ABSTRACT
BACKGROUND: Conventional saphenous vein stripping is difficult to be indicated for the treatment of varicose veins in patients classified as CEAP C4, C5, or C6. OBJECTIVE: This study was developed to evaluate treatment results for varicose veins with active ulcers using endovenous laser (EVL), compared to a group undergoing clinical treatment, during 1 year. PATIENTS AND METHOD: Fifty-two patients presenting with varicose veins with active ulcers for more than 1 year were divided for treatment into two randomized groups: Group 1, clinical treatment, composed of 25 subjects, was submitted to elastic or inelastic compression therapy; Group 2, EVL treatment, composed of 27 subjects, was submitted to great and or small saphenous vein ablation with a 980-nm diode EVL, plus the clinical treatment. Intravenous and perivenous temperatures were measured continuously during the EVL treatment. All patients were followed for 12 months and studied with ultrasound at the beginning and end of the study. The ulcers' areas were evaluated initially and at every 3 months. RESULTS: In 12 months, 81.5% of the wounds in patients in Group 2 and only 24% in patients in Group 1 had healed. Ulcer recurrence rate was 44.4% in Group 1. The mean wound area in Group 1 decreased from 17.48 to 12.76 cm(2) at the end of the year. In Group 2, the wound area decreased from 22.26 to 2.7 cm(2) (p=.0037). Mean intravenous and perivenous temperatures of 79.3 and 43.0 degrees C were recorded. CONCLUSION: The treatment for varicose veins with EVL is safe in patients with active ulcers. Wounds healed faster than in patients undergoing clinical treatment alone during a 1-year period. There was no ulcer recurrence in patients treated with EVL.
Subject(s)
Leg Ulcer/surgery , Saphenous Vein/surgery , Varicose Veins/surgery , Female , Humans , Laser Coagulation/methods , Leg Ulcer/complications , Leg Ulcer/pathology , Male , Middle Aged , Severity of Illness Index , Skin Temperature , Treatment Outcome , Varicose Veins/complications , Varicose Veins/pathology , Wound HealingABSTRACT
It is common belief that the use of high-heeled shoes is deleterious to venous return, by impairing the efficiency of the muscular calf pump. Ambulatory venous pressure obtained with dorsal foot venipuncture is the gold standard in the evaluation of venous pressure during walking, but it is not routinely used in clinical practice. The objective of the present study was to determine the variations in leg venous pressure obtained with a new noninvasive method, in individuals without venous disease, walking without shoes and wearing high-heeled shoes. A new method of evaluation of the venous pressure by means of air plethysmography was applied to 10 volunteers (20 limbs). The patients were evaluated while standing, with orthostatic flexion and extension foot movements, and while walking on a treadmill barefooted and wearing high-heeled shoes. It was found that the variation on the cuff pressure during walking with high-heeled shoes was higher than the variation on the cuff pressure walking barefooted (52.2 +/- 8.89 X 26.65 +/- 6.7 mm Hg, p < 0.0001), and the final hydrostatic venous pressure was lower (51.5 +/- 12.78 X 61.5 +/- 8.44 mm Hg). The use of high-heeled shoes increases muscular effort during walking and diminishes the leg venous pressure compared with barefooted.
Subject(s)
Leg/blood supply , Shoes , Venous Pressure , Walking/physiology , Adult , Blood Pressure Determination , Female , Humans , Middle Aged , Muscle Contraction , Muscle, Skeletal/physiology , Plethysmography/methodsABSTRACT
OBJETIVO: Avaliar os resultados da terapêutica endovenosa com laser no tratamento de varizes primárias. PACIENTES E MÉTODO: No período compreendido entre julho de 2001 e setembro de 2004 (39 meses), 253 pacientes (417 membros) foram tratados ambulatorialmente com laser de diodo de 810 e 980-nm, com energia liberada endovenosamente através de fibra óptica introduzida por punção guiada por eco-Doppler. Foi utilizada anestesia por infiltração intumescente perivasal com solução de lidocaína a 0,2 por cento (50-150 ml). A potência e duração do pulso foram determinadas pelo diâmetro da veia. Os controles foram realizados com eco-Doppler aos 7 dias, 1 mês, 3 meses, 6 meses, 1 ano e, a seguir, anualmente, para avaliar a eficácia do tratamento e os efeitos adversos. RESULTADOS: A oclusão primária da veia safena magna foi obtida em 405 dos 417 membros (97,1 por cento) tratados. Houve reintervenção em 12 casos (2,9 por cento), com sucesso. O tempo médio de observação foi de 18 meses, e, nesse período, a taxa de recidiva global de varizes foi de 7,4 por cento, sendo 6,3 por cento (26 membros) veias colaterais tributárias da crossa e 1,2 por cento (cinco membros) com recanalização da safena magna. Todas as recorrências ocorreram entre o terceiro e o 12° mês. Os efeitos indesejáveis mais freqüentes foram: equimoses (60,6 por cento); dor suportável durante o procedimento (16,1 por cento); hematomas (5,5 por cento); flebite em colaterais não-tratadas (3,4 por cento); hiperpigmentação (2,9 por cento); e parestesia transitória (3,4 por cento). Nenhum caso de tromboflebite da safena magna foi observado. Não houve nenhum caso de trombose venosa profunda ou embolia pulmonar. CONCLUSÃO: O tratamento endovenoso de varizes com laser, conforme descrito, foi eficaz para ocluir a safena magna e seus principais ramos, com efeitos adversos autolimitados e com recorrência inferior a 8 por cento no período de seguimento.
