AXIAL TRANSFORMATION OF THE PROFUNDA FEMORIS VEIN

Purpose: To highlight a special subset of cases of venous stasis in wh ich the profunda femoris vein enlarges to a variable extent (axial tra nsformation) to compensate for severe postthrombotic changes in the ac companying superficial femoral vein. Methods: Among 500 consecutively treated patients with severe venous stasis, 57 patients had axial tran sformation of the profunda femoris vein. Venous obstruction and reflux were assessed by means of arm-foot pressure differential, ambulatory venous pressure measurement, air plethysmography, and duplex examinati on. Ascending and descending venograms also were obtained. A variety o f valve reconstruction techniques were useful in correcting reflux in the enlarged profunda femoris vein and the companion postthrombotic su perficial femoral vein.Results: In 55% of patients the profunda femori s vein was larger than normal and provided partial outflow from the le g through a profunda-popliteal connection, but the superficial femoral vein was still the dominant outflow tract (grades I and II). In 36% o f patients the profunda femoris was the dominant outflow tract from th e leg, and in another 9% it was the sole axial outflow tract (grades I II and IV). The skin changes of advanced venous stasis were present am ong 92% of patients and frank ulceration among 88%. Antireflux operati ons on the profunda femoris vein and companion superficial femoral vei n, including ligation and division in some instances, were well tolera ted. Despite a postthrombotic cause, obstruction did not worsen after surgical treatment, and reflux improved according to most laboratory m easurements. Complete ulcer healing was obtained with the surgical tec hniques described. The actuarial recurrence-free survival rates were 9 0% 1 year and 66% 5 years after treatment. Conclusion: Axial transform ation of the profunda femoris vein is present in a subset of instances in which severe postthrombotic changes are present in the companion s uperficial femoral vein. Profunda femoris reflux is invariably present in these instances because of compensatory dilatation and enlargement of this vessel. Simultaneous valve repair of the axially transformed profunda femoris vein and companion superficial femoral vein to abolis h reflux yields excellent long-term results and healing of stasis ulce ration.