{"id":4800,"date":"2021-05-25T09:00:44","date_gmt":"2021-05-25T09:00:44","guid":{"rendered":"https:\/\/endoscopiaterapeutica.net\/pt\/uncategorized\/downhill-varices\/"},"modified":"2022-05-25T22:15:51","modified_gmt":"2022-05-25T22:15:51","slug":"downhill-varices","status":"publish","type":"post","link":"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/downhill-varices\/","title":{"rendered":"Varizes esof\u00e1gicas descendentes ou downhill varices"},"content":{"rendered":"

Por analogia, entende-se o plexo venoso esof\u00e1gico como uma importante rede de bacias hidrogr\u00e1ficas, que conecta as circula\u00e7\u00f5es portal e sist\u00eamica.<\/span><\/p>\n

A drenagem venosa do es\u00f4fago ocorre predominantemente pelos sistemas \u00e1zigos e hemi\u00e1zigos.<\/span><\/p>\n

Uma obstru\u00e7\u00e3o na veia cava superior (VCS) for\u00e7a o fluxo retr\u00f3grado de sangue para o \u00e1trio direito por meio de canais colaterais para a veia cava inferior (VCI).<\/span><\/p>\n

Se essa obstru\u00e7\u00e3o for acima do n\u00edvel da veia \u00e1zigos, o fluxo sangu\u00edneo de volta para o cora\u00e7\u00e3o ficar\u00e1 confinado \u00e0 parte superior do es\u00f4fago, levando \u00e0 forma\u00e7\u00e3o de varizes no ter\u00e7o superior\/proximal do \u00f3rg\u00e3o (\u201cdownhill varices\u201d).<\/span><\/p>\n

Em contraste, se a obstru\u00e7\u00e3o estiver abaixo ou envolvendo a veia \u00e1zigos, varizes se formar\u00e3o na parte inferior\/distal do es\u00f4fago (\u201cuphill varices\u201d), podendo acometer todo o \u00f3rg\u00e3o, como \u00e9 o caso da hipertens\u00e3o portal que for\u00e7a o fluxo sangu\u00edneo para o sistema da VCI.<\/span><\/p>\n

\"\"<\/a><\/p>\n

A trombose da VCS \u00e9 a etiologia mais comum de varizes esof\u00e1gicas descendentes (\u201cdownhill\u201d), por\u00e9m a obstru\u00e7\u00e3o tamb\u00e9m pode ser causada por hipertens\u00e3o pulmonar grave, tumores da tireoide, doen\u00e7a de Beh\u00e7et, constri\u00e7\u00e3o anormal do m\u00fasculo cricofar\u00edngeo, complica\u00e7\u00f5es com cateteres de hemodi\u00e1lise, fibrose mediastinal e ligadura cir\u00fargica da VCS. Isso contrasta com as varizes ascendentes (\u201cuphill\u201d), que mais comumente causam sangramento e s\u00e3o resultados da hipertens\u00e3o portal.<\/span><\/p>\n

Apesar da malignidade ser descrita como a etiologia subjacente mais comum da obstru\u00e7\u00e3o da VCS, respondendo por at\u00e9 60% dos casos, ela \u00e9 respons\u00e1vel por apenas 14% dos casos de sangramento por \u201cdownhill varices\u201d. As causas mais comuns dessa entidade s\u00e3o as complica\u00e7\u00f5es relacionadas aos cateteres venosos, frequentemente vistas em pacientes com doen\u00e7a renal em est\u00e1gio terminal. Esse achado pode ser atribu\u00eddo \u00e0 les\u00e3o endotelial, fluxo sangu\u00edneo turbulento e tend\u00eancia para trombose, observada em pacientes em hemodi\u00e1lise de longa dura\u00e7\u00e3o.<\/span><\/p>\n

A hemorragia digestiva \u00e9 uma manifesta\u00e7\u00e3o muito rara em pacientes com varizes descendentes. Na verdade, as varizes descendentes representam de 0,4 a 10% das varizes esof\u00e1gicas, por\u00e9m menos de 0,1% do total de pacientes que apresentam hemat\u00eamese<\/a>. Isso pode ser atribu\u00eddo ao fato de que essas varizes est\u00e3o localizadas na submucosa do es\u00f4fago proximal, sendo menos suscet\u00edveis a sangramento do que as varizes ascendentes secund\u00e1rias \u00e0 hipertens\u00e3o portal, que, por sua vez, s\u00e3o mais superficiais (subepiteliais). A diminui\u00e7\u00e3o da exposi\u00e7\u00e3o ao \u00e1cido g\u00e1strico tamb\u00e9m pode contribuir para a menor frequ\u00eancia de sangramento das varizes esof\u00e1gicas proximais.<\/span><\/p>\n

