Influence of compression therapy following varicose vein surgery: a prospective randomized study.

Background: The use of compression dressings after phlebectomy is based solely on clinical experience due to the lack of a unified set of definitive recommendations, which makes clinical practice extremely heterogeneous. Objectives: To evaluate compression therapy with elastic stockings for 7 days after phlebectomy. Methods: We randomly allocated 104 lower limbs with disease classified as C1 and C2 to 1 of 2 groups: an intervention group (64 limbs) - wearing elastic compression stockings for the first 7 days after phlebectomy; or a control group (40 limbs) - given conventional bandaging for 24 hours postoperatively. We compared clinical response by analyzing the evolution of symptoms, hematoma formation, and preoperative vs. postoperative limb volume. Results: Pain (median 1.0 vs. 1.5, p=0.0320) and limb volume (mean 43.7 vs. 99.8, p=0.0071) were significantly improved in patients wearing elastic compression stockings for 7 days after phlebectomy compared with controls. Conclusions: Use of elastic compression therapy for 7 days after phlebectomy was effective for improving pain and lower limb volume.

Contexto: O uso de curativos após flebectomia é baseado apenas na experiência clínica, visto que não existe um conjunto unificado de recomendações definitivas, o que torna a prática clínica extremamente variável. Objetivos: Avaliar o uso de terapia elástica compressiva por 7 dias após flebectomia. Métodos: Cento e quatro membros inferiores, classificados como CEAP C1 e C2, foram randomizados em dois grupos: grupo de intervenção (64 membros) ­ uso de meia elástica por 24 horas após a cirurgia ­ e grupo controle (40 membros) ­ uso de curativo convencional por 7 dias após a cirurgia. A resposta clínica foi comparada por meio de análise da evolução dos sintomas, de hematoma e do volume dos membros antes e depois da cirurgia. Resultados: Os pacientes submetidos a terapia compressiva elástica apresentaram melhora significativa na dor (mediana 1,0 vs. 1,5; p=0,0320) e no volume dos membros (média 43,7 vs. 99,8; p=0,0071) em comparação ao grupo controle. Conclusões: O emprego da terapia compressiva elástica por 7 dias após flebectomia mostrou-se efetivo na melhora da dor e do volume dos membros inferiores.

Brazilian guidelines on diagnosis and management of traumatic vascular injuries.

Trauma is a leading cause of death, permanent disability, and health care cost worldwide. The young and economically active are the most affected population. Exsanguination due to noncompressible torso hemorrhage is one of the most frequent causes of early death, posing a significant challenge to trauma and vascular surgeons. The possibility of limb loss due to vascular injuries must also be considered. In recent decades, the approach to vascular injuries has been significantly modified. Angiotomography has become the standard method for diagnosis, endovascular techniques are currently incorporated in treatment, and damage control, such as temporary shunts, is now the preferred approach for the patients sustaining physiological derangement. Despite the importance of this topic, few papers in the Brazilian literature have offered guidelines on vascular trauma. The Brazilian Society of Angiology and Vascular Surgery has developed Projetos Diretrizes (Guideline Projects), which includes this publication on vascular trauma. Since treating trauma patients is a multidisciplinary effort, the Brazilian Trauma Society (SBAIT) was invited to participate in this project. Members of both societies reviewed the literature on vascular trauma management and together wrote these guidelines on vascular injuries of neck, thorax, abdomen, and extremities.

Guidelines on vascular access for hemodialysis from the Brazilian Society of Angiology and Vascular Surgery.

Chronic kidney disease is a worldwide public health problem, and end-stage renal disease requires dialysis. Most patients requiring renal replacement therapy have to undergo hemodialysis. Therefore, vascular access is extremely important for the dialysis population, directly affecting the quality of life and the morbidity and mortality of this patient population. Since making, managing and salvaging of vascular accesses falls within the purview of the vascular surgeon, developing guideline to help specialists better manage vascular accesses for hemodialysis if of great importance. Thus, the objective of this guideline is to present a set of recommendations to guide decisions involved in the referral, evaluation, choice, surveillance and management of complications of vascular accesses for hemodialysis.

