External femoral vein valvuloplasty with limited anterior plication (LAP):A 10-year randomized, follow-up study

The aim of this study was to evaluate the effects after 10 years of externa l valvuloplasty of the femoral vein (limited anterior plication or LAP). Af ter informed consent patients with venous hypertension due to deep and supe rficial venous incompetence were randomized into two treatment groups. Both groups were treated with superficial vein surgery (ligation and section of the major incompetent superficial veins). Group 2 was treated with the sam e procedure and with LAP. External valvuloplasty of the superficial femoral vein was performed with plication of the anterior vein wall after limited dissection of the vein. Results were evaluated with color-duplex scanning a nd ambulatory venous pressure (AVP) measurements. Endpoints were AVP, refil ling time (RT), presence/absence of reflux at the superficial femoral vein, the variation in the diameter of the vein, and quality of life score (QLS) . No complications were observed. All femoral veins treated with LAP were c ompetent after 10 years. Significantly lower AVP and longer RT were observe d in the LAP group. Also the average diameter of the vein was smaller in th e LAP group. Moreover, QLS was significantly better in the LAP group after 10 years. In conclusion, in selected subjects, with moderate deep venous in competence, functional cusps, or incompetence mainly due to relative enlarg ement of the femoral vein, LAP may be an effective alternative to external valvuloplasty.