Oclusión de la vena safena con cianocrilato, una alternativa para el tratamiento de insuficiencia venosa crónica. Experiencia inicial en el Instituto Guatemalteco de Seguridad Social ­ IGSS / Occlusion of the saphenous vein with cyanoacrylate, an alternative for the treatment of chronic venous insufficiency. Initial experience at the Guatemalan Social Security Institute - IGSS

Las técnicas de termo ablación han revolucionado el tratamiento de la insuficiencia venosa crónica, siendo actualmente el estándar de tratamiento. Con el avance tecnológico han surgido nuevas técnicas quirúrgicas, no térmicas, no tumescentes; como el uso de cianocrilato para la oclusión venosa, el cual ha demostrado ser seguro y eficaz en el tratamiento, y tener menos complicaciones posoperatorias. Objetivo: Describir la experiencia en nuestro hospital con el uso de cianocrilato para la oclusión de vena safena mayor para el tratamiento de insuficiencia venosa crónica. Describir la eficacia a corto y mediano plazo del cierre, las complicaciones y la mejoría de la sintomatología utilizando el cuestionario CIVIQ-20 y EVA. Material y métodos: Estudio retrospectivo observacional. Entre enero y diciembre de 2019 que incluye a pacientes con insuficiencia de unión safeno femoral, sintomáticos. Con diagnóstico mediante clasificación CEAP y ultrasonido Doppler. Seguimiento clínico y ecográfico valorando oclusión de los segmentos tratados y presencia de venas varicosas a los 3 y 6 meses. Se trataron 5 pacientes con oclusión venosa con cianocrilato (100% mujeres). Valoramos la calidad de vida mediante cuestionario CIVIQ-20 y EVA (Escala Analógica Visual) previo y un mes después del procedimiento. También se describe la tasa de éxito y complicaciones inmediatas y tardías. Resultados: La totalidad de los procedimientos se realizaron con anestesia local, siendo bien tolerados. Con un éxito inmediato del 100 % sin necesidad de conversión. Solo se presentó como complicación urticaria en un paciente en el trayecto de la vena tratada con cianocrilato, la cual se trató con esteroides y resolvió. El CIVIQ-20 mostró mejoría global pasando de 35 a 29 puntos en promedio; siendo el parámetro de actividad física el que mostró una mejoría mayor. EVA demostró que la pesadez (principal síntoma) se redujo un 67%. Durante el seguimiento, ningún caso presento repermeabilización o recanalizaciones segmentarias. Conclusiones: El tratamiento endovenoso de la insuficiencia venosa crónica con las nuevas técnicas no térmicas, no tumescentes es seguro y efectivo. A corto-mediano plazo ofrecen resultados similares a las técnicas termoablativas obviando el inconveniente de la tumescencia y el uso de medias compresivas en el posoperatorio, evitando lesiones térmicas y observándose mejoría en la sintomatología. (AU)

Thermo ablation techniques have revolutionized the treatment of chronic venous insufficiency, being currently the standard of treatment. With technological advancement, new non-thermal, non-tumescent surgical techniques have emerged; such as the use of cyanoacrylate for venous occlusion, which has been shown to be safe and effective in treatment, and have fewer postoperative complications. Objective: To describe the experience in our hospital with the use of cyanoacrylate for occlusion of the greater saphenous vein for the treatment of chronic venous insufficiency. Describe the shortand medium-term efficacy of closure, complications, and symptom improvement using the CIVIQ-20 questionnaire and VAS. Material and methods: Retrospective observational study. Between January and December 2019 that includes patients with symptomatic saphenous femoral junction insufficiency. With diagnosis by CEAP classification and Doppler ultrasound. Clinical and ultrasound follow-up evaluating occlusion of the treated segments and the presence of varicose veins at 3 and 6 months. 5 patients with venous occlusion were treated with cyanoacrylate (100% women). We assessed the quality of life using the CIVIQ-20 questionnaire and VAS (Visual Analogue Scale) before and one month after the procedure. The immediate and late success rate and complications are also described. Results: All the procedures were performed under local anesthesia, being well tolerated. With immediate 100% success without the need for conversion. Urticaria only presented as a complication in a patient in the path of the vein treated with cyanoacrylate, which was treated with steroids and resolved. The CIVIQ-20 showed global improvement, going from 35 to 29 points on average; being the physical activity parameter the one that showed the greatest improvement. VAS showed that heaviness (main symptom) was reduced by 67%. During follow-up, no case presented segmental recanalization or recanalization. Conclusions: Endovenous treatment of chronic venous insufficiency with new non-thermal, non-tumescent techniques is safe and effective. In the short-medium term, they offer results similar to thermoablative techniques, avoiding the inconvenience of tumescence and the use of compression stockings in the postoperative period, avoiding thermal injuries and observing improvement in symptoms. (AU)

Disseminated cutaneous atypical mycobacteriosis by M. chelonae after sclerotherapy of varicose veins in a immunocompetent patient: a case report

Atypical mycobacteria are saprophytic organisms not transmitted from person to person, which affect mainly immunosuppressed but also immunocompetent individuals. We present a case of atypical mycobacteriosis after a vascular procedure, with widespread cutaneous lesions associated with polyarthralgia. Mycobacterium chelonae was identified by the polymerase chain reaction (PCR) method. The patient showed improvement after treatment with three antibiotics. Mycobacterium chelonae causes skin lesions after invasive procedures. The clinical form depends on the immune state of the host and on the entry points. The diagnosis is based essentially on culture and the mycobacteria is identified by PCR. We highlight the importance of investigating atypical mycobacteriosis when faced with granulomatous lesions associated with a history of invasive procedures.

