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1.
No Shinkei Geka ; 48(11): 1067-1072, 2020 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-33199665

RESUMO

We describe an extremely rare case of symptomatic nonhemorrhagic and nonthrombotic cervicothoracic epidural varices. A 45-year-old man presented with back pain and left leg weakness. MRI revealed an epidural mass at the Th1 level, on the dorsal aspect of the spinal canal on the right side. Although MRI scans obtained 10 days after the initial scans(obtained at the first visit to our hospital)revealed disappearance of the epidural mass at the Th1 level on non-contrast images and on images obtained 90 s after intravenous gadolinium injection, the images obtained 5 min after intravenous gadolinium injection revealed the epidural mass at the Th1 level. The patient's symptoms had resolved;therefore, we administered conservative therapy. Although the patient initially continued to show symptomatic improvement, he developed clinical relapse without any evidence of relapse on MRI. Left leg weakness and back pain worsened a year later, and repeat MRI revealed reappearance of the epidural mass at the Th1 level. Cervicothoracic laminectomy revealed nonhemorrhagic epidural varices, and we performed total en bloc resection. Histopathological examination of the resected specimen showed nonthrombotic varices. The patient's neurological symptoms improved postoperatively without relapse. Intermittent expansion of varicose veins in accordance with changes in venous pressure may cause compressive myelopathy. Clinicians should consider the possibility of spinal epidural varices in patients who present with spinal epidural lesions that tend to show intermittent improvement with subsequent worsening.


Assuntos
Compressão da Medula Espinal , Varizes , Espaço Epidural/diagnóstico por imagem , Espaço Epidural/cirurgia , Humanos , Laminectomia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Varizes/complicações , Varizes/diagnóstico por imagem , Varizes/cirurgia
2.
Rev Med Suisse ; 16(712): 2042-2045, 2020 Oct 28.
Artigo em Francês | MEDLINE | ID: mdl-33112517

RESUMO

Pelvic congestion syndrome is an underdiagnosed disease, defined as chronic pelvic pain lasting more than 6 months, associated with pelvic varicose veins in premenopausal women. Diagnose is based on imagery after exclusion of other causes of pelvic pains. Echography is first line diagnostic modality. Conservative treatment is often insufficient and pelvic veins embolization is required to improve symptoms.


Assuntos
Embolização Terapêutica , Dor Pélvica/complicações , Dor Pélvica/diagnóstico , Varizes/complicações , Feminino , Humanos , Dor Pélvica/terapia , Pelve/diagnóstico por imagem , Síndrome , Resultado do Tratamento , Varizes/diagnóstico , Varizes/terapia
3.
Medicine (Baltimore) ; 99(35): e21975, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871947

RESUMO

To investigate the efficiency of high ligation, great saphenous vein stripping and subfascial perforator vein surgery for treating great saphenous vein varicosis under the assistance of sterilized electric pneumatic tourniquet and Esmarchs bandage.In total, 274 patients confirmed with primary varicosis between January 2014 and November 2017 were included in this study. Patients were divided intoAfter surgery, the affected limbs in both groups were wrapped up using the elastic bandage for 2 weeks, followed by wearing elastic stocking for 6 months. Then we analyzed the intraoperative bleeding, surgery time, subcutaneous hemorrhage after surgery and postoperative pains.The surgical time in the treatment group was significantly lower than that of control group (58.62 ±â€Š7.47 minutes vs 76.35 ±â€Š9.24 minutes, P < .01). The intraoperative bleeding in the treatment group was significantly lower than that of the control group (17.56 ±â€Š3.52 ml vs 49.87 ±â€Š8.78 ml, P < .01).High ligation, great saphenous vein stripping, and subfascial perforator vein surgery under the assistance of sterilized electric pneumatic tourniquet and Esmarch's bandage was effective for the treatment of varicosis in lower limbs featured by reduced surgery time and less bleeding.


Assuntos
Veia Safena/cirurgia , Torniquetes , Varizes/cirurgia , Procedimentos Cirúrgicos Vasculares/instrumentação , Adulto , Idoso , Feminino , Humanos , Ligadura , Masculino , Pessoa de Meia-Idade
4.
Rozhl Chir ; 99(7): 299-303, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32972147

RESUMO

INTRODUCTION: Endovenous Laser Ablation (EVLA) is a common alternative to surgical treatment of varicose veins. The aim of our study was to demonstrate that laser occlusion is durable, that we can treat all patients in a one day setting, even with veins >10mm in diameter, and that multiple EVLAs can be done at the same time. METHODS: In the period from 1/2017 to 12/2019 EVLA was performed in a total of 1551 consecutive patients with varicose veins and ultrasonographically documented venous reflux. The mid-term results were evaluated in a group of patients operated from 1/2017 to 6/2017 (316 pts.). We compared a risk group that consisted of patients with veins >10mm in diameter (40 pts.) with a control group (the remaining 276 pts.). Patients with veins >10mm are traditionally considered as candidates for conventional surgery. RESULTS: The catheter-based method enabled us to perform more ablations in one procedure. In 2019 we performed 1.44 EVLA procedures per patient. There was only one postoperative follow-up visit, indicating an uncomplicated postoperative course, in 87.5% of patients of the risk group. In the control group 100% of patients had only one follow-up visit including ultrasound examination, showing an uncomplicated postoperative course (p.