A doença renal crônica é um problema de saúde pública global e em seu estágio terminal está associada à necessidade de terapia dialítica. A grande maioria dos pacientes que necessitam realizar a terapia renal substitutiva, a fazem através da hemodiálise. Portanto, o acesso vascular é de extrema importância para a população dialítica, implicando diretamente na qualidade de vida e na morbimortalidade deste grupo de pacientes. Sendo a confecção, gerenciamento e resgate dos acessos vasculares uma das áreas de atuação do cirurgião vascular, é de grande importância a elaboração de uma diretriz que oriente o especialista no manejo mais adequado do acesso vascular para hemodiálise. Assim, o objetivo desta diretriz é apresentar um conjunto de recomendações para guiar as decisões na referenciação, avaliação, escolha, vigilância e gestão das complicações do acesso vascular para hemodiálise.

Brazilian guidelines on chronic venous disease of the Brazilian Society of Angiology and Vascular Surgery.

The Brazilian Society of Angiology and Vascular Surgery has set up a committee to provide new evidence-based recommendations for patient care associated with chronic venous insufficiency. Topics were divided in five groups: 1. Classification, 2. Diagnosis, 3. Conservative or non-invasive treatment, 4. Invasive treatment and 5. Treatment of small vessels. This last series is closely related to the activities of Brazilian angiologists and vascular surgeons, who are heavily involved in the treatment of small superficial veins. These guidelines are intended to assist in clinical decision-making for attending physicians and health managers. The decision to follow a guideline recommendation should be made by the responsible physician on a case-by-case basis taking into account the patient's specific condition, as well as local resources, regulations, laws, and clinical practice recommendations.

A Sociedade Brasileira de Angiologia e de Cirurgia Vascular organizou uma comissão para fornecer novas recomendações baseadas em evidências sobre questões críticas de atendimento ao paciente com insuficiência venosa crônica. São abordados aqui os temas de classificação, diagnóstico, tratamento conservador, tratamento invasivo e tratamento de pequenos vasos. Esta última série está muito relacionada à atividade de angiologistas e cirurgiões vasculares, que possuem forte atuação no tratamento de pequenas veias superficiais. Estas diretrizes destinam-se a auxiliar na tomada de decisões clínicas de médicos assistentes e gestores de saúde. A decisão de seguir uma recomendação de diretriz deve ser feita pelo médico responsável caso a caso, levando em consideração a condição específica do paciente, bem como recursos locais, regulamentos, leis e recomendações de prática clínica.

Brazilian Society for Angiology and Vascular Surgery guidelines on abdominal aortic aneurysm.

The Brazilian Society of Angiology and Vascular Surgery, through the Guidelines Project, presents new Abdominal Aortic Aneurysm Guidelines, on the subject of care for abdominal aortic aneurysm patients. Its development prioritized descriptive guidelines, using the EMBASE, LILACS, and PubMed databases. References include randomized controlled trials, systematic reviews, meta-analyses, and cohort studies. Quality of evidence was evaluated by a pair of coordinators, aided by the RoB 2 Cochrane tool and the Newcastle Ottawa Scale forms. The subjects include juxtarenal aneurysms, infected aneurysms, and new therapeutic techniques, especially endovascular procedures. The current version of the guidelines include important recommendations for the primary topics involving diagnosis, treatment, and follow-up for abdominal aortic aneurysm patients, providing an objective guide for medical practice, based on scientific evidence and widely available throughout Brazil.

