diameter of the popliteal vein reflects the magnitude of venous insufficiency.

Keywords

venous ulcer, Doppler ultrasonography, popliteal vein

References

Van Bemmelen PS, Beach K, Bedford G. The mechanisms of venous valve closure. Its relationship to the velocity of reverse flow. Arch Surg.. 1990;125:617-619.

Strandness Junior DE, Thiele B. Selected Topics in Venous Disorders. 1981.

Zwiebel WJ. Insuficiência Venosa crônica, veias varicosas e mapeamento da veia safena. Introdução à ultra-sonografia vascular. 1996:319-327.

Wilson E. Just briefly prevention and treatment of leg ulcers. Health Trends.. 1989;2:97.

Management of chronic venous leg ulcers: A national clinical guideline. .

Allam MJ, Ruckley CV, Harper DR, Dale JJ. Chronic ulceration of the leg: extent of the problem and provision of care. Br Med J (Clin Res Ed).. 1985;290(6485):1855-6.

Maffei FHA, Magaldi C, Pinho SZ. Varicose veins and chronic venous insufficiency en Brazil: prevalence among 1755 inhabitants of country town. J Epidemiol.. 1986;15:210.

Fowkes FG, Evans CJ, Lee AJ. Prevalence and risk factors of chronic venous insufficiency. Angiology.. 2001;52(Suppl 1):S5-15.

A Consensus Statement. J Cardiovasc Surg.. 1997;38:437-41.

Vanhoutte PM, Corcaud S, Montrion C. Venous disease: From pathophysiology to quality of life. Angiology.. 1997;48:559-567.

Sethia KK, Darke SG. Long saphenous incompetence as a cause of venous ulceration. Br J Surg.. 1984;71:754-5.

Wilson NM, Rutt DL, Browse NL. Repair and replacement of deep vein valves in the treatment of venous insufficiency. Br J Surg.. 1991;78:388-94.

McEnroe CS, O'Donnell Junior TF, Mackey WC. Correlation of clinical findings with venous hemodynamics in 386 patients with chronic venous insufficiency. Am J Surg.. 1988;156:148-52.

Raju S, Fredericks R. Valve reconstruction procedures for nonobstructive venous insufficiency: rationale, techniques, and results in 107 procedures with two- to eight-year follow-up. J Vasc Surg.. 1988;7:310-10.

Payne SPK, London NJM, Jagger C, Newland CJ, Barrie WW, Bell PRF. Clinical significance of venous reflux detected by duplex scanning. Br J Surg.. 1994;81:39-41.

O'Donnell Junior TF, Mackey WC, Shepard AD, Callow AD. Clinical, hemodynamic, and anatomic follow-up of direct venous reconstruction. Arch Surg.. 1987;122:474-82.

Bauer G. The etiology of leg ulcers and their treatment by resection of the popliteal vein. J Int Chir.. 1948;8:937-67.

Shull KC, Nicolaides AN, Fernandes e Fernandes J. Significance of popliteal reflux in relation to ambulatory venous pressure and ulceration. Arch Surg.. 1979;114:1304-6.

Nicolaides NA. From symptoms to leg edema: efficacy of Daflon 500mg. Angiology.. 2003;54(S1):33-44.

Lurie F, Ogawa T, Kistner RL, Eklof B. Changes in venous lumen size and shape do not affect of volume flow measurements in healthy volunteers and patients with primary chronic venous insufficiency. J Vasc Surg.. 2002;35:522-526.

Van Bemmelen PS, Beach K, Bedford G. Quantitative segmental evaluation of venous valvular reflux with ultrasound scanning. J Vasc Surg.. 1989;10(4):425-431.

Fleming MD, Berkebile JS, Hoffer RM. Computer Aided Analysis of LANDSAT-l MSS Data: A Comparison of Three Approaches Including a Modified Clustering Approach. . .

Labropoulus N, Leon M, Nicolaides AN. Venous reflux in patients with ulceration with and other symptoms. J Vasc Surg.. 1994;20:20-6.

Souza Nogueira G, Rodrigues Zanin C, Miyazaki MC, Pereira de Godoy JM. Venous leg ulcers and emotional consequences. Int J Low Extrem Wounds.. 2009;8(4):194-6.

Eklof B, Rutherford RB, Bergan JJ. Revision of the CEAP classification for chronic venous disorders: consensus statement. J Vasc Surg.. 2004;40(6):1248-52.

Bergqvist D, Lindholm C, Nelzen O. Chronic leg ulcers: the impact of venous disease. J Vasc Surg.. 1999;29(4):752-5.

Browse NL, Burnand KG, Irvine AT, Wilson NM. Úlcera venosa: diagnóstico. Doenças Venosas. 2001:485‑520.

Fan CM. Epidemiology and pathophysiology of varicose veins. Tec Vasc Inter Radiol.. 2003;3:108-10.

Labropoulos N, Giannoukas AD, Nicolaides AN, Ramaswami G, Leon M, Burke P. New insights the pathophysiologic condition of venous ulceration with color-flow duplex imaging: implications for treatment?. J Vasc Surg.. 1995;22(1):45-50.

Abbade LPF. Úlcera venosa do membro inferior: avaliação clínica e pelo mapeamento dúplex venoso [tese]. 2006.

Wong JK, Duncan JL, Nichols DM. Whole-leg duplex mapping for varicose veins: observations on patterns of reflux in recurrent and primary legs, with clinical correlation. Eur J Vasc Endovasc Surg.. 2003;25(3):267-75.