Assuntos
Terapia a Laser , Varizes/diagnóstico por imagem , Varizes/cirurgia , Insuficiência Venosa , Humanos , Veia Safena/diagnóstico por imagem , Veia Safena/cirurgia , Resultado do Tratamento
5.
Surgery ; 168(5): 909-914, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32792099

RESUMO

BACKGROUND: This study investigates the clinical outcomes of endovenous microwave ablation and endovenous laser ablation for varicose veins. METHODS: A total of 139 patients who underwent endovenous microwave ablation and 145 patients who underwent endovenous laser ablation were included in this multicenter study. The clinical outcomes and complications were assessed at 1, 6, and 12 months after the procedure. The effect on quality of life was assessed by the Aberdeen Varicose Vein Questionnaire and the EuroQol Group 5-Dimension Self-Report Questionnaire. RESULTS: The endovenous microwave ablation group had a shorter procedure time than the endovenous laser ablation group (42.58 ± 15.62 minutes vs 65.46 ± 24.38 minutes, P < .01), and no significant differences were observed in the other procedure parameters. The incidences of induration (20.26% vs 31.06%) and ecchymosis (13.07% vs 22.98%, P < .05) were lower in the endovenous microwave ablation group. The rates of temporary paresthesia (9.80% vs 18.01%) and residual varicosities (8.61% vs 16.77%, P < .05) were lower in the endovenous microwave ablation group at 1 month. There were no significant differences in paresthesia or saphenous vein closure rates between the groups at 6 and 12 months. Both groups had significant improvements in their Aberdeen Varicose Vein Questionnaire and EuroQol Group 5-Dimension Self-Report Questionnaire scores post-procedure, and no significant differences in Aberdeen Varicose Vein Questionnaire and EuroQol Group 5-Dimension Self-Report Questionnaire scores were confirmed. However, local recurrence below the knee was lower in the endovenous microwave ablation group (2.34% vs 8.46%, P < .05) after 12 months. CONCLUSION: Our results confirmed that the endovenous microwave ablation procedure demonstrated a shorter procedure time, lower complication, and local recurrence than the endovenous laser ablation procedure.


Assuntos
Técnicas de Ablação/métodos , Terapia a Laser/métodos , Micro-Ondas/uso terapêutico , Varizes/cirurgia , Técnicas de Ablação/efeitos adversos , Adulto , Feminino , Seguimentos , Humanos , Terapia a Laser/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Varizes/psicologia
6.
Vasc Endovascular Surg ; 54(8): 687-691, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32744168

RESUMO

BACKGROUND: To investigate the influence of superficial venous ablation on deep venous dilation and reflux in patients with saphenous varicose veins, and to elucidate the association between superficial venous reflux and deep venous morphology and hemodynamics. METHODS: The data of 154 patients with 223 limbs, who underwent endovenous radiofrequency ablation (RFA) of the great saphenous vein for primary varicose veins between September 2014 and March 2016 in Eniwa Midorino Clinic, were retrospectively analyzed. Overall venous hemodynamics of the leg, including functional venous volume (VV) and venous filling index (VFI), was assessed using air-plethysmography. Saphenous and deep vein reflux and diameter were evaluated with duplex scanning. RESULTS: Hemodynamic and morphologic changes were evaluated before and 1 month after RFA. The VV and VFI were significantly decreased in postoperative values than in preoperative values (P < .001). Limbs with deep venous reflux significantly decreased postoperatively than preoperatively (P < .001). There were significant differences in the diameter of the common femoral vein (CFV) and popliteal vein (PV) between the preoperative and postoperative values (P < .001). There were strong to moderate correlations between the VV and the diameter of the CFV or PV (CFV, r = 0.47, P < .001; PV, r = 0.35, P < .001), while there were moderate to weak correlations between the VFI and the diameter of the CFV or PV (CFV, r = 0.23, P < .001; PV, r = 0.33, P <.001). CONCLUSIONS: Superficial venous ablation significantly reduced deep venous dilation and reflux in patients with saphenous varicose veins. Significant correlations existed between the VV or VFI, which reflected superficial venous reflux, and the diameter of the deep veins. These findings reveal that volume overload due to superficial venous reflux is associated with deep venous morphology and hemodynamics.


