Orientador: Hamilton Almeida Rollo / Banca: Luciana Patrícia Fernandes Abbade / Banca: Amélia Cristina Seidel / Banca: Regina Moura / Banca: Domingos de Morais Filho / Resumo: A doença venosa crônica (DVC) é uma doença comum com conseqüênciassócio-econômicas importantes. O refluxo é uma das principais causas da OVC. Detectar e quantificar o refluxo são medidas importantes no diagnóstico de insuficiênciavenosa crônica. A avaliação quantitativa da DVC pode ser realizada por meiode métodos invasivos e não invasivos. Os métodos não invasivos, quantitativos, 810: fotopletismografia (FPG), pletismografia a ar e o mapeamento dúplex. O MO, rão-ouro, permite a detecção e quantificação acurada do refluxo em veias individuais, pela medida da duração do refluxo ou tempo de fechamento da válvula, além de proporcionar informações anatõmicas e funcionais relevantes para direcionar o tratamento de veias varicosas. Nos pacientes com varizes primárias dos membros -'inferioresa veia safena magna (VSM) é freqüentemente acometida, especialmente por refluxo na junção safeno-femoral (JSF), por insuficiência da válvula ostial. A avaliaçãoda VSM é importante porque a sua preservação traz vantagens, pois a mesmatem sido utilizada como substituto arterial em doenças degenerativas, como a doença arterial obstrutiva crônica dos membros inferiores, na revascularização miocárdica e nos traumas vasculares de extremidades. Estudos já publicados mostraram que o MO permite avaliar as alterações morfológicas e funcionais da V5M e quantificá-las, porém dúvidas permaneceram em relação... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The chronic venous disease (CVD) is a common disease with socio-economic consequences. Reflux is one of the main causes of CVD. Detecting and quantifying the reflux are important steps in the diagnosis of chronic venous insufficiency. The quantitative evaluation of CVD may be performed by means of invasive and non-invasive methods. Non-invasive quantitative methods are: photoplethysmography (FPG), air plethysmography and duplex scan. The DS, gold standard, allows the detection and quantification accurate measurement of the vein reflux individual, by the measure of length of reflux or time of valve closure, in addition to providing functional and relevant anatomical information to guide the treatment of varicose veins. In patients with primary varicose veins of the lower limbs the great saphenous vein (GSV) is frequently affected, especially by reflux in the saphenofemoral junction (SFJ), because of the failure of the ostial valve. The evaluation of the GSV is important because its preservation brings advantages so that it has been used as a replacing arterial in degenerative diseases such as chronic obstructive arterial disease of the lower limbs, in myocardial revascularization and in vascular trauma of the extremities. Studies already published showed that the DS makes it possible to evaluate the morphological and functional alterations of the GSV and quantifies them, but doubts remained in relation to the value of these parameters... (Complete abstract click electronic access below) / Doutor

Venous valves (VVs) are critical for unidirectional blood flow from superficial and deep veins towards the heart. Congenital valve aplasia or agenesis may, in some cases, be a direct cause of vascular disease, motivating an understanding of the molecular mechanisms underlying the development and maintenance of VVs. Three gap junction proteins (Connexins), Cx37, Cx43, and Cx47, are specifically expressed at VVs in a highly polarized fashion. VVs are absent from adult mice lacking Cx37; however it is not known if Cx37 is required for the initial formation of valves. In addition, the requirement of Cx43 and Cx47 for VV development has not been studied. Here, we provide a detailed description of Cx37, Cx43, and Cx47 expression during mouse vein development and show by gene knockout that each Cx is necessary for normal valve development. The valve phenotypes in the knockout lines exhibit Cx-specific differences, however, including whether peripheral or central VVs are affected by gene inactivation. In addition, we show that a Cx47 null mutation impairs peripheral VV development but does not affect lymphatic valve formation, a finding of significance for understanding how some CX47 mutations cause inherited lymphedema in humans. Finally, we demonstrate a striking segregation of Foxc2 and NFATc1 transcription factor expression between the downstream and upstream faces, respectively, of developing VV leaflets and show that this segregation is closely associated with the highly polarized expression of Cx37, Cx43, and Cx47. The partition of Foxc2 and NFATc1 expression at VV leaflets makes it unlikely that these factors directly cooperate during the leaflet elongation stage of VV development. (C) 2016 Elsevier Inc. All rights reserved.

