Does surgical correction of the superficial femoral vein valve change the course of varicose disease?

Purpose: We tested the hypothesis that the course of primary chronic venous insufficiency can be changed by correction of the incompetent valve in the superficial femoral vein. Methods: This was a prospective, randomized, controlled study. A total of 1 25 extremities with reflux in greater saphenous and superficial femoral vei ns and belonging to clinical classes C2-C4 were analyzed. During the first 5 years, the type of clinical dynamics and changes in valvular function wer e determined in each patient. Patients were stratified according to the typ e of clinical dynamics and randomly assigned to treatment groups. Phlebecto my was performed in all extremities. In each of 64 extremities (the study g roup), the proximal incompetent superficial femoral vein valve was correcte d as a part of the primary intervention. Patients were followed up for 7 to 8 years after surgery. Results: The clinical dynamics of the extremity significantly depended on r eflux changes. Increase in superficial femoral vein reflux was found in 74% of the extremities with progressive clinical dynamics but in only 47% of e xtremities with stable clinical dynamics (chi (2) = 9.71; P < .01). After s urgical treatment, 65% of the extremities in the control group showed stabl e improvement; in 11%, recurrent Varicosity was found; in 24%, the disease was aggravated Of the extremities in the study group, 86% had stable improv ement, 5% had recurrent varicosity, and 10% were aggravated (P < .05). Extr emities with the progressive type of clinical dynamics were main contributo rs to this difference (chi (2) = 7.86; P < .05). In 92% of the extremities with corrected valves and in 50% of the extremities with increase in reflux after valvuloplasty, clinical improvement was observed (<chi>(2) = 11.5; P < .01). Extremities with corrected valvular function demonstrated superior results in comparison with extremities with stable valvular function in th e control group (clinical improvement in 92% and 66% of extremities, respec tively; P < .005). Conclusions: In patients with chronic venous insufficiency, two types of cl inical dynamics, stable and progressive, can be identified. The progressive type is associated with the presence of superficial femoral vein reflux an d increasing greater saphenous vein reflux. Superficial vein surgery neithe r corrects superficial femoral vein reflux nor prevents it from progressing further. Correction of a single superficial femoral vein valve during prim ary intervention significantly improves the long-term results of superficia l venous surgery. This improvement is associated with the prevention of ref lux progression. Surgical correction of the incompetent superficial femoral vein valve changes the course of primary chronic venous insufficiency.