Estudio descriptivo del manejo de la insuficiencia venosa crónica entre niveles asistenciales / Descriptive study of management of chronic venous insufficiency between levels of care

INTRODUCCIÓN: La coordinación entre niveles asistenciales constituye un elemento esencial para incrementar la eficiencia del sistema sanitario; en este sentido, la enfermedad vascular ocupa un lugar destacado por incluir entidades frecuentes, graves y vulnerables. Debido a la alta prevalencia de la enfermedad, hay actualmente un número desproporcionado de pacientes, que son derivados desde Atención Primaria (AP) a Especializada (AE), con el diagnóstico de sospecha de insuficiencia venosa crónica de miembros inferiores y que realmente no se confirma este diagnóstico. Lo cual lleva a colapsar las consultas de AE, retrasar el diagnóstico, pérdidas de días laborables y todas las repercusiones sanitarias, sociales y económicas. OBJETIVO: El objetivo de este estudio es valorar la realidad de esta patología en el distrito sanitario Huelva Costa. PACIENTES Y MÉTODOS: Para ello realizamos estudio descriptivo de los pacientes pertenecientes a esta área que acuden a médico de AP para consultar sobre patología venosa. Igualmente realizamos estudio descriptivo mediante encuestas, para conocer el grado de conocimiento sobre dicha patología del médico de AP, así como sobre la necesidad de realización de cursos de formación continuada, o bien, analizar si estos cursos transmiten las competencias necesarias a los profesionales para realizar una buena práctica diaria frente a esta entidad clínica. RESULTADOS: Los primeros datos obtenidos muestran que solo se deriva desde AP con acierto en un 42,4% de los casos. Existe una asociación estadísticamente significativa entre la certeza diagnóstica y síntomas como la cercanía a fuente de calor, antecedentes familiares de varices (AFV), pesadez de piernas, venas gruesas en MMII, hinchazón de piernas al final del día y el sexo femenino. CONCLUSIONES: Parece inadecuado el elevado número de paciente derivados desde la AP a la AE bajo la sospecha de IVC en los que no se confirma el diagnóstico

INTRODUCTION: The coordination between levels of care is an essential element to increase the efficiency of the health system. Vascular diseases, in particular would benefit from this due to its frequency, severity and vulnerability. Owing to the high prevalence of the disease, there is currently a disproportionate number of patients being referred from Primary Care (AP) to Specialist Units (AE), with a suspected diagnosis of chronic venous insufficiency of the lower limbs (IVC MMII) without really having this diagnosis confirmed. This leads to collapse in AE consultations, diagnostic delay, lost workdays, as well as all the public health, social and economic repercussions. OBJECTIVE: The aim of this study is to assess the reality of this disease in the Huelva Costa Health District. PATIENTS AND METHODS: A descriptive study was conducted on a population of Huelva Coast Area Health seen by a Primary Care doctor to consult on lower limb venous pathology. The study also included a questionnaire to determine the level of knowledge about this disease of the Primary Care physician, as well as the need for conducting continuing education courses and analyse whether these courses provide professionals with the necessary skills for a good daily practice against this clinical condition. RESULTS: The first data obtained show that only 42.4% of cases referred from Primary Care had a correct diagnosis. There is a statistically significant association between diagnostic accuracy and risk factors/symptoms, such as nearby heat source, a family history of varicose veins, heavy legs, thick veins in the lower limbs, swelling of the legs at the end of the day, and being female. CONCLUSION: There appears to be an inappropriately high number of patients referred from Primary Care to Specialists due to suspicion of IVC, in which the diagnosis is not confirmed

Crosectomía alta sin sección vascular frente a safenectomía clásica. Ensayo clínico aleatorizado: análisis de la recidiva varicosa / High crossectomy without vascular sectioning vs classic saphenectomy. Randomized clinical trial: analysis of recurrent varicose