Made available in DSpace on 2014-06-11T19:32:44Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-05-27Bitstream added on 2014-06-13T20:43:50Z : No. of bitstreams: 1 morbio_ap_dr_botfm.pdf: 1097182 bytes, checksum: 705735f82a7cae684e088a9cf6ac3b54 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Universidade Estadual Paulista (UNESP) / A doença venosa crônica (DVC) é uma doença comum com conseqüênciassócio-econômicas importantes. O refluxo é uma das principais causas da OVC. Detectar e quantificar o refluxo são medidas importantes no diagnóstico de insuficiênciavenosa crônica. A avaliação quantitativa da DVC pode ser realizada por meiode métodos invasivos e não invasivos. Os métodos não invasivos, quantitativos, 810: fotopletismografia (FPG), pletismografia a ar e o mapeamento dúplex. O MO, rão-ouro, permite a detecção e quantificação acurada do refluxo em veias individuais, pela medida da duração do refluxo ou tempo de fechamento da válvula, além de proporcionar informações anatõmicas e funcionais relevantes para direcionar o tratamento de veias varicosas. Nos pacientes com varizes primárias dos membros -'inferioresa veia safena magna (VSM) é freqüentemente acometida, especialmente por refluxo na junção safeno-femoral (JSF), por insuficiência da válvula ostial. A avaliaçãoda VSM é importante porque a sua preservação traz vantagens, pois a mesmatem sido utilizada como substituto arterial em doenças degenerativas, como a doença arterial obstrutiva crônica dos membros inferiores, na revascularização miocárdica e nos traumas vasculares de extremidades. Estudos já publicados mostraram que o MO permite avaliar as alterações morfológicas e funcionais da V5M e quantificá-las, porém dúvidas permaneceram em relação... / The chronic venous disease (CVD) is a common disease with socio-economic consequences. Reflux is one of the main causes of CVD. Detecting and quantifying the reflux are important steps in the diagnosis of chronic venous insufficiency. The quantitative evaluation of CVD may be performed by means of invasive and non-invasive methods. Non-invasive quantitative methods are: photoplethysmography (FPG), air plethysmography and duplex scan. The DS, gold standard, allows the detection and quantification accurate measurement of the vein reflux individual, by the measure of length of reflux or time of valve closure, in addition to providing functional and relevant anatomical information to guide the treatment of varicose veins. In patients with primary varicose veins of the lower limbs the great saphenous vein (GSV) is frequently affected, especially by reflux in the saphenofemoral junction (SFJ), because of the failure of the ostial valve. The evaluation of the GSV is important because its preservation brings advantages so that it has been used as a replacing arterial in degenerative diseases such as chronic obstructive arterial disease of the lower limbs, in myocardial revascularization and in vascular trauma of the extremities. Studies already published showed that the DS makes it possible to evaluate the morphological and functional alterations of the GSV and quantifies them, but doubts remained in relation to the value of these parameters... (Complete abstract click electronic access below)

Introduction: Venous disease impairs the quality of life, necessitates time off work and causes venous ulcers. The focus of this thesis is to explore strategies to prevent chronic venous insufficiency (CVI) and venous ulceration. Aims 1. To identify a population at risk of developing venous ulcers 2. To study the pressure profile required by elastic stockings to halve transit venous time 3. To explore the role of compression following ankle fracture Methods: Data was collected from 231 patients with venous ulcers and age and sex matched 210 controls to identify risk factors for venous ulceration. Univariate and multivariate analysis of potential risk factors was undertaken to identify those that independently predict this risk. After identifying the population at risk, prophylactic strategies were developed. The effect of Engineered Compression Stockings (ECS) delivering 15mmHg, 25mmHg and 35mmHg pressure at the ankle on the calf venous transit time and volume was measured to determine the ideal pressure profile required to halve transit venous time, which should be appropriate for DVT prophylaxis. A dorsal foot vein was cannulated in 15 healthy volunteers with no venous disease. The transit time (secs) for ultrasound contrast from a foot vein to the popliteal vein was measured using duplex ultrasound. Calf volumes were recorded by water displacement. ECS delivering 25mmHg of pressure around the ankle were compared with no compression in a randomized controlled trial (RCT) in 90 patients within 72 hours of ankle fracture. Patients