Associação entre insuficiência de perfurante anterior do joelho e insuficiência de veia safena magna em pacientes com varizes primárias dos membros inferiores / Association between insufficiency of anterior perforator vein of the knee and great saphenous vein insufficiency in patients with primary varicose veins of the lower limbs

A correta identificação dos pontos de refluxo no estudo das varizes primárias dos membros inferiores é importante na abordagem terapêutica desses pacientes. Objetivo: Avaliar a associação entre a insuficiência de veias perfurantes anteriores do joelho e a insuficiência de veia safena magna em pacientes com varizes primárias de membros inferiores. Métodos: Foram avaliados 886 pacientes, correspondendo a 1.772 membros inferiores, em pacientes acima de 18 anos, de ambos os sexos, submetidos ao mapeamento venoso superficial pela ecografia vascular. Resultados: Os pacientes apresentaram idade média de 46,1 ± 14,5 anos, sendo 81,7% do sexo feminino. A insuficiência de veia safena magna foi encontrada em 38,8% dos casos. A insuficiência da perfurante anterior do joelho foi encontrada em 146 membros inferiores (8,2%), com diâmetro médio de 1,7 ± 0,15 mm, sendo predominante a localização infrapatelar (86,4%). A tributária anterior da veia safena magna originou o refluxo na perna em 34%, com relação direta desta tributária com a perfurante anterior do joelho em 79,4%. Observou-se associação entre a presença de perfurante anterior do joelho e insuficiência de veia safena magna (p = 0,0001) e sexo masculino (p = 0,001). Conclusão: Houve associação entre insuficiência de perfurante anterior do joelho e insuficiência de veia safena magna em pacientes com varizes primárias dos membros inferiores submetidos à ecografia vascular, sendo que a correta identificação desta perfurante pode ser importante na abordagem terapêutica desses pacientes

The accurate identification of reflux points in the study of primary varicose veins of the lower limbs is important in the therapeutic approach of these patients. Objective: To evaluate the association between insufficiency of the anterior perforator vein of the knee and great saphenous vein insufficiency in patients with primary varicose veins of the lower limbs. Methods: The study included 886 patients, corresponding to 1,772 lower limbs, in patients older than 18, of both sexes, undergoing superficial venous mapping using vascular ultrasound. Results: The mean age of the patients was 46.1 ± 14.5 and 81.7% were females. Great saphenous vein insufficiency was found in 38.8% of the cases. Insufficiency of the anterior perforator vein of the knee was found in 146 lower limbs (8.2%), with a mean diameter of 1.7 ± 0.15 mm, prevailing in the infrapatellar area (86.4%). The anterior tributary vein of the great saphenous vein originated leg reflux in 34%, with a direct relation of this tributary vein with the anterior perforator vein of the knee in 79.4%. An association between the presence of anterior perforator vein of the knee and great saphenous vein insufficiency (p = 0.0001) and male gender (p = 0.001). Conclusion: There was an association between insufficiency of the anterior perforator vein of the knee and great saphenous vein insufficiency in patients with primary varicose veins of the lower limbs at vascular ultrasound, and the accurate identification of this perforator vein may be important in the therapeutic approach of these patients

Dolor pélvico crónico secundario a síndrome de congestión pélvica: resultados del tratamiento endovascular de la insuficiencia venosa pelviana y várices genitales / Embolization of insufficient pelvic veins for pelvic congestion syndrome: analysis of 17 cases

Background: Pelvic venous insufficiency may cause pelvic congestion syndrome that is characterized by chronic pelvic pain exacerbated by prolonged standing, sexual activity or menstrual cycle. It may be treated by embolizing the dysfunctional pelvic venous drainage and sometimes resecting vulvar, perineal and thigh varices. Aim: To assess the results of embolization of insufficient pelvic or ovarian veins on pelvic congestion syndrome. Material and Methods: Analysis of 17 female patients aged 32 to 53 years, who underwent subjected to a selective coil embolization of insufficient pelvic and/or ovarian veins through the jugular, basilic or cephalic veins. In the preoperative period, all patients had a lower extremity venous duplex pelvic ultrasound examination and some had an abdominal and pelvic CT angiogram. Results: The technical success of the procedure was 100% and no complications were registered. During a 32 month follow up, no patient had symptoms of pelvic venous insufficiency or relapse of vulvar or thigh varices. Conclusions: Embolization of insufficient pelvic and ovarian veins is a safe and successful procedure for the treatment of pelvic venous insufficiency or vulvar varices.

