Surgical reconstruction for deep venous insufficiency.

All patients with significant venous stasis disease should undergo noninvasive evaluation to determine the magnitude, precise location, and etiology of the problem (i.e. obstruction and/or reflux). Patients who fail aggressive medical therapy (compression and skin care) and who have significant symptoms should be considered candidates for surgical correction. The majority of patients screened will have a significant component of superficial venous insufficiency with or without the presence of incompetent perforating veins. In this case we address the superficial and perforating venous systems prior to consideration of deep venous reconstruction. When correction of superficial venous incompetence fails to improve the patient's symptoms, they are then considered for deep venous reconstruction. Patients with primary venous insufficiency are typically good candidates for direct valvuloplasty performed using the open or angioscopic techniques, while patients with damaged (post thrombotic) or absent valves are best managed by vein valve transplantation or segmental transposition. Results for both valvuloplasty and vein valve transplantation demonstrate good intermediate term valvular patency and ulcer healing. It appears that when used as part of a complete treatment protocol addressing superficial, deep, and perforating venous systems, as well as attention to skin care and appropriate compressive therapy that surgical reconstruction for deep venous reflux affords significant benefit to our patients.