Abstract
ResumoContextoA insuficiência venosa crônica (IVCr) é frequente e predomina nas mulheres, mas ainda há poucas informações sobre o refluxo nas veias safenas na população masculina.ObjetivosIdentificar os diferentes padrões de refluxo nas veias safenas magnas (VSMs) e parvas (VSPs) em homens, correlacionando esses dados com a apresentação clínica conforme a classificação Clínica, Etiológica, Anatômica e Fisiopatológica (CEAP).MétodosForam avaliados 369 membros inferiores de 207 homens pela ultrassonografia vascular (UV) com diagnóstico clínico de IVCr primária. As variáveis analisadas foram a classificação CEAP, o padrão de refluxo nas VSMs e VSPs e a correlação entre os dois.ResultadosNos 369 membros avaliados, 72,9% das VSMs apresentaram refluxo com predominância do padrão segmentar (33,8%). Nas VSPs, 16% dos membros inferiores analisados apresentaram refluxo, sendo o mais frequente o padrão distal (33,9%). Dos membros classificados como C4, C5 e C6, 100% apresentaram refluxo na VSM com predominância do refluxo proximal (25,64%), e 38,46% apresentaram refluxo na VSP com equivalência entre os padrões distal e proximal (33,3%). Refluxo na junção safeno-femoral (JSF) foi detectado em 7,1% dos membros nas classes C0 e C1, 35,6% nas classes C2 e C3, e 64,1% nas classes C4 a C6.ConclusõesO padrão de refluxo segmentar é predominante na VSM, e o padrão de refluxo distal é predominante na VSP. A ocorrência de refluxo na JSF é maior em pacientes com IVCr mais avançada.
Highlights
Chronic venous insufficiency (CVI) is a very common condition in the young and middle-aged population, primarily in women, and its prevalence increases progressively with age.[1]According to the Edinburgh study, telangiectasias and reticular veins affect up to 85% of women, while one third of the population of both sexes aged 18 to 64 years have varicose veins.[2]Maffei et al assessed 1,755 adults over the age of 15 years (443 men and 1,312 women) and demonstrated a 47.6% prevalence of varicose veins: 37.9% in men and 50.9% in women.[3]In the lower limbs (LL), CVI manifests with pain, edema, varicose veins, eczema, hyperpigmentation, athrophie blanche, lipodermatosclerosis, and ulcers resulting from venous hypertension caused by reflux in superficial, perforating and/or deep veins
Patients were examined with vascular ultrasound (VU) while standing upright and at the same time a clinical assessment was made of each LL, which were classified using the CEAP
With regard to the male population with CVI, there is scant literature identifying reflux patterns in saphenous veins and their correlations with different phases of the disease. This study investigated this population using quantitative analysis of reflux types based on patterns defined by Engelhorn et al.,[9] and analyzed their correlations with the clinical manifestations of CVI
Summary
Chronic venous insufficiency (CVI) is a very common condition in the young and middle-aged population, primarily in women, and its prevalence increases progressively with age.[1]According to the Edinburgh study, telangiectasias and reticular veins affect up to 85% of women, while one third of the population of both sexes aged 18 to 64 years have varicose veins.[2]Maffei et al assessed 1,755 adults over the age of 15 years (443 men and 1,312 women) and demonstrated a 47.6% prevalence of varicose veins: 37.9% in men and 50.9% in women.[3]In the lower limbs (LL), CVI manifests with pain, edema, varicose veins, eczema, hyperpigmentation, athrophie blanche, lipodermatosclerosis, and ulcers resulting from venous hypertension caused by reflux in superficial, perforating and/or deep veins. According to the CEAP classification, CVI clinical status is graded as follows: C0 – no visible or palpable signs of venous disease; C1 – telangiectasias and reticular veins; C2 – varicose veins; C3 –edema; C4a – pigmentation or eczema; C4b – lipodermatosclerosis or athrophie blanche; C5 – healed venous ulcer; or C6 – active venous ulcer.[7]. Objective: To identify different patterns of reflux in the great and small saphenous veins of men and correlate them with clinical presentation graded according to the Clinical-Etiology-Anatomy-Pathophysiology (CEAP) classification. Results: A total of 369 limbs were evaluated and in 72.9% of them the great saphenous vein (GSV) had reflux, predominantly the segmental pattern (33.8%), while in 16% of the lower limbs analyzed the small saphenous vein (SSV) had reflux, among which the most frequent pattern was distal (33.9%).
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