Assuntos
Ablação por Cateter , Procedimentos Endovasculares , Veia Femoral/fisiopatologia , Hemodinâmica , Veia Poplítea/fisiopatologia , Veia Safena/cirurgia , Varizes/cirurgia , Insuficiência Venosa/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Ablação por Cateter/efeitos adversos , Bases de Dados Factuais , Procedimentos Endovasculares/efeitos adversos , Feminino , Veia Femoral/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Veia Poplítea/diagnóstico por imagem , Estudos Retrospectivos , Veia Safena/diagnóstico por imagem , Veia Safena/fisiopatologia , Resultado do Tratamento , Varizes/diagnóstico por imagem , Varizes/fisiopatologia , Insuficiência Venosa/diagnóstico por imagem , Insuficiência Venosa/fisiopatologia , Adulto Jovem
7.
Eur J Vasc Endovasc Surg ; 60(4): 587-593, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32739105

RESUMO

OBJECTIVE: The aim was to validate the SYM VEIN consensus 3D scoring tool in chronic venous disease (CVD). METHODS: This was a prospective cohort study with a total of 35 consecutive patients with CVD. Patients with CVD undergoing saphenectomy were assessed with the revised Venous Clinical Severity Score (r-VCSS), the CIVIQ-20 quality of life score questionnaire, and the SYM VEIN consensus statement 3D system, pre-operatively and four weeks post-operatively. The total 3D score was tested for reliability, construct validity, and responsiveness. RESULTS: The total 3D score demonstrated good reliability and internal consistency (Cronbach's alpha 0.85). Principal component analysis identified three groups of symptoms (paraesthesia, burning pain, and pruritus, vs. heaviness, sensation of swelling and aching/pain, vs. restless leg and throbbing pain) demonstrating a high intragroup correlation and likely to share similar pathophysiology, indicative of adequate construct validity. The total 3D score showed a significant correlation with r-VCSS and CIVIQ-20 score (rho .46, p = .005 and rho .65, p < .001, respectively) indicative of adequate convergent validity. After saphenectomy, significant reductions (p < .001) of the total 3D, and 3D scores for all but two individual venous symptoms were observed, indicative of excellent responsiveness. Median total 3D score was reduced from 31 to 6 (83.8% decrease, p < .001), median r-VCSS was reduced from 6 to 0 (100% decrease, p < .001), and median CIVIQ-20 score was reduced from 24 to 14 (40% decrease, p < .001). The difference of median percentage change between r-VCSS and CIVIQ-20 score vs. total 3D score was significant (p = .005 and p < .001, respectively). CONCLUSION: The total SYM VEIN 3D score has good reliability, construct validity and excellent responsiveness, although less prone to change after saphenectomy compared with r-VCSS.


Assuntos
Avaliação de Sintomas , Varizes/diagnóstico , Insuficiência Venosa/diagnóstico , Adulto , Idoso , Doença Crônica , Feminino , Nível de Saúde , Humanos , Ligadura , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Qualidade de Vida , Reprodutibilidade dos Testes , Veia Safena/cirurgia , Índice de Gravidade de Doença , Resultado do Tratamento , Varizes/complicações , Varizes/cirurgia , Insuficiência Venosa/complicações , Insuficiência Venosa/cirurgia
8.
Eur J Vasc Endovasc Surg ; 60(3): 430-442, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32771286

RESUMO

OBJECTIVE: This review compares the outcomes of both concomitant and staged superficial varicose tributary (SVT) interventions as an adjunct to endovenous truncal ablation. METHODS: A systematic search of Medline through Pubmed, Embase, and the Cochrane Central Register of Controlled Trials was last performed in November 2019. All studies comparing the outcomes of both concomitant and staged treatments for SVT as an adjunct to endovenous truncal ablation were included. Each included study was subject to an evaluation of methodological quality using the Downs and Black assessment tool. Outcomes assessed included rates of re-intervention, complications, and thrombotic events. Quality of life (QOL) and disease severity were also analysed. Data were pooled with a random effects model. RESULTS: Fifteen studies (6 915 limbs) were included for analysis. Included studies were of reasonable methodological quality. Re-intervention rates were significantly lower in the concomitant group (6.3% vs. 36.1%) when compared with staged intervention (relative risk [RR] 0.21 [95% CI 0.07-0.62], p = .004, I2 = 90%, p ≤ .001). Reported complications (RR 1.14 [95% CI 0.67-1.93], p = .64) and rates of deep venous thrombosis (RR 1.41 [95% CI 0.72-2.77] p = .31) were similar in each group. Overall disease severity (Venous Clinical Severity Score) was lower in the concomitant group (-1.16 [95% CI, -1.97- -0.35] p = .005), while QOL, assessed using the Aberdeen Varicose Vein Questionnaire, favoured concomitant treatment when measured at less than three months (weighted mean difference [WMD] -3.6 [95% CI, -7.17- -0.03] p = .050) and between three and 12 months (WMD -1.61 [95% CI, -2.99- -0.23] p = .020). CONCLUSION: Concomitant and staged treatments are safe and effective. Improvements in early disease severity and QOL scores were better in the concomitant group. While meta-analysis suggests that concomitant intervention offers significantly lower rates of re-intervention, studies assessing its merits are subject to some biases. This benefit was not reflected by the randomised trial subgroup analysis, which identified no difference in re-intervention.


