Purpose: This study assessed whether axillary vein transfer can be successf
ully performed in trabeculated veins and whether patients with this severe
form of postthrombotic syndrome can be helped by an aggressive approach.
Methods: A total of 102 axillary vein transfer procedures were carried out
in 83 limbs with trabeculated veins. More than one venous segment was repai
red in 38 limbs with a second axillary valve in 19, and a different techniq
ue was used in the remainder The superficial and deep femoral veins were th
e most common target sites. "Bench repair" of leaky axillary valves was per
formed before the transfer in 32 cases. Venous stasis dermatitis or ulcerat
ion was present in 90% of the limbs. The operability rate and chance of suc
cessful valve reconstruction was high, even in the presence of severe venog
raphic appearance.
Results: The actuarial transplant patency rate was 83% at 10 years. The act
uarial freedom from recurrent ulceration rate was more than 60% at 10 years
, similar to the results obtained in a matched group of axillary vein trans
fers to nontrabeculated veins. Severe preoperative ambulatory venous hypert
ension (venous filling time [VFT] of less than 5 seconds), which was presen
t in 67% of patients, did not adversely affect outcome, but short VFTs that
persisted after surgery did. VFT and VPI90 (venous filling index, air plet
hysmography) improved after valve transfer. Swelling disappeared or was sig
nificantly reduced in 55% of patients (11 of 20 patients) who had moderate
or severe preoperative swelling. In 82% of patients (31 of 37 patients) who
had mild or no preoperative swelling, the swelling remained stable after s
urgery, and in 18% of patients (6 of 37 patients), it became worse. Pain wa
s significantly diminished in 70% of patients; 23% of patients with severe
pain had complete resolution.
Conclusion: Axillary vein transfer, in combination with other antirefluxive
procedures when indicated, is safe, effective, and durable in patients wit
h trabeculated veins and severe forms of postthrombotic syndrome. It may be
considered as an option when conservative therapy or other types of surger
y fail.