ABSTRACT
Introduction: Pelvic varicose veins, one of the main causes of chronic pelvic pain and dyspareunia, are an important source of reflux for lower limb varicose veins, especially in recurrent cases. Color Doppler ultrasound of the lower limbs and transvaginal ultrasound are the noninvasive diagnostic methods most commonly used to assess pelvic venous insufficiency, whereas phlebography is still considered as the gold standard. Objectives: To determine the prevalence of lower limb varicose veins originating from the pelvis in a group of female patients and to determine the agreement between results obtained via color Doppler ultrasound of the lower limbs, transvaginal ultrasound, and phlebography. Methods: The sample comprised female patients referred to a vascular laboratory for lower limb screening. Patients diagnosed with deep venous thrombosis were excluded. Data analysis included kappa coefficient of agreement, McNemar's test, sensitivity and specificity values. Results: Of a total of 1,020 patients, 124 (12.2 percent) had findings compatible with reflux of pelvic origin. Among these patients, 51 (41.2 percent) were recurrent cases. A total of 249 were submitted to transvaginal ultrasound. There was significant agreement between lower limb ultrasonographic findings and transvaginal findings. Phlebography was performed in 54 patients. The comparison between transvaginal ultrasound and phlebography was associated with a 96.2 percent sensitivity and 100 percent specificity. Conclusions: The authors draw attention to the relatively high prevalence of lower limb varicose veins originating from the pelvis, suggesting an important but underdiagnosed cause of recurrent varicose veins.
Introdução: AS VARIZES Pélvicas, uma das principais causas de dor pélvica crônica e dispareunia, são uma importante fonte de refluxo para as varizes dos membros inferiores, especialmente em casos recorrentes. O Doppler colorido dos membros inferiores e o ultrassom transvaginal são os métodos diagnósticos não-invasivos mais comumente usados para avaliar a insuficiência venosa pélvica, enquanto a flebografia ainda é considerada como o padrão-ouro. Objetivos: Determinar a prevalência de varizes dos membros inferiores originadas na pélvis em um grupo de pacientes do sexo feminino e determinar a concordância entre os resultados obtidos por Doppler colorido dos membros inferiores, ultrassom transvaginal e flebografia. Métodos: A AMOstra incluiu pacientes do sexo feminino encaminhadas para o laboratório vascular para triagem dos membros inferiores. As pacientes diagnosticadas com trombose venosa profunda foram excluídas. A análise dos dados incluiu o coeficiente de concordância kappa, o teste de McNemar e os valores de sensibilidade e especificidade. Resultados: De um total de 1.020 pacientes, 124 (12.2 por cento) tiveram achados compatíveis com refluxo de origem pélvica. Entre essas pacientes, 51 (41.2 por cento) eram casos recorrentes. Um total de 249 foram submetidas a ultrassom transvaginal. Houve concordância significativa entre os achados ultrassonográficos dos membros inferiores e os achados transvaginais. A flebografia foi realizada em 54 pacientes. A comparação entre o ultrassom transvaginal e a flebografia foi associada a 96.2 por cento de sensibilidade e 100 por cento de especificidade. Conclusões: OS AUTores chamam a atenção para a prevalência relativamente alta de varizes dos membros inferiores originadas na pélvis, sugerindo uma importante, embora subdiagnosticada, causa de varizes recorrentes.
Subject(s)
Humans , Female , Adult , Lower Extremity/blood supply , Health Research Evaluation , Venous Insufficiency/classification , Varicose Veins/diagnosis , Echocardiography, Doppler, Color/methods , Phlebography/methodsABSTRACT
The Brazilian National Forum on Carotid Surgery gathered the consensus of 15 Regional Chapters of the Braziliam Society of Angiology an Vascular Surgery.Established diagnostic method and newly developed tecchiques were discusses.Concerning the method of anesthesia, there was a concensus that the surgical skills, rather tan the type of anesthesia, are the main factors for good or bad results.Local anesthesis does not avoid complications caused by inadequte technique.There was a concensus that utilization of a temporary shunt in select cases may lower the incidence of post-operative neurologic deficits, wich not surpas 3 porcents.Angioplasty and carotid stenting were considered experimental procedures and with no approval of the medical community so far, except when performed under research protocols, submitted to boards of ethics and with informed consent.Finally, it was emphasized that the carotid surgery is to be perfomed in regional centers to which patients should be referred in order to archieve the best results.