Assuntos
Técnicas de Ablação , Procedimentos Endovasculares , Varizes/cirurgia , Técnicas de Ablação/efeitos adversos , Adulto , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Qualidade de Vida , Fatores de Risco , Resultado do Tratamento , Varizes/diagnóstico por imagem
10.
PLoS One ; 15(7): e0235656, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32628724

RESUMO

AIM: To assess the feasibility and technical success of endovenous laser ablation (EVLA) of recurrent varicose veins arising from the former sapheno-femoral junction (SFJ). METHODS: We retrospectively analyzed all EVLA procedures treated in our institution by one surgeon between March 2019 and April 2020 and selected all consecutive cases with SFJ recurrence occuring after surgical high ligation and stripping or endovenous thermal ablation for incompetence of the great saphenous vein (GSV) in superficial venous insufficiency. The feasibility, technical success as determined by duplex ultrasound on the postoperative visit, complications and rate of endothermal heat-induced thrombosis (EHIT) were recorded. A subgroup definition was performed based on sonographic morphology of the recurrence and resulting strategy of ablation. RESULTS: Thirty-five limbs with SFJ recurrence in 34 patients were treated with EVLA in order to shut down the highest refluxing point. In 22 interventions, it was required to switch off a short stump or a neovascularization by direct puncture (Subgroup 1). In 13 treatments, the presence of residual GSV segments, or persistent, varicose transformed major tributaries like the anterior accessory great saphenous vein, enabled cannulation and advancing the laser fiber from distal to the former SFJ (Subgroup 2). The EVLA procedures could be successfully carried out in all 35 cases. There were no major complications, no thromboembolism or EHIT, and no local groin complications. In one case, the patient developed a phlebitic response that required temporary medication. Technical success was achieved with 34/35 treatments (97.1%). When comparing the subgroups, the morphological pattern of the SFJ recurrence and the resulting technique of puncture, cannulation and ablation did not influence the result. CONCLUSIONS: The results of this case series suggest that SFJ recurrences can also be successfully treated in situations where there are tortuous or short stumps that require direct puncture and ablation.


Assuntos
Procedimentos Endovasculares/métodos , Varizes/cirurgia , Adulto , Idoso , Procedimentos Endovasculares/efeitos adversos , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neovascularização Fisiológica , Complicações Pós-Operatórias , Recidiva , Estudos Retrospectivos , Veia Safena/patologia , Insuficiência Venosa/patologia , Insuficiência Venosa/cirurgia
11.
Rev Med Chil ; 148(3): 288-294, 2020 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-32730372

RESUMO

BACKGROUND: Upper gastrointestinal bleeding (UGIB) is one of the main reasons of hospitalization due to gastrointestinal causes. Reported mortality rates range from 5 to 12%. AIM: To determine hospital mortality and associated risk factors in hospitalized patients with UGIB. To compare the clinical characteristics and outcomes of patients with variceal versus non-variceal UGIB. MATERIAL AND METHODS: Review of medical records of 249 patients (62% males) discharged with the diagnosis of UGIB at a clinical hospital between 2015 to 2017. Demographic and clinical characteristics and adverse clinical outcomes (surgery, length of hospital stay and in-hospital mortality) were recorded. A comparative analysis between patients with Variceal and Non-variceal UGIB was carried out. RESULTS: Seventy two percent of UGIB were non-variceal (peptic ulcer in 44%). Two patients required surgery (both died). Median of length of hospital stay was seven days (interquartile range (IQR) 4-13). Overall hospital mortality was 13 and 4% in variceal and non-variceal UGIB, respectively (p = 0.024). The variables associated with mortality were: red blood cell transfusion (odds ratio (OR): 18.7, p < 0.01), elevated creatinine on admission (OR: 3.30, p = 0.03) and variceal bleeding (OR: 3.23, p = 0.02). CONCLUSIONS: Hospital mortality of UGIB remains high, especially in variceal UGIB. Elevated creatinine levels on admission, the need of transfusion of red blood cells and variceal etiology are risk factors for mortality.


