Clinical results of deep venous valvular repair for chronic venous insufficiency.

OBJECTIVE

To evaluate the results of venous valvular repair in the treatment of 16 cases of chronic venous insufficiency (CVI).

DESIGN

A retrospective analysis of 16 venous valve repair operations (15 patients) with a minimum follow-up of 2 years.

SETTING

A 650-bed university-affiliated teaching hospital.

PATIENTS

Fifteen consecutive referred patients who had CVI had deep vein valve surgery. All cases were refractory to prolonged conservative care and removal of incompetent superficial and perforating veins. Investigation included ascending and descending venography, air plethysmography (APG) and colour flow duplex scanning (CFDS). All patients had class 4, 5 or 6 CVI and all demonstrated deep venous reflux from the groin to below the knee on descending venography.

INTERVENTIONS

Superficial femoral vein valvuloplasty (12 operations) and venous valve transfer from the axillary vein to the above-knee popliteal vein (4 operations).

MAIN OUTCOME MEASURES

Healing of ulcers, relief of edema and improvement in symptoms were clinical criteria of success. An attempt was made to correlate preoperative and postoperative APG, CFDS and descending venography.

RESULTS

Ninety-two percent of the valvuloplasty patients and 75% of the valve transfer patients were clinically improved. In this series no statistical association existed between preoperative and postoperative changes noted on APG.

CONCLUSION

This series suggests that deep vein valvular reconstruction for CVI refractory to conservative management and superficial surgery offers a good chance of clinical improvement.