Eficácia da troxerrutina e cumarina no tratamento das varizes dos membros inferiores: [revisão] / Troxerutin-coumarin efficacy in the treatment of varicose veins of the lower limbs: [review]

As varizes dos membros inferiores são responsáveis pelo desenvolvimento de insuficiência venosa crônica (IVC). O tratamento cirúrgico é indicado na maioria dos casos, no entanto em algumas situações outras alternativas terapêuticas podem ser empregadas, como é o caso da terapia compressiva e das drogas flebotrópicas. Entre as drogas flebotrópicas faremos algumas considerações sobre a associação da troxerrutina e cumarina no tratamento da insuficiência venosa crônica dos membros inferiores.Os efeitos da associação troxerrutina-cumarina são mais importantes na microcirculação, diminuindo a permeabilidade capilar e reduzindo o edema. Além do território venocapilar, tem atuação também sobre os vasos linfáticos, colaborando da mesma forma para a redução do edema intersticial. Outras ações descritas da associação troxerrutina-cumarina apontam para efeitos hemorreológicos limitando a agregação eritrocitária, assim como efeito antiflogístico diminuindo a inflamação perivascular.Do ponto de vista clínico, as drogas flebotrópicas têm demonstrado sua eficácia na diminuição dos principais sintomas da IVC, sendo, dessa forma, largamente empregadas no tratamento primário ou coadjuvante da IVC. Embora o preciso mecanismo de ação das drogas flebotrópicas ainda não tenha sido completamente elucidado, a larga experiência adquirida com seu uso em quase todo o mundo justifica sua utilização no tratamento clínico da insuficiência venosa crônica dos membros inferiores.

Drug treatment of portal hypertension.

Despite advances in endoscopic management, variceal bleeding is still associated with a significant mortality. In recent years, several therapeutic agents have been shown to lower the portal pressure and reduce variceal bleeding. In patients presenting with acute variceal bleeding, the drug of choice is somatostatin; it is as effective as endoscopic treatment and is virtually free of side-effects. The second-line drug therapy in acute variceal bleeding is a combination of vasopressin and nitroglycerine. Every patient with a history of variceal bleeding is at an increased risk of rebleeding and should receive some form of preventive therapy. In these patients, non-selective beta-blockers and endoscopic treatment are equally effective and either modality can be used. Since each episode of variceal bleeding carries a 30%-50% risk of death, cirrhotics who have never experienced variceal bleeding but are at high risk to develop this complication (high portal pressure, variceal grade III and IV, and presence of red wale markings over the varices) should be identified and treated. Beta-blockers are the treatment of choice and should be continued for the rest of the patient's life. Isosorbide-5-mononitrate is also useful in lowering the portal pressure and may be combined with beta-blockers in those who do not respond to the use of beta-blockers alone. However, isosorbide-5-mononitrate should not be given alone for a long duration because of its adverse haemodynamic effects. Additional measures which are useful in decreasing the risk of variceal bleeding are good control of ascites, especially with spironolactone and a low salt diet, and early recognition and treatment of bacterial infections.

Uso del Adenosin -5- Monofosfato (My-Bden) en el tratamiento de las várices y sus complicaciones / Use of Adenosine -5- Monophosphate (My-Bden) in the treatment of varicoses veins and their complications

Se presentaron 27 casos (100%) de pacientes con patología varicosa sintomática y complicada. Existe mejoría marcada de los síntomas en la mayoría de los pacientes tratados. Fueron tratados 3 casos de Tromboflebitis con mejoría satisfactoria. La respuesta de los pacientes al tratamiento con Acido Adenílico es más satisfactoria que con otros medios terapéuticos, y se recomienda en aquellos pacientes sintomáticos que van a ser objeto de intervención quirúrgica

O tratamento da síndrome varicosa no idoso: resultados obtidos com aminaftona / Treatment of varicose syndrome in the aged: results obtained with aminaphtone

Foram tratados 40 pacientes idosos acometidos por síndrome varicosa crônica com aminaftona, com dose diária de 225 mg, durante 75 dias. No final do tratamento foi evidenciada uma nítida melhora dos vários parâmetros subjetivos e objetivos tomados em consideraçäo, juntamente a uma perfeita tolerância do medicamento

Tratamiento esclerosante de las venas varicosas de miembros inferiores con el uso de polidocanol / Esclerosing treatment of varicose veins in the lonerlimbs with polidocanol

Presentamos nuestra experiencia en 1.500 pacientes a quienes se les hizo tratamiento esclerosante de várices en los miembros inferiores con polidocanol, un agente anestésico con marcada efectividad como esclerosante venoso. Se obtuvieron buenos resultados en el 85% de los pacientes tratados, regulares en 13% y malos en el 2%. En hace un estudio comparativo con datos obtenidos del uso de dos fármacos diferentes, el Morruato de Sodio y el Arilit, usados en nuestro país en forma regular en la terapéutica varicosa