Maleti Oscar, Lugli Marzia
Department of Cardiovascular Surgery, Hesperia Hospital, Modena, Italy.
J Vasc Surg. 2006 Apr;43(4):794-9. doi: 10.1016/j.jvs.2005.12.053.
The purpose of this study was to evaluate a new neovalve construction technique in postthrombotic syndrome. The surgical procedure is described, and preliminary results of the first case series are given.
From December 2000 to June 2004, neovalve construction in 18 limbs was performed on 16 patients (8 male and 8 female; median age, 55.5 years; range, 34-79 years) to treat severe chronic venous insufficiency in cases of postthrombotic syndrome. Surgical treatment was recommended in cases of nonhealing or recurrent ulcers (CEAP classification class C6). Preoperative duplex scanning, ascending/descending venography, and air plethysmography were routinely performed. Valvular cusps were created by dissecting the thickened venous wall to obtain material with which to fashion a new monocuspid or bicuspid valve. Mean follow-up was 22 months (range, 1-42 months). Postoperative duplex scanning and air plethysmography were performed in all patients. Descending venography was performed after surgery in 15 limbs.
In 16 lower extremities (89%), the ulcer healed within 4 to 25 weeks (median, 12 weeks), and no recurrences occurred. Neovalve competence was confirmed in 17 cases (95%). Postoperative duplex scan and air plethysmography showed a significant improvement in hemodynamic parameters (P < .001), especially in younger patients with good muscle pump function. In 17 limbs (95%), the treated segments remained primarily patent at median follow-up of 22 months. Early thrombosis below the neovalve site occurred in two patients (12%). No perioperative pulmonary embolism was observed. A late occlusion occurred in one patient (6%), 8 months after surgery. Minor postoperative complications occurred in three patients (17%).
Neovalve construction seems to be effective in restoring femoral competence in postthrombotic reflux. Although these preliminary results are encouraging, long-term follow-up and a larger series are required to validate the technique.
本研究旨在评估一种用于血栓形成后综合征的新型人工瓣膜构建技术。描述了手术过程，并给出了首个病例系列的初步结果。
2000年12月至2004年6月，对16例患者（8例男性，8例女性；中位年龄55.5岁；范围34 - 79岁）的18条肢体进行了人工瓣膜构建，以治疗血栓形成后综合征导致的严重慢性静脉功能不全。对于不愈合或复发性溃疡（CEAP分类C6级）的病例建议进行手术治疗。常规进行术前双功超声扫描、上行/下行静脉造影和空气体积描记法。通过解剖增厚的静脉壁获取材料来制作新的单尖瓣或二尖瓣瓣膜。平均随访时间为22个月（范围1 - 42个月）。所有患者均进行了术后双功超声扫描和空气体积描记法。15条肢体术后进行了下行静脉造影。
16条下肢（89%）的溃疡在4至25周内愈合（中位时间12周），且无复发。17例（95%）人工瓣膜功能得到证实。术后双功超声扫描和空气体积描记法显示血流动力学参数有显著改善（P <.001），尤其是在肌肉泵功能良好的年轻患者中。17条肢体（95%）在中位随访22个月时，治疗节段基本保持通畅。两名患者（12%）在人工瓣膜部位下方发生早期血栓形成。未观察到围手术期肺栓塞。一名患者（6%）在术后8个月发生晚期闭塞。三名患者（17%）出现轻微术后并发症。
人工瓣膜构建似乎对恢复血栓形成后反流中的股静脉功能有效。尽管这些初步结果令人鼓舞，但仍需要长期随访和更大规模的病例系列来验证该技术。