were randomised to either i) ECS and air-cast boot or ii) a liner and air-cast boot and were followed at 2, 4, 8, 12 weeks and 6 months. The primary outcome was functional recovery measured using the Olerud Molander Ankle Score (OMAS). Secondary outcomes were i) The American Orthopaedic Foot and Ankle Score (AOFAS), ii) SF12v2 Quality of Life score (QoL), iii) pain, and iv) frequency of DVT. Results The risk factors significantly associated with venous ulceration on multivariate analysis included a history of Deep Vein Thrombosis (DVT), phlebitis, hip replacement, poor mobility, weight/kg>100Kg, varicose veins (VV), family history of VV and weight (kg) between 75-100kg. A simple diagnostic scoring system was derived from this regression analysis with scores of . 3 predicting a 6.7% annual risk and of < 1 a 0.6% risk. Mean transit time without compression was 35, 32 and 33 secs while standing, sitting and lying. Transit time was consistently halved by ECS delivering 25mmHg to 14, 13 and 14 secs respectively (p<0.001). Mean leg volume whilst standing was reduced significantly from 3447ml with no ECS to 3259ml, 3161ml and 3067ml with ECS applying 15, 25 and 35mmHg respectively (p<0.001). ECS in ankle fracture patients reduced ankle swelling at all time points and significantly improved mean OMAS score at six months to 98 compared with 67 for the liner (p<0.001). AOFAS and SF12v2 scores were also significantly improved (p<0.001, p= 0.016). Of 86 patients with duplex imaging at four weeks, only five (12%) of the 43 ECS patients had a DVT compared with 10 (23%) of the 43 controls (p= 0.26). Conclusions: The risk score for venous ulcers will allow us to undertake RCTs on the prevention of leg ulceration. The pressure profile required to halve transit venous time is 25mmHg. The frequency of asymptomatic DVT following ankle fracture is sufficient to justify prophylaxis. Compression has a potential role in the management of ankle fractures by improving functional outcome and QoL. These studies facilitate research into the prevention of venous disease.

Abstract The purpose of the present research was (I-II) to evaluate the effects of clinical, hand-held Doppler (HHD) and duplex ultrasonographic examinations on the planning of operative procedure for primary varicose veins, (III) to assess the feasibility, safety and efficacy of endovenous saphenous vein obliteration with radiofrequency-resistive heating and (IV) to compare endovenous saphenous vein obliteration with conventional stripping operation in terms of short-term recovery and costs. Sixty-two legs (in 49 consecutive patients) and 142 legs (in 111 consecutive patients) with primary uncomplicated varicose veins were examined clinically and with HHD and duplex ultrasonography for planning the subsequent treatment. At the saphenous-femoral junction (SFJ) and at the saphenous-popliteal junction (SPJ), sensitivity was 56-64% and 23%, specificity 93-97% and 96%, positive predictive value 97-98% and 43% and negative predictive value 44-45% and 91%, respectively. In 9% of the cases, the treatment plan was modified on the basis of the duplex ultrasound findings. The present study showed that, in primary uncomplicated varicose veins, the accuracy of HHD is unsatisfactory. Thirty legs of 27 patients with varicose veins were treated using an endovenous catheter (Closure® System, VNUS Medical Technologies, Inc., Sunnyvale, CA), which was inserted under ultrasound guidance via a percutaneous puncture or a skin incision. The persistence of vein occlusion and complications potentially attributable to the endovenous treatment were assessed at 1-week, 6-week, 3-month, 6-month and 1-year follow-up visits. By the time of the last follow-up visit, occlusion of the treated segment of the LSV had been achieved in 22 (73.3%) legs. Persisting patency or recanalization of LSV was detected in 8 legs (26.7%). Postoperative complications included saphenous nerve paresthesia in 3 legs (10%) and thermal skin injury in one limb (3.3%). Twenty-eight selected patients admitted for operative treatment of varicose veins in the tributaries of the primary long saphenous were randomly assigned to endovenous obliteration (n = 15) or stripping operation (n = 13). The patients were followed up for 7-8 weeks postoperatively and examined by duplex ultrasonography. The comparison of costs included both direct medical costs and costs due to lost of productivity. All operations were successful, and the complication rates were similar in the two groups. The sick leaves were significantly shorter in the endovenous obliteration group [6.5 (SD 3.3) vs. 15.6 (SD 6.0), 95 % CI 5.4 to 12.9, p &lt; 0.001, t-test]. When the value of the lost working days was included, the endovenous obliteration was societally cost-saving.