Clinical, ultrasonographic and histological findings in varicose vein surgery

SUMMARY OBJECTIVE This study aims to correlate the demographic data, different clinical degrees of chronic venous insufficiency (CEAP), ultrasound findings of saphenofemoral junction (SFJ) reflux, and anatomopathological findings of the proximal segment of the great saphenous vein (GSV) extracted from patients with primary chronic venous insufficiency (CVI) submitted to stripping of the great saphenous vein for the treatment of lower limb varicose. METHOD This is a prospective study of 84 patients (110 limbs) who were submitted to the stripping of the great saphenous vein for the treatment of varicose veins of the lower limbs, who were evaluated for CEAP clinical classification, the presence of reflux at the SFJ with Doppler ultrasonography, and histopathological changes. We study the relationship between the histopathological findings of the proximal GSV withdrawal of patients with CVI with a normal GSV control group from cadavers. RESULTS The mean age of the patients was higher in the advanced CEAPS categories when comparing C2 (46,1 years) with C4 (55,7 years) and C5-6(66 years), as well as C3 patients (50,6 years) with C5-6 patients. The normal GSV wall thickness (mean 839,7 micrometers) was significantly lower than in the saphenous varicose vein (mean 1609,7 micrometers). The correlational analysis of reflux in SFJ with clinical classification or histopathological finding did not show statistically significant findings. CONCLUSIONS The greater the age, the greater the clinical severity of the patients. The GSV wall is thicker in patients with lower limb varicose veins, but those histopathological changes are not correlated with the disease's clinical severity or reflux in the SFJ on a Doppler ultrasound.

RESUMO OBJETIVO Este estudo tem como objetivo correlacionar os dados demográficos, os diferentes graus clínicos da insuficiência venosa crônica (Ceap), com achados ultrassonográficos de refluxo da junção safenofemoral (JSF) e os achados anatomopatológicos do segmento proximal da veia safena magna (VSM) extraído de pacientes com insuficiência venosa crônica (IVC) primária submetidos à safenectomia magna para correção de varizes dos membros inferiores. MÉTODO Estudo prospectivo de 84 pacientes e 110 membros submetidos à safenectomia magna para o tratamento de varizes de membros inferiores, correlacionando a sua classificação clínica Ceap, presença de refluxo na JSF ao ultrassom Doppler e alterações histopatológicas. Comparamos ainda os achados histopatológicos da VSM proximal retirada dos pacientes com IVC com grupo controle de VSM normal retirada de cadáveres. RESULTADOS Média de idade dos pacientes foi maior nos Ceaps avançados quando comparado Ceap C2 (46,1 anos) com C4 (55,7 anos) e C5-6 (66 anos), e pacientes C3 (50,6 anos) com C5-6. A espessura da parede da VSM normal (média de 839,7 micrômetros) foi significativamente menor do que das VSM varicosas (média de 1.609,7 micrômetros). As análises de correlação da presença do refluxo em JSF com a classificação clínica ou achado histopatológico não demostraram ser estatisticamente significativas. CONCLUSÕES Quanto maior a idade, mais avançada é a classificação clínica da IVC dos pacientes. A espessura da parede da crossa da VSM é maior nos pacientes com IVC e essas alterações não se correlacionam com a classificação clínica da doença ou com a presença de refluxo na JSF ao ultrassom Doppler.

Evaluation of embolization for periuterine varices involving chronic pelvic pain secondary to pelvic congestion syndrome

OBJECTIVES: To evaluate the clinical response and success rate after periuterine varices embolization in patients with chronic pelvic pain secondary to pelvic congestion syndrome and to report the safety of endovascular treatment and its rate of complications. METHODS: Retrospective cohort of patients undergoing endovascular treatment of pelvic congestion syndrome in our department from January 2012 to November 2015. Data were analyzed based on patient background, imaging findings, embolized veins, rate of complications, and clinical response as indicated by the visual analog pain scale. RESULTS: We performed periuterine varices embolization in 22 patients during the study, four of which required a second embolization. Seventeen patients reported a reduction in pelvic pain after the first embolization and three patients reported a reduction in pelvic pain after the second embolization. Minor complications were observed in our patients, such as postural hypotension, postoperative pain, and venous perforation during the procedure, without clinical repercussion. CONCLUSION: Periuterine varices embolization in patients with chronic pelvic pain secondary to pelvic congestion syndrome appears to be an effective and safe technique.