A Sociedade Brasileira de Angiologia e Cirurgia Vascular, por meio do projeto Diretrizes, apresenta as novas Diretrizes de Aorta Abdominal, referentes aos cuidados de pacientes com aneurisma de aorta abdominal. Para sua elaboração, foram priorizadas diretrizes descritivas, utilizando as bases EMBASE, LILACS e PubMed. As referências incluem ensaios clínicos randomizados, revisões sistemáticas, metanálises e estudos de coorte. A qualidade das evidências foi examinada por uma dupla de coordenadores, com auxílio da ferramenta RoB 2 da Colaboração Cochrane e dos formulários da Newcastle Ottawa Scale. Aneurismas justarrenais, infectados e novas técnicas terapêuticas, principalmente no âmbito endovascular, estão entre os temas estudados. A versão atual das Diretrizes apresenta importantes recomendações para os principais itens que envolvem o diagnóstico, tratamento e acompanhamento de pacientes com aneurisma de aorta abdominal, oferecendo um guia objetivo para prática médica, construído a partir de evidências científicas e amplamente acessível em todo o território nacional.

Patterns of flow drainage from varicose veins originating in the incompetent great saphenous vein.

Background: Chronic venous insufficiency affects the lives of many people and therefore constitutes a public health problem. Knowledge of the drainage patterns of reflux from varicose veins secondary to incompetent saphenous veins is essential to define the best therapeutic management. Objectives: To determine the reflux drainage patterns from varicose veins originating in incompetent GSV, the prevalence of perforating veins (PV), and their relationships with symptoms. Methods: 55 ultrasound reports were analyzed to determine the drainage patterns of reflux from the GSV, location and diameter of PV drainage, and staging of symptoms. Results: In 64% of the sample, reflux from varicose veins drained to PVs, in 4% reflux drained to the GSV itself, in another 4% drainage was to the small saphenous vein, and in 29% drainage was to varicose trunk veins in which no direct communication with the deep system could be identified. No associations were observed between symptoms and reflux drainage patterns or PV diameters. Conclusions: For this sample, PVs were responsible for draining flow from varicose veins in 64% of cases. Neither PV diameters nor GSV reflux patterns were associated with severity of symptoms.

Introdução: A insuficiência venosa crônica impacta a vida de muitas pessoas, constituindo-se, assim, como um problema de saúde pública. Conhecer o padrão de drenagem do refluxo das varizes associadas à veia safena incompetente é fundamental para definir a melhor programação terapêutica. Objetivos: Determinar os padrões de drenagem do refluxo de varizes originadas da veia safena magna incompetente, a prevalência de veias perfurantes e a relação com os sintomas. Métodos: Foram analisados 55 registros ultrassonográficos de pacientes com refluxo da veia safena magna para determinar padrões de drenagem do refluxo dessa veia, pontos de refluxo das varizes, localização e diâmetro das perfurantes de drenagem e graduação dos sintomas. Resultados: O principal padrão de refluxo encontrado foi originado da junção safenofemoral com comprometimento proximal da veia safena magna. Em 64% dos pacientes, o refluxo das varizes drenou para veias perfurantes - 4% drenavam para a própria veia safena magna; em outros 4%, a drenagem era para a veia safena parva; e, em 29%, a drenavam destinava-se para varizes tronculares em que não se identificou comunicação direta com o sistema venoso profundo. Não foi observada associação dos sintomas com os padrões de drenagem do refluxo ou diâmetro das perfurantes. Conclusão: Para essa amostra, as veias perfurantes foram responsáveis pelo escoamento do fluxo oriundo das varizes em 64% dos casos. O diâmetro das veias perfurantes e o padrão de refluxo da veia safena não estiveram associados à gravidade dos sintomas.

WIfI classification: the Society for Vascular Surgery lower extremity threatened limb classification system, a literature review.