Résumé : Le rôle du réseau veineux est central dans la fonction cardiovasculaire, pourtant, au regard de la littérature scientifique, il apparaît comme le« parent pauvre » comparé au cœur ou au réseau artériel. Ce constat vaut aussi bien pour la compréhension de l'hémodynamique veineuse que pour l'analyse physiopathologique de la maladie veineuse chronique en général et plus particulièrement lorsque le lien est fait avec la situation d'exercice. Nos différentes investigations avaient pour buts d'une part de mieux comprendre les adaptations du système veineux lors de l'activité physique et lors de la phase de récupération post-exercice et d'autre physiopathologiques de l'hyper pression veineuse sur la microcirculation chez le sujet atteint d'une pathologie veineuse. Ils ont également apporté une meilleure compréhension de la phase de récupération post-exercice et des effets bénéfiques des méthodes de récupération sur la performance et sur les adaptations vasculaires. L'interdépendance entre les différents secteurs (cœur, artères, microcirculation, veines) du système cardiovasculaire est un élément essentiel mis en évidence dans nos différents travaux. Ainsi, nous avons démontré que l'hémodynamique veineuse ne pouvait être analysée de manière isolée, mais au contraire part d'évaluer l'impact de la maladie veineuse chronique sur l'activité physique et réciproquement. Pour cela nous avons étudié les effets aigus de l'activité physique sur le fonctionnement de l'hémodynamique veineuse (évaluation de la pompe veineuse surale), et les effets de différentes méthodes de récupération (compression, immersion, électro stimulation neuro musculaire). Par ailleurs nous avons exploré les conséquences de la pathologie veineuse sur la réalisation d'une activité physique à travers l'analyse de la claudication veineuse. Les principaux résultats de nos travaux ont permis de mieux appréhender les adaptations de l'hémodynamique veineuse liées à l'exercice chez le sujet sain d'une part et de mieux comprendre les conséquences qu'elle devait être évaluée dans sa globalité, en mesurant les implications sur le remplissage cardiaque en aval et sur les échanges au niveau tissulaire en amont, et en recherchant la part du réseau splanchnique et celle du réseau des membres aux propriétés bien différentes sur le retour veineux systémique. En conclusion, nous avons comblé une partie des lacunes de la littérature en permettant une meilleure appréhension des relations veines, exercice physique, récupération et pathologie veineuse. Cependant, des interrogations persistent concernant la méthodologie à mettre en place pour l'évaluation du réseau veineux et les effets chroniques de la pratique intensive d'une activité physique sur la maladie veineuse chronique. / The role of the venous system is central to cardiovascular fonction, yet, in terms of scientific literature, it appears to be the "poor relation" compared to the heart or arterial system. This is true both for the physiological understanding of venous hemodynamics and for the pathophysiological analysis of chronic venous disease and more particularly when the link is made with exercise. The aim of our investigations was to better understand the adaptations of the venous system during physical activity and during the post-exercise recovery period and, to evaluate the impact of chronic venous disease on physical activity and vice versa. We have studied the acute effects of physical activity on venous hemodynamics (evaluation of the calf venous pump), and the effects of various recovery methods ( compression, immersion, calf low frequency electrical stimulation), and we have also explored the consequences of chronic venous disease upon physical activity through the analysis of venous claudication. The main results of our work enabled a better understanding of the adjustments in venous hemodynamics linked to exercise in healthy subjects and to better understand the pathophysiological consequences of high venous pressure on the microcirculation of patients with chronic venous disease. Our findings also provide a detailed understanding of venous hemodynamics during post-exercise recovery and the positive effects of recovery methods on both performance and vascular adjustments. The interdependence of the different organs and tissues (heart, arteries, microcirculation, veins) of the cardiovascular system is an essential element highlighted in this work. Thus, we demonstrated that venous hemodynamics could not be analyzed in isolation, but rather that it should be assessed as a whole by measuring implications on cardiac filling and on tissue exchange, and looking for the part of the splanchnic system and limbs system on systemic venous return. ln conclusion, we have filled some of the gaps in the literature by examining the relationships between veins, physical exercise, recovery and venous pathology. However, questions remain regarding the methodology to be implemented for the evaluation of the venous system and the chronic effects of the intensive physical activity practice on the chronic venous disease prevalence