Assuntos
Trato Gastrointestinal Superior , Varizes Esofágicas e Gástricas , Hemorragia Gastrointestinal , Humanos , Tempo de Internação , Estudos Retrospectivos , Varizes
12.
Acta Gastroenterol Belg ; 83(2): 331-333, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32603056

RESUMO

In this paper we present the case of a male 55-year old patient with known ulcerative colitis and nodular regenerative hyperplasia, a rare form of noncirrhotic portal hypertension. He presented four visits to the emergency department with rapidly progressive anal discomfort. After two weeks a transjugular intrahepatic portosystemic shunt was placed using the gun-sight technique with immediate relief of the unbearable anal pain and pressure. To our knowledge, this is the first case where transjugular intrahepatic portosystemic shunt placement is applied for non- bleeding, congestive anorectal varices.


Assuntos
Hemorragia Gastrointestinal , Derivação Portossistêmica Transjugular Intra-Hepática , Varizes , Canal Anal , Hemorragia Gastrointestinal/terapia , Humanos , Hiperplasia , Masculino , Pessoa de Meia-Idade , Reto , Varizes/terapia
13.
Surgery ; 168(2): 267-273, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32536489

RESUMO

BACKGROUND: The ligation of the splenic vein during pancreaticoduodenectomy with synchronous resection of the spleno-mesenteric-portal venous confluence has been associated with the development of left portal hypertension despite preservation of the natural confluence with the inferior mesenteric vein. This study aimed to assess whether a left splenorenal venous shunt might mitigate clinical signs of left portal hypertension associated with splenic vein ligation. METHODS: We retrospectively evaluated the presence of left portal hypertension based on biologic and radiologic parameters in patients undergoing pancreaticoduodenectomy with synchronous resection of the spleno-mesentericoportal confluence between January 1, 2012, and December 31, 2018. We compared several parameters between patients undergoing splenic vein ligation with preservation of the inferior mesenteric vein confluence and a splenorenal venous shunt: the early and late spleen volumes and spleen volume ratios, an early and late platelet count, the presence of thrombocytopenia, the presence of varices, and digestive bleeding in the long-term. RESULTS: There were 114 consecutive patients: 36 with splenic vein ligation and 78 with splenorenal venous shunt. All had a pancreaticogastrostomy. Patients with splenic vein ligation had a comparable baseline and early and late platelet counts. Although baseline splenic volumes were comparable between the 2 groups (242 ± 115 mL vs 261 ± 138 mL; P = .51), patients with splenic vein ligation showed a statistically significant greater splenic volume beyond the 6th postoperative months (334 ± 160 mL vs 241 ± 111 mL; P = .004), higher early and late spleen volume ratios (1.42 ± 0.67 vs 1.10 ± 0.3; P = .001 and 1.38 ± 0.38 vs 0.97 ± 0.4; P = .0001) than patients with splenorenal venous shunt. Splenic vein ligation was also associated with a higher rate of varices (81% vs 50%; P = .002) and more frequent varices with a caliber greater than 1 cm (57% vs 36%; P = .05) and more colonic varices (33% vs 12%; P = .01). Only 1 patient had long-term digestive bleeding (splenic vein ligation). CONCLUSION: The left splenorenal shunt decreases clinical signs of left portal hypertension associated with splenic vein ligation and inferior mesenteric vein confluence preservation.


Assuntos
Hipertensão Portal/etiologia , Ligadura/efeitos adversos , Pancreaticoduodenectomia/efeitos adversos , Veia Esplênica/cirurgia , Derivação Esplenorrenal Cirúrgica , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/cirurgia , Contagem de Plaquetas , Estudos Retrospectivos , Esplenomegalia/etiologia , Varizes/etiologia
14.
Enferm. actual Costa Rica (Online) ; (38): 209-229, Jan.-Jun. 2020. tab, graf
Artigo em Espanhol | LILACS, BDENF - Enfermagem | ID: biblio-1090097

RESUMO

Resumen El objetivo de este estudio fue analizar la mejor evidencia científica disponible relacionada con la intervención médica conservadora comparada con la intervención más invasiva incluyendo la quirúrgica para el tratamiento de venas varicosas en miembros inferiores durante el embarazo y la prevención de la aparición posterior. Inició con Se aplicó la metodología de evaluación rápida de la evidencia. Se llevó a cabo una búsqueda de literatura en las bases de datos, sin límite de fechas. Criterios de inclusión: Gestantes con patología varicosa en miembros inferiores de cualquier edad. Los tipos de estudios analizados fueron Revisiones Sistemáticas, ECA, Meta-análisis o Guías de Práctica Clínica en inglés, portugués o español. Se utilizó la plataforma FLC 2.0 y Agree II para el análisis y la plantilla de Sackett para la interpretación de niveles de evidencia y grados de recomendación. Se recuperaron 322 artículos, se seleccionaron tres. Se obtuvo que la intervención recomendada es la terapia conservadora, solo en casos excepcionales se determinará otra intervención. El tratamiento invasivo incluyendo el quirúrgico, se reserva para casos delicados ya que los riesgos superan los beneficios. Se concluye que el tratamiento de primera línea para el tratamiento de varicosidades en gestantes son las medias de compresión. Los rutósidos y anticoagulantes orales parecen ayudar pero no es seguro de utilizar durante el embarazo.


