SURGICAL-TREATMENT OF DEEP VENOUS INSUFFI CIENCY - TECHNIQUES, INDICATIONS AND RESULTS

Introduction: complications of deep venous insufficiency can lead to s urgery if one fails with medical treatment. The etiology can be primit ive or secondary, the symptoms are identicals. They go from heaviness of the legs to chronical legs ulcers. Indication and technic of surger y depend on the etiology and the preoperatory evaluation. Preoperatory evaluation: it has to be anatomical and functional. Invasive investig ations as venous blood pressure, ascending and descending venography, and non invasive investigations as duplex or triplex Doppler and pleth ysmography are usued. Technics : one can use three technics. Valvulopl asty with or without venotomy, and with or without Dacron cuff. Transp lantation of an axillary valvulated venous segment to femoral or popli teal vein. Transposition to a valvulated and compentent great saphenou s vein or deep femoral vein. Indications : one can propose transplanta tion or transposition for secondary deep venous insufficiency, and val vuloplasty for primary deep venous insufficiency. Stade 2 or 3 can be a clinical indication for surgery. Results : valvuloplasty has good re sults with 60 to 80 % free of clinical recurrence at 2 years. The resu lts of the other technics seem to be less good. Conclusion : the fair results of surgery allow the use of it for some patients with a good e valuation. The improvement of the surgical results lie on the developm ent of paraclinical evaluation and research on venous valvular hemodyn amic (J Mal Vasc 1994; 19 : pages 175-184).