O impacto do tratamento com espuma densa eco-guiada na insuficiência venosa crônica

Abstract

The present doctoral thesis comprises three studies addressing different aspects of the treatment of great saphenous vein (GSV) insufficiency and chronic venous disease (CVD), contributing to a thorough understanding of these conditions and providing valuable insights for therapeutic practices with echo-guided foam sclerotherapy. The first study, “Combined Ambulatory Intervention for Large Great Saphenous Vein”, investigated the feasibility of combined ambulatory intervention in patients with large GSV diameters, including those with open ulcers. Results suggested that this approach is safe, effective, and feasible, leading to improvements in the patients' quality of life up to the third year of follow-up. The second study, “Echo-Guided Foam Sclerotherapy for Pain Management in Chronic Venous Disease” highlighted the effectiveness of echo-guided foam sclerotherapy in managing pain in patients with CVD and GSV insufficiency. This approach proved valuable in various stages of CVD, providing an alternative when endothermal ablation is not possible. Furthermore, clinical improvement did not exclusively correlate with axial vein occlusion patterns, emphasizing the importance of factors such as gender, age, and clinical classification in the outcome. The last study, “Polidocanol Foam Concentrations in the Great Saphenous Vein (GSV)”, investigated the efficacy of polidocanol foam concentrations (POL) at 1%, 2%, and 3% in GSV insufficiency treatment. While all concentrations demonstrated efficacy in improving venous pain scores (Visual Analog Scale) and clinical severity (Venous Clinical Severity Score), the 1% POL was associated with a higher number of sessions and suggested a trend toward more frequent pigmentation, especially in larger GSV. Collectively, these studies underscore the importance of personalized treatment for GSV insufficiency and CVD. The combined ambulatory technique proved to be a safe and effective option, even in symptomatic patients with large GSV diameters, emphasizing the relevance of treating axial disease with varicosities despite unfavorable anatomical conditions. This integrated approach can yield clinically significant and enduring results, paving the way for more efficient and individualized therapeutic practices.