ANGIOSCOPIC EXTERNAL VALVULOPLASTY IN THE TREATMENT OF VARICOSE-VEINS

Objective: To report on the surgical treatment of varicose veins by an gioscopic valvuloplasty to preserve the long saphenous vein (LSV) and the efficacy of this method compared with conventional stripping and h igh ligation. Methods: A total of 306 limbs in 187 patients with reflu x at the sapheno-femoral junction to below knee level were operated on using intraoperative angioscopy to diagnose valve insufficiency. Angi oscopic external valvuloplasty was attempted for the subterminal valve s in the LSV by three techniques: total plication of the dilated annul us by running polypropylene sutures (technique 1), plication by autoge nous femorofascial sleeve or Dacron-reinforced silicone (technique 2), and plication of the commissure with shortening of the cusps from out side the vein wall (technique 3), Partial stripping or segmental ligat ion was performed for varicose veins below knee level and the incompet ent perforating veins were treated simultaneously by suprafascial liga tion. Results: The subterminal valves were classified as follows: valv es with elongated and atrophic cusps type I, 136 (44%); valves with ex panded and depressed commissures with cusp changes - type II, 108 (35% ); valves that had cusps with other deformities - type III, 38 (13%); and absence of valves between the saphenofemoral junction and mid-thig h level, 24 limbs (8%). Valvuloplasty of the LSV was successfully perf ormed in 62 limbs (20%). There were two cases with occlusion of the LS V (3%) and four with recurrence of varicose veins (6%) at 2-89 (mean 5 5, SD 21) months follow-up.