Abstract The objective of this study was to analyze the best available scientific evidence related to conservative medical intervention compared to the most invasive intervention including surgery for the treatment of varicose veins in the lower limbs during pregnancy and the prevention of subsequent onset. It started with The rapid evidence evaluation methodology was applied. A search of literature in the databases was carried out, with no date limit. Inclusion criteria: Pregnant women with varicose pathology in lower limbs of any age. The types of studies analyzed were Systematic Reviews, RCTs, Meta-analysis or Clinical Practice Guidelines in English, Portuguese or Spanish. The FLC 2.0 and Agree II platform was used for the analysis and the Sackett template for the interpretation of levels of evidence and grades of recommendation. 322 items were retrieved, three were selected. It was obtained that the recommended intervention is conservative therapy, only in exceptional cases will another intervention be determined. Invasive treatment, including surgical treatment, is reserved for sensitive cases since the risks outweigh the benefits. It is concluded that the first line treatment for the treatment of varicose veins in pregnant women is compression stockings. Routine and oral anticoagulants seem to help but it is not safe to use during pregnancy.


Resumo O objetivo deste estudo foi analisar as melhores evidências científicas disponíveis relacionadas à intervenção médica conservadora em comparação com a intervenção mais invasiva, incluindo cirurgia para o tratamento de varizes nos membros inferiores durante a gravidez e a prevenção de subsequente aparecimento. Começou com A metodologia de avaliação rápida de evidências foi aplicada. Foi realizada uma pesquisa bibliográfica nas bases de dados, sem data limite. Critérios de inclusão: Gestantes com patologia varicosa em membros inferiores de qualquer idade. Os tipos de estudos analisados foram Revisões Sistemáticas, ECR, Meta-análise ou Diretrizes de Prática Clínica em inglês, português ou espanhol. A plataforma FLC 2.0 e Agree II foi utilizada para a análise e o modelo de Sackett para a interpretação dos níveis de evidência e graus de recomendação. 322 itens foram recuperados, três foram selecionados. Foi obtido que a intervenção recomendada é terapia conservadora, apenas em casos excepcionais será determinada outra intervenção. O tratamento invasivo, incluindo o tratamento cirúrgico, é reservado para casos sensíveis, pois os riscos superam os benefícios. Conclui-se que o tratamento de primeira linha para o tratamento de varizes em gestantes são as meias de compressão. Anticoagulantes de rotina e orais parecem ajudar, mas não é seguro para uso durante a gravidez.


Assuntos
Humanos , Feminino , Gravidez , Varizes , Gravidez , Gestantes
15.
Sao Paulo Med J ; 138(2): 98-105, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32491084

RESUMO

BACKGROUND: Diagnosis and treatment of small saphenous vein (SSV) insufficiency is of utmost importance for relieving chronic venous insufficiency symptoms. OBJECTIVES: To investigate the efficacy and safety of five different treatment approaches among patients with SSV insufficiency. DESIGN AND SETTING: Two-center retrospective clinical study, conducted at cardiovascular surgery clinics in a local training and research hospital and a state hospital. METHODS: A total of 282 extremities of 268 patients with SSV insufficiency alone who were treated for symptomatic varicose veins between January 2012 and January 2017 were included in the study. All extremities included in the study were divided into five groups as follows: high ligation + stripping; radiofrequency ablation (RFA); cyanoacrylate closure (CAC); and endovenous laser ablation (EVLA) at the wavelengths 980 nm and 1,470 nm. RESULTS: Although the recurrence rate at six months was similar among the treatment groups, we found significant differences in recurrence rates at one year, with lower rates in the CAC, RFA and 1,470 nm EVLA groups, compared with the other treatments (P = 0.005). No sural neuritis was observed in the CAC group. The pigmentation rate was higher in the two EVLA groups (980 nm and 1,470 nm). CONCLUSIONS: Our study results showed that although CAC, RFA and EVLA at 1,470 nm seemed to be effective methods for treating SSV insufficiency alone, CAC and RFA had better aesthetic results than EVLA at 1,470 nm. We consider that endovenous non-thermal techniques for treating SSV insufficiency may be preferable because of relatively low risk of nerve injury.


