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Efeitos colaterais em escleroterapia com espuma da Safena Magna e Parva

A escleroterapia das veias safenas é um procedimento que precisa ser bem avaliado por aqueles especialistas que se dispoem a aplicá-lo em seus pacientes. A técnica de esleroterapia com espuma já se revelou uma ótima solução para o tratamento das varizes e das microvarizes. Não é uma técnica nova como parecem mostrar algumas páginas da internet e principalmente alguns programas de televisão. Entretanto, a sua aplicação nas veias safenas vem apresentando uma série de efeitos colaterais que precisam ser seriamente levados em consideração.
Na medida do possível disponibilizarei neste blog publicações concernentes ao tema.
Abaixo um resumo de um controle prospectivo multicêntrico publicado em 01 de junho de 2009 na revista PHLEBOLOGY, envolvendo 1025 pacientes de 20 clínicas de flebologia na França.
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Side-effects and complications of foam sclerotherapy of the great and small saphenous veins: a controlled multicentre prospective study including 1025 patients
J-L Gillet * , J M Guedes , J-J Guex , C Hamel-Desnos , M Schadeck **, M Lauseker and F A Allaert
* 51 bis Avenue Professeur Tixier, 38300 Bourgoin-Jallieu, France; 31 rue Amiral Gourbeyre, 63200 Riom, France; 32 boulevard Dubouchage, 06000 Nice, France; 18 rue des Rocquemonts, 14050 Caen, France; ** 5 rue Michel Charles, 75012 Paris, France; 7 B rue de l’Hopital, 67600 Selestat, France; Chaire d’Evaluation Médicale Ceren ESC & Cenbiotech/dim CHU du Bocage, 21000 Dijon, France

Correspondence: J-L Gillet MD, Vascular Medicine – Phlebology, 51 bis Avenue Professeur Tixier, 38300 Bourgoin-Jallieu, France. Email: gilletjeanluc@aol.com

Objectives: Increasing interest in foam sclerotherapy (FS) for saphenous insufficiency has highlighted the need to study the side-effects and complications of this treatment. The aim of this study is to better assess their nature and incidence.

Methods: A multicentre, prospective and controlled study was carried out in which patients treated with FS for great (GSV) and small saphenous veins (SSV) trunk incompetence were included. Immediate untoward events were reported. Duplex ultrasound (DUS) examination was carried out to assess all patients between the eighth and 30th day. In addition, 20% of patients were called by an external auditor.

Results: In total, 818 GSV and 207 SSV were treated in 1025 patients in 20 phlebology clinics. Ninety-nine percent of patients were controlled with DUS and non-duplex-checked patients were all called. The saphenous trunk was occluded in 90.3% of patients. Twenty-seven (2.6%) side-effects were reported: migraine (n = 8, 4 with visual disturbance); visual disturbance alone (n = 7); chest pressure alone (n = 7); and chest pressure associated with visual disturbance (n = 5). Eleven thrombo-embolic events occurred: 10 deep vein thrombosis (DVT) but only five in symptomatic patients, and one pulmonary embolism that occurred 19 days following the FS without DVT identified by DUS. One transient ischaemic stroke, with complete clinical recovery in 30 minutes, and one septicaemia with satisfactory outcome were reported as well.

Conclusion: This study demonstrates in a large sample of patients a low rate of adverse reactions after FS of great and small saphenous trunks. However, but the eventuality of exceptional but more serious complications has to be taken into account in the management of patients. A multicentre study like this one takes into account different practices and reports all possible complications, thus demonstrating the need for a common validated protocol.

Key Words: foam sclerotherapy • venous insufficiency • side-effect • complication

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