Avaliação do coto residual após 12 meses de safenectomia sem ligadura alta da junção safeno-femoral
Assessment of residual stumps 12 months after saphenectomy without high ligation of the saphenofemoral junction
Giovanna Golin Guarinello; Francisco Eduardo Coral; Jorge Rufino Ribas Timi; Sarah Folly Machado
Resumo
Palavras-chave
Abstract
Background: Currently, the first-choice option recommended for varicose vein surgery is thermal ablation of the saphenous vein, but this procedure is not available on the Brazilian National Health Service (SUS - Sistema Único de Saúde). In an effort to improve results, surgical techniques have been developed to mimic the new technologies, without their high costs. The most prominent such method involves conventional saphenectomy, without ligation of tributaries. Objectives: To assess progression of the residual stump after saphenectomy without high ligation of the saphenofemoral junction but with stump invagination and to assess the behavior of anterior/posterior accessory veins. Methods: Prospective intervention study. A total of 52 limbs were treated with saphenectomy without high ligation of the saphenofemoral junction followed by invagination of the residual stump. Patients were assessed preoperatively and at 7 days, and 3, 6, and 12 months postoperatively using vascular ultrasonography with Doppler to analyze the length of the residual stump, the diameters of the residual stump and the anterior/posterior accessory vein, reflux in the accessory vein, and presence of neovascularization. Statistical analysis involved calculation of means, standard deviations, medians, minimum and maximum values, frequencies, and percentages, and Fisher’s test and the binomial test. Results: There was evidence of a significant time effect on residual stump diameter (p < 0.001) and length (p = 0.002), but the same was not observed with relation to diameter (p = 0.355) or reflux of the anterior accessory vein. Neovascularization was found in 7 (14.3%) limbs. Conclusions: After use of the technique described, the residual stump retracted, its diameter reduced over the 1 year postoperative period, and it did not transfer reflux to the accessory vein. Neovascularization rates were in line with the literature.
Keywords
References
1 Porciunculla MM, Leiderman DBD, Altenfeder R, et al. Clinical, ultrasonographic and histological findings in varicose vein surgery. Rev Assoc Med Bras. 2018;64(8):729-35. PMid:30673044.
2 Oliveira RÁ, Mazzucca A, Pachito D, Riera R, Baptista-Silva J. Evidence for varicose vein treatment : an overview of systematic reviews. Sao Paulo Med J. 2018;136(4):324-32.
3 Rocha F, Lins E, Almeida C, et al. Quality of life assessment before and after surgery for lower limb varicose veins. J Vasc Bras. 2020;19:1-7.
4 Maffei FH, Magaldi C, Pinho SZ, et al. Varicose veins and chronic venous insufficiency in Brazil: prevalence among 1755 inhabitants of a country town. Int J Epidemiol. 1986;15(2):210-7.
5 Biemans A, Kockaert M, Akkersdijk G, et al. Comparing endovenous laser ablation, foam sclerotherapy, and conventional surgery for great saphenous varicose veins. J Vasc Surg. 2013;58(3):727-34.e1.
6 Kemp N. A synopsis of current international guidelines and new modalities for the treatment of varicose veins. Aust Fam Physician. 2017;46(4):229-33. PMid:28376578.
7 Wittens C, Davies A, Baekgaard N, et al. Editor’s Choice – Management of chronic venous disease: clinical practice guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2015;49(6):678-737.
8 Argyriou C, Papasideris C, Antoniou GA, et al. The effectiveness of various interventions versus standard stripping in patients with varicose veins in terms of quality of life. Phlebology. 2018;33(7):439-50. PMid:28720052.
9 Heim D, Negri M, Schlegel U, De Maeseneer M. Resecting the great saphenous stump with endothelial inversion decreases neither neovascularization nor thigh varicosity recurrence. J Vasc Surg. 2008;47(5):1028-32.
10 Theivacumar NS, Darwood R, Gough M. Neovascularisation and recurrence 2 years after varicose vein treatment for sapheno-femoral and great saphenous vein reflux: a comparison of surgery and endovenous laser ablation. Eur J Vasc Endovasc Surg. 2009;38(2):203-7.
