Transcommissural valvuloplasty: Technique and results

Purpose: The purpose of this study was to describe the technique of a varia tion of closed external venous valve repair (transcommissural valvuloplasty ), its complication rate, and duplex scan durability. Methods: The "blind" transcommissural valve repair of the vein was performe d by placing transluminal sutures along the valve attachment lines, which s imultaneonsly closed the valve attachment angle and also tightened the valv e cusps. A total of 179 successfully repaired valve sites of 141 limbs in 1 29 patients were followed up 1 to 42 months through clinical observation an d with duplex Doppler ultrasound scan. Results: Postoperative complications (< 30 days) occurred in 12 (9%) of 141 limbs: superficial (1) and deep (1) wound infection, large wound hematoma (4), seroma (1), and deep vein thrombosis (5), with associated pulmonary em bolus in one patient. Seventy-eight percent (reflux time <less than or equa l to> 0.5 seconds) and 81% (reflux time less than or equal to 1.0 seconds) of valve sites were competent. The cumulative competency rate at 30 months was 59% and 63%, respectively. The cumulative ulcer recurrence-free interva l was 63% at 30 months (n = 92). The pain score and swelling grade substant ially improved. Conclusion: Transcommissural valvuloplasty is a safe procedure with low mor bidity. It is relatively rapid and simple to perform, and its competency ra tes are comparable to those of internal valvuloplasty. Advantages over the internal repair are that venotomy is not required, repair can be extended t o small-caliber veins, and multiple valve stations can be repaired in a sin gle stage.