The Society for Vascular Surgery has proposed a new classification system for the threatened lower limb, based on the three main factors that have an impact on limb amputation risk: Wound (W), Ischemia (I) and foot Infection ("fI") - the WIfI classification. The system also covers diabetic patients, previously excluded from the concept of critical limb ischemia because of their complex clinical condition. The classification's purpose is to provide accurate and early risk stratification for patients with threatened lower limbs; assisting with clinical management, enabling comparison of alternative therapies; and predicting risk of amputation at 1 year and the need for limb revascularization. The objective of this study is to collect together the main points about the WIfI classification that have been discussed in the scientific literature. Most of the studies conducted for validation of this classification system prove its association with factors related to limb salvage, such as amputation rates, amputation-free survival, prediction of reintervention, amputation, and stenosis (RAS) events, and wound healing.

Total reversal of internal carotid blood flow in a patient with severe stenosis of the brachiocephalic trunk.

Occlusions and severe stenoses of the innominate artery (brachiocephalic trunk) are rare and present with a wide variety of clinical manifestations, with hemispheric, vertebrobasilar and right upper limb ischemic symptoms. The most common cause is atherosclerosis. Duplex scanning may show right vertebral artery flow reversal, diminished subclavian flow, and several patterns of right carotid flow disturbance, including slow flow, partial flow reversal during the cardiac cycle and even complete reversal of flow in the internal carotid artery, which is a very uncommon finding. Herein, the authors describe the case of a female patient who was a heavy smoker, had severe stenosis of the brachiocephalic trunk, and had episodes of collapse. Besides the subclavian steal and partial flow reversal in the common carotid artery, duplex scanning also showed high-velocity reversed flow in the internal carotid artery during the entire cardiac cycle, a finding that is not reported in the literature at this magnitude.

Influence of linear intravenous energy density on the success of intravenous laser ablation for treatment of chronic venous insufficiency.

BACKGROUND: It is relevant to elucidate the influence that mean linear endovenous energy density (LEED) has on the success of endovenous laser ablation treatment for chronic venous insufficiency, in order to reduce the method's adverse effects. OBJECTIVES: To evaluate the influence of mean LEED on the prevalence of saphenous closure 30 days after the laser ablation procedure. METHODS: 153 lower limbs from 118 patients seen at a tertiary hospital and treated for chronic venous insufficiency with endovenous 1470 nm laser ablation under local anesthesia were evaluated. The mean LEED used to treat patients was calculated to determine whether greater than average LEED was required for treatment success. RESULTS: A significant difference (p = 0.021) in saphenofemoral junction closure was associated with mean LEED used above the knee. Conversely, there was no significant difference in the thigh segment. CONCLUSIONS: Linear intravenous energy density greater than the mean of 70.57 J/cm was associated with a higher rate of closure at the saphenofemoral junction. However, density did not have an influence on the result for the thigh segment, showing that an energy density exceeding 70.57 J/cm tends not to be required for treatment of this segment.

Polidocanol echosclerotherapy treatment for lymphocele: case report and review.

Formation of lymphocele secondary to transection of lymphatic channels during surgical procedures or traumas is relatively common and is reported in the postoperative period of approximately 30% of lymph node resection procedures. The condition may be asymptomatic or can present with complications such as pain, secondary infection, and compression of blood vessels, which can cause stasis, thrombosis, and edema. There is no consensus on treatment. This article describes three cases in which treatment was provided using polidocanol echosclerotherapy. Its relevance lies in the scarcity of reports in the literature.

Agenesis of the internal carotid artery.

Agenesis of the internal carotid artery is a rare anomaly. It is usually asymptomatic because of the presence of anastomoses, but it can be associated with complications, especially when there is evidence of other anatomical abnormalities or severe atherosclerotic disease. We report the case of a 63-year-old female patient with hypertension and diabetes and a history of intracranial aneurysm clipping. Doppler ultrasonography and computed tomography angiography of the carotid and vertebral arteries showed unilateral agenesis of the left internal carotid artery. This report aims to highlight the importance of suspecting vascular malformations during investigation of neurological conditions. Internal carotid agenesis has a significant association with intracranial aneurysms and their early detection can spare the patient serious complications.

Vascular Forum: collective intelligence in the resolution of vascular clinical cases.

