ABSTRACT
OBJECTIVE: Pelvic venous reflux may be responsible for pelvic venous disorders and/or lower-limb (LL) varicose veins. Ultrasound investigation with Doppler allows a complete study of the entire infra-diaphragmatic venous reservoir. The aim of this study was to guide and standardize the investigation of the pelvic origin of venous reflux in female patients with LL varicose veins. METHODS: In this case-control study, we applied a comprehensive ultrasound investigation protocol, which involved four steps: (1) venous mapping of the lower limbs; (2) transperineal and vulvar approach; (3) transabdominal approach; and (4) transvaginal approach. RESULTS: Forty-four patients in group 1 (patients with LL varicose veins and pelvic escape points [PEPs]) and 35 patients in group 2 (patients with LL varicose veins without PEPs [control group]) were studied, matched by age. The median age was 43 years in both groups. The calculated body mass index was lower in group 1 (23.4 kg/m2) compared with the control group (25.4 kg/m2), and this difference reached statistical significance (P < .001). The presence of pelvic varicose veins (PVs) by transvaginal ultrasound was 86% in group 1 and 31% in group 2. Perineal PEPs were the most prevalent, being found in 35 patients (79.5%), more frequent on the right (57.14%) than on the left (42.85%) and associated with bilateral PVs 65.7% of the time. In group 1, 23 patients (52%) reported recurrent varicose veins vs eight patients (23%) in the control group (P = .008). Regarding the complaint of dyspareunia, a significant difference was identified between the groups (P = .019), being reported in 10 (23%) patients in group 1 vs one patient (2.9%) in the control group. The median diameters in the transabdominal approach of the left gonadal veins were 6.70 mm for group 1 and 4.60 mm for group 2 (P < .001). In patients with PVs in group 1, the median diameter of PEPs at the trans-perineal window was 4.05 mm. In the transvaginal examination, the mean diameter of the veins in the peri uterine region was 8.71 mm on the left and 7.04 mm on the right. CONCLUSIONS: The identification of PEPs by venous mapping demonstrates the pelvic origin of the reflux and its connections with the LL varicose veins. For a more adequate treatment plan, we suggest a complete investigation protocol based on the transabdominal and transvaginal study to rule out venous obstructions, thrombotic or not, and confirm the presence of varicose veins in the pelvic adnexal region.
Subject(s)
Varicose Veins , Venous Insufficiency , Humans , Female , Adult , Venous Insufficiency/therapy , Case-Control Studies , Ultrasonography, Doppler, Duplex/methods , Varicose Veins/therapy , Lower Extremity/blood supplyABSTRACT
Introdução: Os fatores associados ao comprometimento da qualidade de vida em pacientes com isquemia crônica ameaçadora ao membro não estão bem estabelecidos. Objetivo: Verificar se existe associação entre a qualidade de vida e os índices de rigidez arterial, velocidade de onda de pulso (VOP) e o índice de aumentação normalizado para a frequência cardíaca de 75 bpm (AIx@75). Métodos: Trata-se de um estudo transversal, observacional, com a participação de 17 pacientes (65,65 ±11,79 anos) com isquemia crônica ameaçadora ao membro definida pela classificação de Rutherford 4, 5 e 6, e com o índice tornozelo-braço (ITB) < 0,80. A avaliação dos parâmetros vasculares e os índices de rigidez arterial foram realizadas com o aparelho Mobil-O-Graph ® que gera a onda de pulso aórtica a partir da oscilometria da artéria braquial. A qualidade de vida foi avaliada pelo questionário Vascular quality of life questionaire (VascuQoL-6), versão curta, desenvolvido especificamente para avaliar pacientes com comprometimento circulatório, arterial ou venoso. Resultados: Os valores do ITB e do escore de qualidade de vida foram 0,48 ± 0,14 e 15,88 ± 1,03; respectivamente. Dos 17 pacientes, 12 apresentavam hipertensão arterial sistólica e dezesseis apresentaram a VOP maior que 10 m/s. Não foram observadas correlações entre o escore de qualidade de vida com o AIx@75 (p=0,54 e r=0,16), a VOP (p=0,332 e r=0,248) e o ITB (p=0,707 e r=0,098). Conclusão: O presente estudo demonstrou que pacientes com isquemia crônica ameaçadora ao membro apresentam comprometimento importante da qualidade de vida sem associação com os índices de rigidez arterial e ITB.
Introduction: The factors associated with impaired quality of life in patients with chronic limb-threatening ischemia are not well established. Objective: Check whether there is an association between quality of life and arterial stiffness indexes, pulse wave velocity (PWV) and the augmentation index corrected to 75 beats per minute heart rate (AIx@75). Methods: This is a cross-sectional, observational study, with the participation of 17 patients (65.65 ± 11.79 years) with chronic limb-threatening ischemia defined by the Rutherford classification 4, 5 and 6, and with the ankle-arm index (ABI) < 0.80. The evaluation of vascular parameters and arterial stiffness indeces was performed with the MobilO-Graph ® device that generates the aortic pulse wave from the brachial artery oscillometry. Quality of life was assessed using the questionnaire Vascular quality of life questionaire (VascuQoL-6), short version, developed specifically to evaluate patients with circulatory, arterial or venous involvement. Results: The values of the ITB and the quality of life score were 0.48 ± 0.14 and 15.88 ± 1.03; respectively. Of the 17 patients, 12 had systolic arterial hypertension and sixteen had PWV greater than 10 m / s. No correlations were observed between the quality of life score with AIx @ 75 (p = 0.54 and r = 0.16), PWV (p = 0.332 and r = 0.248) and ABI (p = 0.707 and r = 0.098). Conclusion: The present study demonstrated that patients with chronic limb-threatening ischemia present significant impairment of quality of life without association with arterial stiffness and ABI.
