Estudo comparativo da termoablação da veia safena magna na coxa, com e sem tumescência

Abstract

Background: Endovenous laser treatment of saphenous veins offers patients a procedure with low rates of complications and an early return to occupational activities. Objective: To compare rates of formation of bruising, of paresthesia along the path of the great saphenous vein (GSV), and of GSV obliteration 30 days after thermal ablation in the thigh, performed with or without tumescence and using two different types of fiber. Methods: This was a prospective study, analyzing three groups of patients who underwent GSV thermal ablation in the thigh, using a wavelength of 1470 nm. Patients in group 1 were treated with a conventional fiber using tumescence; those in group 2 were treated with a conventional fiber without using tumescence; and patients in group 3 were treated with a double radial fiber without tumescence. After 30 days, the rates of obliteration shown by Doppler ultrasonography, of paresthesias, and of bruising were compared. Results: Comparison of the results of thermal ablation of 90 GSVs in the thigh revealed similar rates of obliteration, with no statistical differences. The rate of paresthesia along the path of the GSV in the thigh was higher in the groups without tumescence than in the group with tumescence, but the difference only attained statistical significance for the comparison with the group that was treated with the conventional fiber. There was bruising in all groups, with greater frequency in group 1 (73.33%). Conclusions: Tumescence proved useful for preventing minor neurological injuries, but didn't have any influence on the rates of bruising occurrence or of occlusion of the GSV in the thigh up to 30 days after thermal ablation.

Uso do laser de 1.470 nm para o tratamento de insuficiência venosa superficial

“…A number of explanations have been proposed for the relationship between tumescence and lower rates of paresthesia. 10 However, this variable could not be evaluated in the present study because the technique was used infrequently (23.3%). Erzinger et al 10 made this comparison and found that 7 days after surgery, paresthesia was significantly less frequent among patients in whom the tumescence technique had been used.…”

“…In this study, there was a high prevalence of complaints of local “dormancy”, which was higher than rates reported in previous studies. 10 , 24 , 28 This may have occurred for a number of reasons: use of ablation in distal segments, not employing tumescence, exeresis of varicose collaterals during the same session, administration of conventional sclerotherapy and/or sclerotherapy with dense foam, and even because there was a specific question on the postoperative control protocol. On the other hand, it was impossible to estimate the duration of this symptom, because the question was only posed once, at the 7-day follow-up.…”

“…The standard intervention to avoid disease progression had been ligature and stripping of the great saphenous vein (GSV) and/or small saphenous vein (SSV) combined with exeresis of varicose veins and ligature of incompetent perforating veins. 10 As treatments have developed, new approaches offering equivalent results and employing less invasive techniques have emerged, including endovenous laser treatment (EVLT), radio frequency, foam sclerotherapy, combined or not with phlebectomy, and liquid sclerotherapy. 10 - 12 …”

“… 10 As treatments have developed, new approaches offering equivalent results and employing less invasive techniques have emerged, including endovenous laser treatment (EVLT), radio frequency, foam sclerotherapy, combined or not with phlebectomy, and liquid sclerotherapy. 10 - 12 …”

“…This technique employs endovenous laser to provoke venous ablation, treating reflux in the territory. 10 , 13 - 16 However, there is endless debate on the effects of different types of fibers, wavelengths, and laser power and also on the linear intravenous energy density (LEED) that should be administered to achieve the best therapeutic results and minimize complications such as pain, ecchymosis, thrombophlebitis, endothermal heat-induced thrombosis (EHIT), and deep venous thrombosis (DVT). Against this background, the present study describes the results of treatment of superficial venous insufficiency with 1,470 nanometer (nm) diode laser.…”