Assuntos
Varizes , Insuficiência Venosa , Humanos , Estudos Retrospectivos , Veia Safena , Resultado do Tratamento
16.
Medicine (Baltimore) ; 99(22): e20332, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32481409

RESUMO

BACKGROUND: There is a continued discussion on which is the best sclerosant to treat lower extremity varicose veins. Therefore, we did this meta-analysis to determine that foam sclerotherapy versus liquid sclerotherapy, which could perform better in the treatment of lower extremity varicose veins. MATERIALS AND METHODS: We independently searched 5 databases from inception to February 1, 2019, for randomized controlled trials and prospective controlled trials for comparing foam sclerotherapy and liquid sclerotherapy for the treatment of lower extremity varicose veins. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of studies. The primary outcome and secondary outcomes were analyzed using stata 15.0. This meta-analysis was performed according to Cochrane Handbook. RESULTS: There were significant differences in effective rate (P < .001, odd ratios = 5.64, 95% confidence interval = 3.93-8.10) and incidence rate of pain (P = .030, odd ratios = 1.52, 95% confidence interval = 1.04-2.21) between foam sclerotherapy and liquid sclerotherapy. And there were no significant differences among local inflammation (P = .896, rate difference = 0.00, 95% confidence interval = -0.03 to 0.03), thrombophlebitis (P = .90, rate difference = 0.00, 95% confidence interval = -0.02 to 0.02) and hyperpigmentation (P = .336, rate difference = 0.05, 95% confidence interval = -0.05 to 0.14). CONCLUSIONS: Although foam sclerotherapy has a higher incidence rate of complications, it could achieve a more stable clinical efficacy in the treatment of lower extremity varicose veins than liquid sclerotherapy.


Assuntos
Soluções Esclerosantes/uso terapêutico , Escleroterapia/métodos , Varizes/tratamento farmacológico , Ensaios Clínicos como Assunto , Humanos , Incidência , Perna (Membro) , Estudos Prospectivos , Recidiva , Projetos de Pesquisa , Soluções Esclerosantes/administração & dosagem , Soluções Esclerosantes/efeitos adversos
17.
Ann R Coll Surg Engl ; 102(7): 525-531, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32538106

RESUMO

INTRODUCTION: Flush ligation at the saphenofemoral junction and stripping of the great saphenous vein is being increasingly replaced by endovenous methods such as radiofrequency or endovenous laser ablation for the treatment of varicose veins. These modalities are expensive and not widely available. A minimally invasive ultrasound-guided surgery with non-flush ligation and stripping under local anaesthesia is a cost-effective alternative with similar postoperative outcomes. MATERIALS AND METHODS: A total of 62 limbs (58 patients) with saphenofemoral junction incompetence underwent clinical evaluation including the CEAP clinical score, the venous clinical severity score, the venous disability score and venous doppler. Patients were randomly assigned to either group A (radiofrequency ablation) or group B (ultrasound-guided non-flush ligation and stripping of the great saphenous vein) for procedures under tumescent anaesthesia and ultrasound guidance. Patients were followed-up on days 7, 30 and 90 to assess primary (obliteration rates) and secondary (venous clinical severity score and venous disability score) outcomes. RESULTS: Both the groups showed 100% obliteration of the great saphenous vein at day 90. The venous clinical severity and venous disability scores significantly improved from day 0 to day 90 in both groups (p = 0.0001). There were no major complications. Group A showed significantly lower minor complications (p = 0.001). None required conversation to general anaesthesia. CONCLUSIONS: The ultrasound-guided non-flush ligation and stripping of the great saphenous vein are as efficacious as radio frequency ablation, with similar obliteration rates, improvement in disability scores and complication profile at a lower cost. It has the potential for wider availability in the community as most surgeons are conversant with the surgical procedure.


Assuntos
Ablação por Cateter/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Veia Safena/cirurgia , Cirurgia Assistida por Computador/métodos , Ultrassonografia Doppler Dupla/métodos , Varizes/cirurgia , Adolescente , Adulto , Feminino , Seguimentos , Humanos , Ligadura/métodos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
18.
Vasa ; 49(5): 411-417, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32513095

RESUMO

Background: Varicosis of the great saphenous vein (GSV) is a common disease. Most of the therapeutic concepts attempt to remove or destroy the truncal vein. However, the absence of the GSV could be harmful for further treatments of artherosclerotic disease as the GSV is often used as bypass graft in lower extremity or coronary artery revascularisations. External valvuloplasty (EV) is one of the vein-sparing treatment options. The aim of this clinical study was to describe the outcome, safety and complications of this procedure in a prospective multicentre trial. Patients and methods: The function of the terminal and preterminal valve was restored by external valvuloplasty. Furthermore, multiple phlebectomies of tributaries were performed. Patients were reinvestigated six weeks after surgery. Primary endpoint was the function of the external valvuloplasty measured by diameter of the GSV and the prevalence of reflux in the GSV. The eligibility of the vein as a potential bypass graft was noticed. CEAP class and VCSS scores were analysed. Results: A total of 359 patients were included in the study. After six weeks 297 patients could be reinvestigated. The function of the external valvuloplasty was sufficient in 284 patients (95.6%). Treatment failed in 8 patients (2.6%) due to an occlusion or junctional reflux despite valvuloplasty. The GSV was estimated as suitable as a bypass graft in 261 patients (87.8%). Reflux at the saphenofemoral junction was significantly reduced after treatment and the diameter of the GSV near the saphenofemoral junction significantly decreased from 4.4 mm to 3.8 mm (p < 0.05). The VCSS was significantly reduced from 4.6 preoperatively to 2.6 postoperatively. Conclusions: External repair of the great saphenous vein can reduce venous symptoms and may preserve the great saphenous vein as a bypass graft. Nevertheless, this treatment option is only suitable for a limited number of patients.