Garcia-Gimeno M, Rodriguez-Camarero S, Tagarro-Villalba S. Duplex mapping of 2036 primary varicose veins. J Vasc Surg.. 2009;49(3):681-9.

Labropoulos N, Gasparis AP, Pefanis D, Leon LR, Tassiopoulos AK. Secondary chronic venous disease progresses faster than primary. J Vasc Surg.. 2009;49(3):704-10.

Myers KA, Ziegenbein RW, Zeng GH, Mattews PG. Duplex ultrasonography scanning for chronic venous disease: patterns of venous reflux. J Vasc Surg.. 1995;21(4):605-12.

Sukovatykh BS, Belikov LN, Akatov AL, Itinson AI, Sukovatykh MB. Role of blood refluxes in the genesis of venous trophic disorders in patients with chronic venous insufficiency. Angiol Sosud Khir.. 2007;13(2):73-8.

Sukovatykh BS, Akatov AL, Itinson AI, Sukovatykh MB. Hemodynamic characteristics and priority of blood refluxes in genesis of trophic ulcers in patients with varicose disease of lower extremities. Vestn Khir Im I I Grek.. 2006;165(4):38-41.

Brittenden J, Bradbury AW, Allan PL, Prescott RJ, Harper DR, Ruckley CV. Popliteal vein reflux reduces the healing of chronic venous ulcer. Br J Surg.. 1998;85(1):60-2.

Porto CL, Milhomens AL, Pires CE. Changes on venous diameter and leg perimeter with different clinical treatments for moderate chronic venous disease: evaluation using Duplex scanning and perimeter measurements. Int Angiol.. 2009;28(3):222-31.

Krasinski Z, Sajdak S, Staniszewski R. Pregnancy as a risk factor in development of varicose veins in women. Ginekol Pol.. 2006;77(6):441-9.

Carpentier PH, Maricq HR, Biro C. Prevalence, risk factors, and clinical patterns of chronic venous disorders of lower limbs: a population-based study in France. J Vasc Surg.. 2004;40:650-9.

Abbade LP, Lastoria S, De Almeida Rollo H, Stolf HO. A sociodemographic, clinical study of patients with venous ulcer. Int J Dermatol.. 2005;44(12):989-92.

Rosales A, Jorgensen JJ, Slagsvold CE, Stranden E, Risum O, Kroese AJ. Venous valve reconstruction in patients with secondary chronic venous insufficiency. Eur J Vasc Endovasc Surg.. 2008;36(4):466-72.

Labas P, Ohradka B. Anti-reflux surgery of the popliteal vein. Bratisl Lek Listy.. 1998;99(2):116-8.

Salles-Cunha SX, Shuman S, Beebe HG. Planning endovascular vein valve implantation: significance of vein size variability. J Vasc Surg.. 2003;37(5):984-90.

Takahashi PY, Chandra A, Cha SS, Crane SJ. A predictive model for venous ulceration in older adults: results of a retrospective cohort study. Ostomy Wound Manage.. 2010;56(4):60-6.

Murli NL, Navin ID. Classical varicose vein surgery in a diverse ethnic community. Med J Malaysia.. 2008;63(3):193-8.

Tuchsen BF, Krause N, Hannerz H, Kristensen TS. Standing at work and varicose veins. Scand J Work Environ Health.. 2000;26:414-20.

Ziegler S, Eckhardt G, Stoger R, Machula J, Rudiger HW. High prevalence of chronic venous disease in hospital employees. Wien Klin Wochenschr.. 2003;115(15-16):575-9.

Kamber V, Widmer LK, Munst G. Prevalence. Peripheral Venous Disorders: Prevalence and Sociomedical Importance. 1978:43-50.

Matousek V, Prerovsky I. A contribution to the problem of the inheritance of primary varicose veins. Hum Hered.. 1974;24:225-35.

Cornu-Trenard A, Boivin P, Baud NM. Importance of the familial factor in varicose disease: Clinical study of 134 families. J-Derm Surg Oncol.. 1994;20:318-326.

Hirai M. Prevalence and characteristics of muscle cramps in patients with varicose veins. Vasa.. 2000;29(4):269-73.

Milic DJ, Zivic SS, Bogdanovic DC, Karanovic ND, Golubovic ZV. Risk factors related to the failure of venous leg ulcers to heal with compression treatment. J Vasc Surg.. 2009;49(5):1242-7.

Margolis DJ, Berlin JA, Strom BL. Which venous leg ulcers will heal with limb compression bandages?. Am J Med.. 2000;109(1):15-9.

Chaby G, Viseux V, Ramelet AA, Ganry O, Billet A, Lok C. Refractory venous leg ulcers: a study of risk factors. Dermatol Surg.. 2006;32(4):512-9.

Ioannou CV, Giannoukas AD, Kostas T. Patterns of venous reflux in limbs with venous ulcers. Implications for treatment. Int Angiol.. 2003;22(2):182-7.

O'Donnell TF, Iafrati MD. The small saphenous vein and other 'neglected' veins of the popliteal fossa: a review. Phlebology.. 2007;22(4):148-55.

Pittaluga P, Chastanet S, Locret T, Barbe R. The effect of isolated phlebectomy on reflux and diameter of the great saphenous vein: a prospective study. Eur J Vasc Endovasc Surg.. 2010;40(1):122-8.

Recek C. The venous reflux. Angiology.. 2004;55(5):541-8.

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