[First experience in forming a multi-flap valve of the common femoral vein in avalvulation of the deep veins of lower extremities].

From 2008 to 2009, we operated on a total often 40-to-54-year-old patients (eight women and two men). In four cases, avalvulation of the deep veins was congenital (primary) and in the remaining six instances, it was secondary to postthrombotic lesions of the valves with complete recanalization and pronounced vertical reflux along the deep veins. The distribution of the patients according to the CEAP classification was as followed: two patients were found to have grade C4b, seven patients were diagnosed with grade C5 and one patient suffered grade C6. All patients were subjected ultrasonographic duplex scanning. Four patients required additional procedures following aortic repair. Retrograde phlebography performed in all the patients revealed that all had grade 4 pathological reflux according to R. Kistner's classification. Nine patients had a history of previously performed interventions on the superficial and perforating veins. The operation was indicated in severe forms of chronic venous insufficiency and failure of conventional methods of surgical and conservative treatment. The formation of a multi-flap valve of the common femoral vein was carried out according to an original technique suggested by J. C. Opie (2008). Clinical improvement (i.e., pain syndrome relief, decreased oedemas, lowered degree of trophic disorders in crural soft tissue, permanent healing of trophic ulcers) was observed in eight (80%) patients. According to the VCSS scale, we registered a significant decrease in intensity of manifestations of chronic venous insufficiency along all parameters. The integrated index decreased from 7.53 +/- 0.54 to 4.33 +/- 0.42 (chi2 = 4.67; p < 0.01). The malleolar volume decreased from 271.1 +/- 4.7 to 231.5 +/- 5.7 mm (chi2 = 7.17; P < 0.001). Pathological reflux of blood was corrected in all patients within the follow-up terms amounting to 8 months. No thrombotic complications were observed.