Made available in DSpace on 2014-12-17T15:16:20Z (GMT). No. of bitstreams: 1 DiegoNA_DISSERT.pdf: 3427521 bytes, checksum: 8cca32583d3549111fe36c75cda96e2e (MD5) Previous issue date: 2014-02-04 / Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico / Venous wounds cause physical, psychological and financial problems that impact the quality of life of patients. Treatment alternatives are investigated in order to reduce healthcare costs and improve quality of life of people affected by this problem. Physical resources, such as therapeutic ultrasound (US), are being considered in the treatment of ulcers as a potential healing agent. This study aimed to investigate the application of US as a treatment for venous ulcers. Subjects were divided into two groups: US group, where treatment consisted of 5 sessions of pulsed US (3 MHz, 1W/cm?) associated with compression and kinesiotherapy; and sham group, where individuals went through the same procedures, but with sham US therapy. Subjects were evaluated for wound size by planimetry and digital photography, visual analogue scale for pain, quality of life by the questionnaires SF- 36 and VEINES-QoL/Sym and enzymatic activity of metalloproteinases 2 and 9 by zymography. It was observed mean reduction in wound area of 41.58?53.8% for the US group and 63.47?37.2% for the placebo group, maintenance of quality of life scores in the US group and significant improvement (p<0.05) in the placebo group by VEINES questionnaire. It was observed decreased perception of pain in the placebo group. Sample feasibility for analysis of the protein activity of metalloproteinases 2 and 9 by zymography collected by swab method was also confirmed. Our data did not give us evidence to support the theory that the US accelerates healing of venous ulcers in a short-term analysis. However, we observed that standard care associated with compression therapy and kinesiotherapy were able to significantly shorten the progression of chronic venous ulcers / As ?lceras cut?neas de origem venosa causam problemas f?sicos, psicol?gicos e financeiros que impactam a qualidade de vida dos pacientes. Alternativas de tratamento s?o investigadas no intuito de reduzir gastos com a sa?de e melhorar a qualidade de vida das pessoas acometidas com esse problema. Recursos f?sicos como o ultrassom (US) terap?utico vem sendo considerados no tratamento de ?lceras como potencial agente cicatrizador. O objetivo desse estudo foi investigar a aplica??o de US como terap?utica para a ?lcera venosa. Indiv?duos foram divididos em dois grupos: grupo US, onde o tratamento consistia de 5 sess?es de aplica??o de US pulsado (3 MHz, 1W/cm?) associadas ? terapia compressiva e cinesioterapia; e grupo placebo, onde os indiv?duos passavam pelos mesmos procedimentos, por?m com US placebo. Foram avaliados quanto ao tamanho do ferimento por planimetria e fotografia digital, dor por escala visual anal?gica, qualidade de vida pelos question?rios SF-36 e VEINES-QoL/Sym e atividade enzim?tica de metaloproteinases 2 e 9 por meio de zimografia. Foi observada redu??o m?dia da ?rea da ferida 41,58%?53,8 para o grupo US e 63,47%?37,2 para o grupo placebo, manuten??o dos escores de qualidade de vida no grupo US e melhora significativa (p<0,05) no grupo Placebo pelo question?rio VEINES. Observou-se diminui??o da percep??o de dor no grupo placebo. Confirmou-se viabilidade de amostra para an?lise da atividade proteica de metaloproteinases 2 e 9 por zimografia coletada por m?todo de swab. Diante dos dados, n?o obtivemos evid?ncias suficientes para suportar a teoria que o US acelera a cicatriza??o de ?lceras venosas em curto prazo. No entanto, pudemos observar que o tratamento padr?o associado ? terapia compressiva e ? cinesioterapia foram capazes de abreviar significativamente a progress?o das ?lceras venosas cr?nicas

