Ensaio Clínico Randomizado sobre os efeitos da Compressão Elástica Prolongada no tratamento da Insuficiência Venosa Periférica por Ecoescleroterapia com espuma em pacientes com obesidade

Abstract

Chronic venous disease (CVD) of the lower extremities is a high prevalence disease in general population and is associated with great morbidity. Patients with body overweigh are more likely to present themselves with more severally symptoms and are challenging for conventional surgical treatment. The advent of ultrasound guided foam sclerotherapy (UGFS)has broaden the possibility of treatment for these patients However, the hemodynamic peculiarities of these patients may influence the effectiveness of foam sclerotherapy, being necessary to evaluate the properties of treatment and long -term compression in this group. Objective: This study aims to evaluate the effects of long term compression in UFGS therapeutic response, the specificities of the technique, as well as the occurence of adverse effects in obese patients.Method: In this clinical trial, the lower limbs were allocated according to body mass index (BMI) between obese and non-obese groups and then randomly allocated to use or notelastic compression after insufficient venous treatment and submitted to one or two sessions of ultrasound guided sclerotherapy. The evaluations were performed after 3 weeks, 3 and 6 months considering as primary outcome the occlusion of the treated venous segment and as secondary outcome the absence of blood reflux in the segment. Results:186 lower’s limbs were treated: 97 of patients with BMI<30 and 89 for obese patients. In the comparison of baseline characteristics there were significant differences in abdominal circumference and distribution of clinical severity of peripheral venous insufficiency between groups. A total of 261 foam echosclerotherapy, of which 168 were first interventions and 93 reinterventions, were performed throughout the sample .The number of sessions was higher among obese patients (p<0.001). In the evaluation of the primary outcome, patients without obesity presented higher rates of venous segment occlusion, which were significant for the great saphenous vein throughout the follow-up (p<0.001). For the secondary outcome, there were no statistically different differences between the groups. Long-term elastic compression did not interfere with primary or secondary UGFS outcomes, however it was associated with a significantly greater decrease in venous diameters (p<0.001). Conclusion: Foam echosclerotherapy is an effective alternative in the treatment of peripheral venous insufficiency in obese patients. However, a greater number of sessions should be provided for them. There was no interference of elastic compression in the therapeutic response. In addition, the elastic compression seems to be associated to a significant reduction of venous diameters over time