THE CLINICAL AND HEMODYNAMIC-RESULTS AFTER AXILLARY-TO-POPLITEAL VEINVALVE TRANSPLANTATION

Purpose: To evaluate the results of axillary vein to popliteal vein va lve transplantation (VVTX), we reviewed the clinical, phlebographic, a nd noninvasive hemodynamic results in 15 patients. Methods: All patien ts had postthrombotic destruction of deep venous valves as determined by ascending phlebography, whereas descending phlebography demonstrate d grade III or IV reflux in all patients. A segment of valve-bearing a xillary vein was transplanted to the popliteal vein in the affected li mb. Postoperative evaluation was by clinical, noninvasive, and phlebog raphic means. Results: Over a mean follow-up period of 5.3 years (1.25 to 11 years), 13 of 14 patients (93%) had symptomatic improvement wit h relief of swelling, whereas all 14 patients who were admitted with p ain had relief after operation. Thirteen of 15 patients (87%) returned to work or household duties. Physical findings of edema, skin pigment ation, and lipodermatosclerosis improved in most patients. Only three patients (21%) had development of recurrent ulcers, with an average po stoperative ulcer-free interval of 4 years by life-table analysis. The cumulative ulcer-free survival rate for the group averaged 62% at lat e follow-up. All three patients with ulcer recurrence had a functionin g valve by descending phlebography, but recurrent perforating veins we re found in two patients, and deep venous thrombosis above a patent VV TX was observed in the third. Late assessment of reflux by venous fill ing index and valve closure times for the entire sample demonstrated m ean values of 4.9 seconds in the latter and 6.8 ml/sec in the former. Residual volume fraction, which correlates with invasive ambulatory ve nous pressures, was reduced to a mean of 31%. No deterioration in late sequential noninvasive values could be detected. Conclusion: VVTX is a durable procedure for preventing recurrent venous ulcers.