Fundamento. El presente estudio fue diseñado con el propósito de definir un nuevo procedimiento quirúrgico para la cirugía de las varices y compararlo con estudios de crosectomía clásica en términos de reducir la tasa derecidiva varicosa. Material y métodos. El estudio presentado es un ensayo clínico aleatorizado, doble ciego. Para facilitar el acceso se seleccionaron 150 pacientes que acudieron a consulta Unidad de Flebología, que facilitaron su consentimiento cumpliendo los criterios de inclusión. Se hicieron dos grupos: Grupo 1: safenectomía clásica (CS); 75 pacientes. Grupo 2 : crosectomía alta sin sección vascular (HCWVS) . En ambos grupos el seguimiento se realizó a los 12 y 24 meses por estudio eco- Doppler. Resultados. La incidencia de recidiva varicosa a los 12meses de seguimiento fue de 69,3 % en el grupo de pacientes sometidos a safenectomía clásica, mientras que en el grupo que recibió HCWVS fue 29,3 % (p < 0,0001).Estas diferencias, aunque menores, siguen siendo estadísticamente significativa a los 24 meses de evolución (76 % vs 48 %, p = 0,0004). El tipo más común de recurrencia es del tipo I, con diferencias estadísticamente significativas a los 12 y 24 meses. Conclusiones. La crosectomía alta sin sección vascular tiene una probabilidad global de recurrencia significativamente menor que la safenectomía clásica a los 12 meses (29,3 % frente a 69,3 % ) , que sigue siendo , aunque más pequeña , estadísticamente significativa a los dos años de evolución ( 48 % vs 76 % ) . La tasa de recurrencia del tipo reticular es significativamente menor en el grupo de pacientes sometidos a alta crosectomía sin sección vascular que en los sometidos a safenectomía clásica (AU)

Background. This study was designed with the purpose of defining a new surgical procedure for varicose veins surgery and to be compared with classic crossectomy interms of reducing varicose recurrence rate. Material and methods. Double-blind randomized clinical trial. For easy access, we selected 150 patients who came to Phlebology Unit Consultation, meeting the criteria for inclusion in the study with their informed consent, to be included in a study group using random table numbers table numbers. Group 1: (CS) Saphenectomy classic 75 patients. Group 2: (HCWVS) High crossectomy without vascular sectioning. In both groups the monitoring was conducted at 12 and 24 months by Eco-Doppler study. Results. The incidence of varicose recurrence at 12months follow up was 69.3% in the group of patients undergoing CS, while in the group receiving HCWVS was29.3% (p <0.0001). These differences, though minor, remain statistically significant at 24 months of evolution (76% vs. 48%, p = 0.0004). The most common type of recurrence is the type I with statistically significant differences at 12 and 24 months. Conclusions. High crossectomy without vascular section has a global recurrence probability significantly lower than with classic saphenectomy at 12 months (29.3% vs. 69.3%), which remains, though smaller, statistically significant at two years of evolution (48% vs.76%). The recurrence reticular type rate is significantly lower in the group of patients undergoing high crossectomy without vascular section compared to those undergoing saphenectomy with classic crossectomy (AU)

High crossectomy without vascular sectioning vs classic saphenectomy. Randomized clinical trial: analysis of recurrent varicose veins.

BACKGROUND: This study was designed with the aim of defining a new surgical procedure for varicose veins and for comparison with classic crossectomy in terms of reducing the recurrence rate of varicose veins. MATERIAL AND METHODS: Double-blind randomized clinical trial. For easy access, we selected 150 patients who came to the Phlebology Consultation Unit meeting inclusion criteria. With their informed consent, they were included in a study group using random table numbers. Group 1: (CS) Classic saphenectomy, 75 patients. Group 2: (HCWVS) High crossectomy without vascular sectioning. Both groups were monitorised at 12 and 24 months by Eco-Doppler study. RESULTS: The incidence of varicose vein recurrence at 12 month follow-up was 69.3% in the group of patients undergoing CS, while in the group receiving HCWVS it was 29.3% (p <0.0001). These differences, though minor, remained statistically significant at 24 months of evolution (76% vs. 48%, p = 0.0004). The most common recurrence type was type I, with statistically significant differences at 12 and 24 months. CONCLUSIONS: We believe that saphenectomy with crossectomy without vascular sectioning is the appropriate procedure to treat varicose veins, reducing type 1 or reticular relapse rate and maintaining the principles of classic surgery to reduce type 2 or truncular recurrence rate. This technique should be implemented with procedures based on saphenous sclerosis with foam art the saphenous femoral junction, in order to assess the recurrence rate of type 2 or truncular varicose veins.