BACKGROUND: Collective intelligence is extremely important in collective groups that discuss clinical medical cases, assisting professionals in their decision-making processes, and consequently, helping their patients. OBJECTIVES: To evaluate the rate of resolution and characteristics of the clinical discussions carried out in a private instant messaging group and its clinical applicability. METHODS: Retrospective analysis of clinical discussions and events on the Vascular Forum, an open group for specialists accessed with mobile devices. RESULTS: From July 2015 to July 2017, 1013 subjects were discussed among 680 members. Twenty-six (2.57%) of these subjects were curiosities, 101 (9.97%) related to diagnostic doubts, 492 (48.57%) to treatment doubts, and 205 (20.24%) to general doubts, while 189 (17.5%) were case reports. The mean number of interactions per event was 16.599 (±1.366). The mean time from posting of a new subject to the first reply was 42.14 (±7.55) min. The subject discussed was miscellaneous in 358 cases, venous in 336 cases, lymphatic in 15 cases, and arterial in 304 cases and the total number of replies was 15985. CONCLUSIONS: Interaction between experts using instant messaging technology proved capable of raising subjects for discussion and eliciting management approaches quickly. The rate of resolution, defined as the time taken for the first correct answer to be posted, was also high. The Vascular Forum proved to be a tool of great clinical value for its participants, confirming the importance of collective intelligence in medicine.

Accidental guide wire migration and late percutaneous externalization after central venous catheterization.

A 70-year-old man was admitted to the emergency department with recent spontaneous externalization of a metallic device from his right inner thigh. He had been experiencing mild local pain for 2 weeks and had a recent hospitalization due to cardiogenic hemodynamic instability, requiring a central venous catheter placement in his right internal jugular vein 3 months earlier. Doppler ultrasound confirmed the intravascular foreign body hypothesis as a guidewire was identified inside the right femoral vein, associated with femoropopliteal venous thrombosis. The guidewire was successfully removed percutaneously through simple manual traction guided by radioscopy. The patient was discharged the following day on oral anticoagulation with rivaroxaban. On outpatient follow-up 4 weeks post discharge, he had no complaints in the right lower limb except for slight swelling. Central venous catheterization is a common invasive procedure that, although unquestionably safe and well stablished in medical practice, can lead to serious complications when performed without proper technique.

Endovascular treatment of subclavian artery injury with a complex post-traumatic fistula: Case report.

BACKGROUND: Endovascular treatment in trauma is a promising strategy to reduce perioperative morbidity and mortality. We report the case of a gunshot wound causing an initially undiagnosed subclavian artery injury, with delayed progression to a complex, difficult-to-manage arteriovenous (AV) fistula. Placement of an encapsulated endovascular stent graft resolved the primary lesion, but persistent cervical arteriovenous communications were only repaired after multiple, sequential embolization procedures. REPORT: A 25-year-old male sustained a gunshot wound to the right neck. Initial treatment failed to identify any vascular injury, and the patient was discharged. Three weeks later, he presented to our facility with headache and a palpable right-sided cervical thrill. Arteriography showed contrast extravasation from the right subclavian artery and an AV fistula with the ipsilateral internal jugular vein. The arterial injury was repaired with an encapsulated stent graft, but residual contrast leak persisted on follow-up angiography. Three months after the first intervention, cervical thrill was still present; a right vertebral-right internal jugular AV fistula was identified and repaired by distal coil embolization. One month later, persistent symptoms prompted repeat arteriography, which again identified contrast extravasation, now involving the thyrocervical trunk. Selective thyrocervical embolization was ultimately successful, with resolution of symptoms and no further evidence of contrast leak. CONCLUSION: Delayed management of neck trauma can be challenging due to neovascularization, which hinders open repair in this delicate region. Post-traumatic arteriovenous fistulas are thus a particularly fearsome complication, and can be very difficult to approach; as in our patient, multiple interventions may be required. This case highlights the importance of detecting vascular trauma as early as possible, as a delay in diagnosis can hinder treatment and eventuate challenging late complications. Further studies are needed to demonstrate the long-term benefits of endovascular management of complex vascular injuries of the neck region.