Chronic venous disease (CVD) affects about 0.5 to 3.0% of the population. The venous ulcer (UV) is the most advanced stage of CVD and affects the patient-age, worsening their quality of life and burdens the welfare system. Venous reflux is related to the genesis, development and maintenance of UV. To evaluate venous reflux in patients with UV. A cross-sectional study was performed, observational Vascular Surgery Service at the Federal University of Sergipe - Aracaju-SE, in a sample of 162 patients with active UV divided into two groups for evaluation of reflux: G1 (primary etiology) and G2 ( etiopathogenesis secondary) seen consecutively in the period of 03 / 2009-10 / 2010. Five patients were excluded because they had chronic ischemia, because they have two non-recanalized vein thrombosis and one for being pregnant. We investigated the age, gender, distribution of venous reflux in the superficial venous system (SVS), the deep venous system (DVS) and perforating veins (PVs), location of reflux in the SVS, types of reflux in the saphenous vein (GSV ) and saphenous vein (VSP) and distribution of reflux in the DVS. Statistical method: the database and statistical analysis were performed using the SPSS 18.0. Quantitative variables were summarized as mean and standard deviation. Categorical variables were described by simple frequency and percentages with their respective confidence intervals for 95%. The mean age was 53.7 years with a predominance of women (79%). The distribution of reflux was observed that all patients in G1 had reflux in the SVS without reflux in the DVS, VPs with 92% in G2 and 83.3% had reflux in the SVS, with 100% DVS and 92.3% in the VPs. Regarding the location of reflux in the SVS group G1 showed reflux in 96% in GSV and 14% VSP and G2 showed reflux in GSV 70% and 13% in VSP. Considering the types of saphenous vein reflux in G1 90% of the type I had reflux in the GSV and 71.5% type IV in VSP in G2 while 84% of reflux in the GSV type I and type IV 85.7% in VSP. In Group G2 approximately 70% of patients had reflux in these veins of the legs and 54% in the popliteal veins. The superficial system reflux was present in all patients with primary venous insufficiency and in most patients with secondary failure. The finding most often found in the superficial venous system was the GSV reflux. The reflux in the GSV type I and type IV reflux in VSP findings were more often found in the superficial venous system of patients in both groups. Approximately 70% of deep venous reflux was located in the leg, the popliteal vein being the most frequently affected. / A doença venosa crônica (DVC) atinge cerca de 0,5 a 3,0% da população. A úlcera venosa (UV) é o estágio mais avançado da DVC e atinge o paciente em idade produtiva, piora a sua qualidade de vida e onera o sistema previdenciário. O refluxo venoso está relacionado com a gênese, desenvolvimento e manutenção da UV. Avaliar o refluxo venoso nos portadores de UV. Realizado estudo de corte transversal, observacional no Serviço de Cirurgia Vascular da Universidade Federal de Sergipe - Aracaju SE, em amostra de 162 pacientes com UV em atividade dividida em dois grupos para avaliação do refluxo: G1 (etiopatogenia primária) e G2 (etiopatogenia secundária) atendidos consecutivamente no período de 03/ 2009 a 10/ 2010. Foram excluídos cinco pacientes por apresentarem isquemia crônica, dois por apresentarem trombose venosa não recanalizada e um por estar gestante. Foram pesquisadas as variáveis idade, gênero, distribuição do refluxo venoso no sistema venoso superficial (SVS), no sistema venoso profundo (SVP) e em veias perfurantes (VPs); localização do refluxo no SVS; tipos de refluxo na veia safena magna (VSM) e em veia safena parva (VSP) e distribuição do refluxo no SVP. Método estatístico: o banco de dados e a análise estatística foram efetuados no programa SPSS 18.0. As variáveis quantitativas foram sumarizadas como média e desvio-padrão. As variáveis categóricas foram descritas mediante frequência simples e porcentagens com seus respectivos intervalos de confiança para 95%. A idade média foi de 53,7 anos com predomínio de mulheres (79%). Quanto a distribuição do refluxo observou-se que no G1 todos pacientes apresentaram refluxo no SVS, sem refluxo no SVP, com 92% em VPs e no grupo G2 83,3% tinham refluxo no SVS, com 100% no SVP e 92,3% VPs. Em relação a localização do refluxo no SVS do grupo G1 96% apresentaram refluxo em VSM e 14% em VSP e do G2 70% apresentaram refluxo em VSM e 13% em VSP. Considerando os tipos de refluxo em veias safenas no G1 90% apresentaram refluxo do tipo I em VSM e 71,5% do tipo IV em VSP enquanto que no G2 84% de refluxo do tipo I em VSM e 85,7% do tipo IV em VSP. No Grupo G2 aproximadamente 70% dos pacientes apresentaram refluxo em veias de pernas e destes 54% em veias poplíteas. O refluxo no sistema superficial esteve presente em todos os pacientes com insuficiência venosa primária e na maioria dos pacientes com insuficiência secundária. O achado mais frequentemente encontrado no SVS foi o refluxo VSM. O refluxo tipo I em VSM, bem como o refluxo tipo IV em VSP foram os achados mais frequentemente encontrados no SVS de pacientes dos dois grupos. Aproximadamente 70% do refluxo venoso profundo estava localizado na perna, sendo a veia poplítea a mais frequentemente acometida.