O tratamento definitivo deve ser direcionado para a causa subjacente da obstru\u00e7\u00e3o vascular, porque essa \u00e9 a \u00fanica abordagem que ir\u00e1 curar a s\u00edndrome cl\u00ednica e tamb\u00e9m prevenir sua recorr\u00eancia. Em casos em que h\u00e1 alto risco de procedimento ou baixa probabilidade de corrigir o dist\u00farbio m\u00e9dico subjacente, existem outras abordagens para controlar as varizes descendentes. As op\u00e7\u00f5es endosc\u00f3picas mais comuns incluem <\/span>ligadura el\u00e1stica e escleroterapia<\/span><\/a>. Essas abordagens devem ser realizadas sempre na extremidade proximal da variz, de onde o fluxo sangu\u00edneo \u00e9 fornecido, diferentemente do que os endoscopistas est\u00e3o habituados a fazer nas varizes ascendentes (hipertens\u00e3o portal), quando o tratamento ocorre a partir da extremidade distal. A ligadura el\u00e1stica parece ser mais segura do que a escleroterapia no manejo das varizes do ter\u00e7o proximal do es\u00f4fago (\u201cdownhill varices\u201d).<\/span><\/p>\n

Como citar este artigo<\/h2>\n

Brasil G. Varizes Esof\u00e1gicas Descendentes ou \u201cDownhill Varices\u201d. Endoscopia Terap\u00eautica; 2021. Dispon\u00edvel em: <\/span>https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/downhill-varices<\/span><\/p>\n

Refer\u00eancias Bibliogr\u00e1ficas<\/h2>\n
    \n
  1. Downhill Esophageal Varices: A Prevalent Complication of Superior Vena Cava Obstruction From Benign and Malignant Causes. J Comput Assist Tomogr. Volume 39, Number 2, March\/April 2015<\/li>\n
  2. Downhill esophageal varices: a therapeutic dilemma. Ann Transl Med 2018;6(23):463.<\/li>\n
  3. Therapeutic approach to \u2018\u2018downhill\u2019\u2019 varices bleeding. GASTROINTESTINAL ENDOSCOPY Volume 68, No. 5 : 2008.<\/li>\n
  4. Bleeding \u2018downhill\u2019 esophageal varices associated with benign superior vena cava obstruction: case report and literature review. Loudin et al. BMC Gastroenterology (2016) 16:134<\/li>\n
  5. Variants of Varices: Is It All \u2018\u2018Downhill\u2019\u2019 from Here?\u00a0Digestive Diseases and Sciences<\/a>\u00a0volume\u00a060,\u00a0pages316\u2013319(2015)<\/li>\n<\/ol>\n

    Acesse o <\/span>Endoscopia Terap\u00eautica<\/span><\/a> para tomar contato com mais <\/span>artigos comentados<\/span><\/a>, <\/span>assuntos gerais<\/span><\/a>, <\/span>casos cl\u00ednicos<\/span><\/a>, <\/span>quizzes<\/span><\/a>, <\/span>classifica\u00e7\u00f5es<\/span><\/a> e mais!<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

    Por analogia, entende-se o plexo venoso esof\u00e1gico como uma importante rede de bacias hidrogr\u00e1ficas,…<\/p>\n","protected":false},"author":2079,"featured_media":7725,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[151],"tags":[],"ano":[262],"tipo":[158],"volume":[263],"class_list":["post-4800","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-assuntosgerais","ano-262","tipo-endoscopia-bariatrica","volume-volume-i"],"yoast_head":"\nVarizes esof\u00e1gicas descendentes ou downhill varices • Endoscopia Terapeutica<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/downhill-varices\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Varizes esof\u00e1gicas descendentes ou downhill varices\" \/>\n<meta property=\"og:description\" content=\"Por analogia, entende-se o plexo venoso esof\u00e1gico como uma importante rede de bacias hidrogr\u00e1ficas, que conecta as circula\u00e7\u00f5es portal e sist\u00eamica. 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