Assuntos
Veia Femoral , Humanos , Estudos Prospectivos , Veia Safena , Resultado do Tratamento , Varizes , Insuficiência Venosa
19.
Angiol Sosud Khir ; 26(2): 95-102, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32597889

RESUMO

AIM: The purpose of this study was to prove that Detravenol is not inferior by clinical efficacy to Detralex® in the course administration in patients presenting with chronic venous insufficiency of the lower extremities caused by lower limb varicose veins. PATIENTS AND METHODS: Ours was a prospective randomized open-liable comparative trial aimed at determining efficacy and safety of the two drugs in parallel groups with active control. The trial enrolled a total of 106 patients with chronic venous insufficiency of the lower extremities secondary to lower limb varicose veins. The patients took the drug during 60 days twice daily. The primary outcome measure of efficacy was reduction of the malleolar circumference upon completion of treatment as compared with the baseline values, with the secondary outcome measures being the dynamics of parameters according to the Venous Clinical Severity Score (VCSS), CIVIQ-2 quality of life questionnaire, and the findings of ultrasonographic duplex scanning. RESULTS: The obtained findings demonstrated efficacy of therapy with the use of Detravenol in treatment of patients with chronic venous insufficiency of the lower limbs. The 60-day therapy with the study drug resulted in decreased oedema of the lower extremities: the malleolar circumference reduced averagely by 4%, the composite index of the venous clinical severity score diminished averagely by 50%, and the subjective measure of quality of life increased. Patients taking the study drug demonstrated positive dynamics according to the findings of ultrasonographic duplex scanning, with no serious adverse events during the trial observed. CONCLUSION: By the primary outcome measure of efficacy (reduction of the malleolar circumference) therapy using the investigational drug proved to be not inferior to therapy with the comparator drug. By the secondary outcome measures the compared therapies appeared equally effective. The study drug and the comparator were found to have a similar safety profile.


Assuntos
Varizes/diagnóstico , Insuficiência Venosa/diagnóstico , Humanos , Extremidade Inferior , Estudos Prospectivos , Qualidade de Vida , Índice de Gravidade de Doença , Resultado do Tratamento
20.
Angiol Sosud Khir ; 26(2): 103-109, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32597890

RESUMO

AIM: The purpose of the study was to assess efficacy of endovenous laser ablation of major saphenous veins by means of the Mediola single-ring radial light guides with the use of the 'Optical Handpiece MHP02 (Colibri)'. PATIENTS AND METHODS: This non-comparative prospective study included 430 consecutive patients who underwent a total of 511 endovenous laser ablation procedures from January 2018 to March 2019. The great saphenous vein was subjected to obliteration in 343 (67.1%) cases, the anterior accessory saphenous vein - in 94 (18.4%) cases, and the small saphenous vein - in 74 (14.5%) cases. There were 170 (39.5%) men and 260 (60.5%) women, with a mean age of 52±12.8 years. RESULTS: The next day after the intervention the patients revisited the clinic for control examination, with the obtained findings demonstrating that occlusion of the target vein had been achieved in all 511 (100%) cases. At 2 months, we examined 411 (95.6%) people with a total of 484 (94.7%) treated veins. After 6 months, 399 (92.8%) people with 472 (92.4%) veins were examined. Recanalization with pathological reflux during the entire follow-up period was registered in 6 (1.3%) cases. Hence, the long-term rate of obliteration amounted to 98.7%. CONCLUSIONS: 1) endovenous laser ablation of major saphenous veins by means of the Mediola laser unit with wavelength of 1470 nm and single-ring radial light guides with the use of the 'Optical Handpiece MHP02 (Colibri)' made it possible to achieve obliteration of the target vein in 98.7% of cases at 6 months of follow up; 2) within the mentioned terms, the need for repeat intervention could appear in 1.1% of cases; 3) the Colibri system provides a possibility of decreasing the final cost of radial light guides for endovenous laser ablation by 30-50%.


Assuntos
Terapia a Laser , Varizes/diagnóstico , Insuficiência Venosa/diagnóstico , Adulto , Feminino , Veia Femoral , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Veia Safena/diagnóstico por imagem , Resultado do Tratamento
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