Endovascular treatment of anterior nutcracker syndrome and pelvic varices in a patient with an anterior and a posterior renal vein.

There are few data on endovascular treatment of anterior nutcracker syndrome and pelvic varices in patients with anterior and posterior renal veins. Our objective is to report a case, identify occurrences and compare diagnosis and treatments. A 42-year-old woman presented with flank and pelvic pain and hematuria. She had anterior nutcracker syndrome and pelvic varices with an anterior and a posterior renal vein. A successful complete endovascular approach was done with stent implantation in the anterior renal vein and left gonadal vein embolisation. After 12-month follow-up, the patient remained asymptomatic with good results on CT. Only two case reports of patients with nutcracker syndrome with anterior and posterior renal veins were identified. In both, a self-expanding stent was implanted in the anterior renal vein. In conclusion, endovascular treatment represents a safe and successful option in patients with nutcracker syndrome and pelvic varices with an anterior and a posterior renal vein.

Saphenous reflux patterns in C2 patients: A record of 1196 ultrasound reports.

OBJECTIVES: To describe saphenous reflux patterns in patients classified as CEAP C2 by analysis of 2027 vascular ultrasound examination reports. METHODS: A total of 2027 venous mapping studies were reviewed and 1196 patients classified as CEAP C2 were selected. Patients were classified according to patterns of reflux for the great saphenous vein and for the small saphenous vein, and rates of great saphenous vein and small saphenous vein reflux were analyzed for both sexes. RESULTS: The overall prevalence of saphenous vein reflux was 45%. Males had significantly higher great saphenous vein reflux prevalence than females (p < 0.001). The most common great saphenous vein reflux pattern in females was segmental reflux and the most common pattern in males was proximal reflux. CONCLUSIONS: Saphenous vein reflux is common in C2 patients and is more frequent in males. Standardization of classifications of reflux patterns is very important for correct management of the disease.

Comparison of the effects of endovenous laser ablation at 1470 nm versus 1940 nm and different energy densities.

OBJECTIVES: To evaluate histological and immunohistochemical changes in the great saphenous vein after endovenous laser ablation at two different wavelengths (1470 vs. 1940 nm) and linear endovenous energy density values (50 vs. 100 J/cm). METHOD: Segments were obtained from the conventional eversion removal of great saphenous vein and divided into a control group and four groups for ex vivo irradiation (control group; A: 1470 nm, 50 J/cm; B: 1470 nm, 100 J/cm; C: 1940 nm, 50 J/cm; D: 1940 nm, 100 J/cm). Fifty venous segments ( n = 10/group) were analyzed. Changes were classified into low-temperature changes, moderate-temperature changes, high-temperature changes, and very high-temperature changes. RESULTS: In the intima, low-temperature changes + moderate-temperature changes were significantly more prevalent in group A (65.4%) than in D ( p = 0.001). In the media, low-temperature changes + moderate-temperature changes were achieved mostly in groups A and C (77.4% and 75.0%, respectively). In adventitia fragments, 100% of changes in group A were low-temperature changes + moderate-temperature changes. CONCLUSIONS: The 1940-nm laser wavelength with linear endovenous energy density of 100 J/cm was excessively destructive to the intima and media causing a high rate of high-grade thermal damage. These findings corroborate the possibility of using lower linear endovenous energy densities with 1940-nm devices to achieve effective occlusion with less high grade thermal damage to the intima and media, as well as to prevent damages to the adventitia and perivenous tissues, including venous perforation and its attendant clinical consequences.

Spontaneous Heterotopic Triplet Pregnancy with a Two Viable Intrauterine Embryos and an Ectopic One with Right Tubal Rupture.