OBJETIVE: To evaluate results of endovenous laser treatment for primary varicose veins. PATIENTS AND METHOD: From July 2001 to September 2004 (39 months), 253 outpatients (417 limbs) were treated with 810 and 980 nm diode laser energy delivered percutaneously using optical fiber introduced by puncture under ultrasound guidance. Tumescent anesthesia (50-150 ml of 0.2 percent lidocaine) was delivered perivenously. Power and duration of the pulse were determined by vein diameter. Duplex control was performed at 7 days, 1 month, 3 months, 6 months, 1 year and yearly thereafter to assess treatment efficacy and adverse effects. RESULTS: Primary great saphenous vein occlusion was obtained in 405 of 417 members (97.1 percent). Twelve recurrent cases (2.9 percent) were successfully treated. Mean follow-up time was 18 months. During this period, global recurrence rate of varicose veins was 7.4 percent; 6.3 percent (26 limbs) related to tributary and collateral veins of the saphenofemoral junction, and 1.2 percent (five limbs) with great saphenous vein recanalization. All recurrences occurred between 3 and 12 months. Ecchymosis was the most common adverse effect (60.6 percent). Other complications were: moderate pain during the procedure (16.1 percent); hematoma (5.5 percent), superficial phlebitis of varicose tributaries (3.4 percent), hyperpigmentation (2.9 percent), transient paresthesia (3.4 percent). There were no cases of great saphenous vein thrombophlebitis, deep vein thrombosis or pulmonary emboli. CONCLUSION: Varicose vein treatment with endovenous laser technique was successful in occluding great saphenous vein and its branches, with self-limited adverse effects and recurrence rate lower than 8 percent in the follow-up period.
Subject(s)
Humans , Male , Female , Adult , Laser Therapy/methods , Laser Therapy , Varicose Veins/surgery , Varicose Veins/complicationsABSTRACT
Objetivo: Estabelecer a utilidade da medida indireta da pressão venosa periférica (PVP) na avaliação de pacientes com esclerose sistêmica (ES). comparando com uma população controle normal. Métodos: Estudo prospectivo avaliando 18 pacientes esclerodérmicas do sexo feminino (sendo oito delas com úlcera cutânea isquêmica) submetidas à medida indireta da PVP (por pletismografia). Os dados foram comparados a um grupo controle normal de 18 mulheres hígidas, pareadas para idade. Resultados: Os níveis de pressão arterial foram semelhantes nos dois grupos. Os valores de PVP estavam significativamente diminuídos nos pacientes com ES (58.9 + ou - 11.6 mmHg no grupo ES e 96.9 + ou - 7.1 mmHg no grupo controle; p < 0.0001); no grupo com ES, os pacientes com úlceras cutâneas isquêmicas apresentaram níveis de PVP significativamente diminuídos comparando-se com os pacientes com ES sem úlceras (50.6 + ou - 10.8 mmHg no grupo com úlceras e 65.5 + ou - 7.2 mmHg no grupo sem úlceras; p = 0.006). Conclusões: Pode-se inferir que a diminuição nos níveis de PVP na Es parece estar associada a uma diminuição do fluxo sangüíneo, predispondo ao aparecimento de úlceras isquêmicas nestes pacientes.
Subject(s)
Humans , Female , Scleroderma, Systemic , Skin Ulcer , Venous PressureABSTRACT
Descrevem-se dois casos de pacientes com aneurisma venoso da veia jugular, que foram objeto de estudo anátomo-patológico e flebográfico. Uma revisäo da escassa literatura sobre o assunto é apresentada. O quadro clínico, diagnóstico e etiologia säo discutidos. Alerta-se para o fato desta entidade ser mais freqüente que os raros relatos na literatura
Subject(s)
Middle Aged , Humans , Female , Aneurysm/diagnosis , Jugular Veins , Aneurysm/pathology , PhlebographyABSTRACT
Os autores apresentam caso de paciente com fístula para prótese entérica, com comunicaçäo entre prótese de dacron aorto-femoral superficial pelo foramen obturdor e duodeno, diagnosticada através de injeçäo de contraste ao redor da prótese infectada. Säo discutidos aspectos relativos ao diagnóstico, quadro clínico, patogenia, prevençäo e tratamento
