DURABILITY OF VENOUS VALVE RECONSTRUCTION TECHNIQUES FOR PRIMARY AND POSTTHROMBOTIC REFLUX

Purpose: The durability of the variety of valve reconstruction techniq ues in ''primary'' reflux and postthrombotic reflux was studied. Metho ds: A total of 423 valve repairs in 235 patients with a follow-up peri od ranging from 1 to 12 years were analyzed. End points for assessment consisted of ulcer recurrence and Doppler competence in serial duplex examination. Multivariate analysis with Cox proportional hazards mode l was used. Results: Ulcer-free survival curves were similar for ''pri mary'' and postthrombotic reflux. No significant difference in ulcer r ecurrence was seen regardless of the technique used. Different results were obtained when valve competence instead of ulcer recurrence was u sed for assessment of durability. Reconstructions in ''primary'' reflu x were more durable than those in postthrombotic reflux. Durability di fferences were also noted among different techniques. A cohort of post erior tibial repairs proved extraordinarily durable (0 failures in 23 repairs). Conclusions: Valve reconstruction in postthrombotic reflux c an yield clinical results similar to those in ''primary'' reflux. Alth ough any of the several described techniques can produce similar clini cal results, Doppler competence suggests the following order for choic e of procedures: (1) internal valvuloplasty, (2) prosthetic sleeve in situ, (3) external valvuloplasty, and (4) axillary vein transfer.