Heterotopic pregnancy (HP) is defined as the simultaneous development of an intra- and an extra uterine gestation. The occurrence of a spontaneous triplet HP is an exceptionally rare medical condition. We report the case of a young woman with spontaneous heterotopic triplets at 8 weeks of gestation, with a misdiagnosis of topic twins and acute appendicitis. The ectopic tubal pregnancy was ruptured and a salpingectomy was performed by laparotomy. The intrauterine pregnancy progressed uneventfully. The two healthy babies were delivery by cesarean section at 36 ± 2 weeks of gestation. Heterotopic triplets with ruptured tubal ectopic pregnancy represent a special diagnostic and therapeutic challenge for the obstetrician. A high rate of clinical suspicion and timely treatment by laparotomy or laparoscopy can preserve the intrauterine gestation with a successful outcome of the pregnancy.

A gravidez heterotópica é definida como o desenvolvimento simultâneo de uma gestação intra- e extra-uterina. A ocorrência de gravidez tripla heterotópica espontânea é uma condição médica excepcionalmente rara. Relatamos o caso de uma jovem com gravidez tripla espontânea, às 8 semanas de gestação, com um diagnóstico errôneo de gêmeos tópicos e apendicite aguda. A gravidez tubária ectópica estava rota e uma salpingectomia foi realizada por laparotomia. A gravidez intrauterina progrediu sem intercorrências. Os bebês nasceram saudáveis por cesariana realizada às 36 semanas de gestação. A gravidez de heterotópicos com ectopia e rotura tubária é um desafio diagnóstico e terapêutico. Um alto índice de suspeita e tratamento oportuno por laparotomia ou laparoscopia podem preservar a gestação intrauterina com um resultado bem sucedido da gravidez tópica.

Influence of compression therapy following varicose vein surgery: a prospective randomized study / Influência da terapia compressiva no pós-operatório de flebectomia: um estudo prospectivo e randomizado

Abstract Background The use of compression dressings after phlebectomy is based solely on clinical experience due to the lack of a unified set of definitive recommendations, which makes clinical practice extremely heterogeneous. Objectives To evaluate compression therapy with elastic stockings for 7 days after phlebectomy. Methods We randomly allocated 104 lower limbs with disease classified as C1 and C2 to 1 of 2 groups: an intervention group (64 limbs) - wearing elastic compression stockings for the first 7 days after phlebectomy; or a control group (40 limbs) - given conventional bandaging for 24 hours postoperatively. We compared clinical response by analyzing the evolution of symptoms, hematoma formation, and preoperative vs. postoperative limb volume. Results Pain (median 1.0 vs. 1.5, p=0.0320) and limb volume (mean 43.7 vs. 99.8, p=0.0071) were significantly improved in patients wearing elastic compression stockings for 7 days after phlebectomy compared with controls. Conclusions Use of elastic compression therapy for 7 days after phlebectomy was effective for improving pain and lower limb volume.

Resumo Contexto O uso de curativos após flebectomia é baseado apenas na experiência clínica, visto que não existe um conjunto unificado de recomendações definitivas, o que torna a prática clínica extremamente variável. Objetivos Avaliar o uso de terapia elástica compressiva por 7 dias após flebectomia. Métodos Cento e quatro membros inferiores, classificados como CEAP C1 e C2, foram randomizados em dois grupos: grupo de intervenção (64 membros) - uso de meia elástica por 24 horas após a cirurgia - e grupo controle (40 membros) - uso de curativo convencional por 7 dias após a cirurgia. A resposta clínica foi comparada por meio de análise da evolução dos sintomas, de hematoma e do volume dos membros antes e depois da cirurgia. Resultados Os pacientes submetidos a terapia compressiva elástica apresentaram melhora significativa na dor (mediana 1,0 vs. 1,5; p=0,0320) e no volume dos membros (média 43,7 vs. 99,8; p=0,0071) em comparação ao grupo controle. Conclusões O emprego da terapia compressiva elástica por 7 dias após flebectomia mostrou-se efetivo na melhora da dor e do volume dos membros inferiores.