de Oliveira Alexandre Faraco, de Oliveira Horácio
Universidade do Planalto Catarinense - UNIPLAC, Lages, SC, Brasil.
Clínica Ana Carolina, Lages, SC, Brasil.
J Vasc Bras. 2017 Oct-Dec;16(4):270-275. doi: 10.1590/1677-5449.008217.
Ulcers are the end result of varicose veins associated with reflux in saphenous veins.
To demonstrate the possibility of combining two procedures, foam sclerotherapy of saphenous veins and skin grafting, to treat patients with venous ulcers related to reflux in saphenous vein.
20 limbs were treated in 20 patients. All patients had ulcers related to saphenous vein reflux. We performed the grafting with expanded skin, followed by administration of ultrasound guided polidocanol foam sclerotherapy in veins associated with ulcers, accessed by puncture or dissection of the vein.
In all cases there was improvement of ulcer-related symptoms and healing of the lesion. In 11 cases we achieved full skin grafting viability. In four cases there was healing of about 50% of the lesion and in the other five cases approximately 75% of the lesion healed. The first control ultrasonographic examination revealed complete sclerosis of the vessels treated in 19 of 20 cases, with partial sclerosis in one case, but no detectable reflux. The second ultrasonographic examination performed at 45 days showed complete sclerosis in 15 cases. In five cases there was partial sclerosis, without detectable reflux in three and with reflux in isolated segments associated with varicose veins in two. The most common complication was pigmentation along vein paths, observed in 13 patients. In one case there was asymptomatic thrombosis of muscle veins of the leg.
This combination of procedures is a valid option, with the potential to provide quicker and less expensive treatment.
溃疡是与隐静脉反流相关的静脉曲张的最终结果。
证明将两种手术方法——隐静脉泡沫硬化疗法和皮肤移植相结合，用于治疗与隐静脉反流相关的静脉性溃疡患者的可能性。
对20例患者的20条肢体进行治疗。所有患者均患有与隐静脉反流相关的溃疡。我们先进行扩张皮肤移植，然后对与溃疡相关的静脉进行超声引导下聚多卡醇泡沫硬化疗法，通过穿刺或静脉解剖来进入相关静脉。
所有病例中，溃疡相关症状均有改善，病变愈合。11例实现了移植皮肤完全存活。4例约50%的病变愈合，另外5例约75%的病变愈合。首次超声检查显示，20例中有19例治疗的血管完全硬化，1例部分硬化，但未检测到反流。45天时进行的第二次超声检查显示，15例完全硬化。5例部分硬化，3例未检测到反流，2例在与静脉曲张相关的孤立节段有反流。最常见的并发症是沿静脉路径的色素沉着，13例患者出现该情况。1例患者出现小腿肌肉静脉无症状血栓形成。
这种联合手术是一种有效的选择，有可能提供更快且成本更低的治疗。