11 Cappelli M, Molino-Lova R, Giangrandi I, Ermini S, Gianesini S. Ligation of the saphenofemoral junction tributaries as risk factor for groin recurrence. J Vasc Surg Venous Lymphat Disord. 2018;6(2):224-9.
12 Anwar MA, Idrees M, Aswini M, Theivacumar N. Fate of the tributaries of sapheno femoral junction following endovenous thermal ablation of incompetent axial vein – A review article. Phlebology. 2019;34(3):151-5.
13 Pittaluga P, Chastanet S, Guex J. Great saphenous vein stripping with preservation of sapheno-femoral confluence: hemodynamic and clinical results. J Vasc Surg. 2008;47(6):1300-4, discussion 1304-5.
14 Casoni P, Lefebvre-Vilardebo M, Villa F, Corona P. Great saphenous vein surgery without high ligation of the saphenofemoral junction. J Vasc Surg. 2013;58(1):173-8.
15 Brasil. Ministério da Saúde. Banco de dados do Sistema Único de Saúde-DATASUS. Brasília: Ministério da Saúde; 2021 [citado 2021 fev 27]. Disponível em:
16 Lynch P, Clarke M, Fulton G. Surgical management of great saphenous vein varicose veins: a meta-analysis. Vascular. 2015;23(3):285-96.
17 Casana R, Tolva V, Odero A Jr, Malloggi C, Parati G. Three-year follow-up and quality of life of endovenous radiofrequency ablation of the great saphenous vein with the ClosureFastTM procedure: influence of BMI and CEAP class. Vascular. 2018;26(5):498-508.
18 Wallace T, El-Sheikha J, Nandhra S, et al. Long-term outcomes of endovenous laser ablation and conventional surgery for great saphenous varicose veins. Br J Surg. 2018;105(13):1759-67.
19 Hassanin A, Aherne T, Greene G, et al. A systematic review and meta-analysis of comparative studies comparing nonthermal versus thermal endovenous ablation in superficial venous incompetence. J Vasc Surg Venous Lymphat Disord. 2019;7(6):902-913.e3.
20 Sincos IR, Baptista APW, Coelho F No, et al. Prospective randomized trial comparing radiofrequency ablation and complete saphenous vein stripping in patients with mild to moderate chronic venous disease with a 3-year follow-up. Einstein (Sao Paulo). 2019;17(2):eAO4526.
21 Brittenden J, Cooper D, Dimitrova M, et al. Five-year outcomes of a randomized trial of treatments for varicose veins. N Engl J Med. 2019;381(10):912-22.
22 Toniolo J, Chiang N, Munteanu D, Russell A, Hao H, Chuen J. Vein diameter is a predictive factor for recanalization in treatment with ultrasound-guided foam sclerotherapy. J Vasc Surg Venous Lymphat Disord. 2018;6(6):707-16.
23 Boros MJ, O’Brien S, McLaren J, Collins J. High ligation of the saphenofemoral junction in endovenous obliteration of varicose veins. Vasc Endovascular Surg. 2008;42(3):235-8.
24 Cirocchi R, Henry B, Rambotti M, et al. Systematic review and meta-analysis of the anatomic variants of the saphenofemoral junction. J Vasc Surg Venous Lymphat Disord. 2019;7(1):128-138.e7.
25 Stücker M, Moritz R, Altmeyer P, Reich-Schupke S. New concept: different types of insufficiency of the saphenofemoral junction identified by duplex as a chance for a more differentiated therapy of the great saphenous vein. Phlebology. 2013;28(5):268-74.
26 De Maeseneer M, Pichot O, Cavezzi A, et al. Duplex ultrasound investigation of the veins of the lower limbs after treatment for varicose veins - UIP consensus document. Eur J Vasc Endovasc Surg. 2011;42(1):89-102.
27 Recek C. Significance of reflux abolition at the saphenofemoral junction in connection with stripping and ablative methods. Int J Angiol. 2015;24(4):249-61. PMid:26648666.
Submitted date:
02/27/2021
Accepted date:
05/02/2021
Facebook
Google+
Twitter
LinkedIn
Mendeley
StumbleUpon
CiteULike
Reddit
Email