THE ROLE OF EXTERNAL BANDING VALVULOPLASTY IN THE SURGICAL-MANAGEMENTOF CHRONIC DEEP VENOUS DISEASE

Objective: Correction of venous reflux by perivalvular banding in pati ents suffering from chronic venous stasis secondary to primary valvula r incompetence. Design: Prospective study in a group of patients with severe venous insufficiency. One patient (one extremity) was lost to f ollow-up. Setting: Tertiary care teaching hospital. Patients: Twelve p atients (13 extremities) with severe or moderate venous insufficiency. Interventions: Correction of valvular incompetence by narrowing a val vular ring with an external band. Twenty-seven bands were fitted to in competent valves of 13 extremities. Main outcome measures: Abolition o f reflux and improvement of muscle pump measured by clinical, plethysm ographic and venographic criteria. Results: Symptomatic improvement wa s found in 10 extremities (77%) and complete correction of reflux on v enography in eight extremities (67%). Plethysmographically measured re flux improved in 6 extremities (50%) and muscle pump function improved in 7 extremities (58%). No correlation was found between plethysmogra phic and clinical or venographic outcome. Conclusion: Perivalvular ban ding can correct reflux and alleviate clinical symptoms of chronic ven ous stasis in patients with primary valvular incompetence. Selection o f patients, valves to be corrected, necessary degree of valvular ring narrowing and need for additional interventions should be further inve stigated.