Preliminary report of a new approach to sparing the greater saphenous veinfor grafting: Valvuloplasty combined with axial transposition of a competent tributary vein

Purpose: To compare a new vessel-sparing technique combining valvuloplasty with axial transposition of a competent tributary vein versus single valvul oplasty for the treatment of greater saphenous vein (GSV) incompetence. Methods: In 55 patients with GSV incompetence, 29 of 57 limbs were treated by angioscopic valvuloplasty of the subterminal valve alone, whereas the re maining 28 limbs underwent angioscopic valvuloplasty combined with axial tr ansposition of a competent tributary vein identified preoperatively by dupl ex scanning. After angioscopic valvuloplasty in the latter group, the compe tent tributary vein was exposed and cut 1.5 cm distal to its insertion poin t on the GSV. The transected vein was anastomosed end to side to the GSV, w hich was ligated between the tributary insertion site and the anastomosis. Changes in venous hemodynamics, including venous filling index (VFI), eject ion fraction (EF), and residual volume fraction (RVF), were analyzed by use of air plethysmography. Results: In the 1-year follow-up, no venous thrombosis was detected in eith er group. In the valvuloplasty-only group, 22 (75.9%) limbs exhibited reflu x in the proximal GSV; recurrent varicose veins were detected in 5 (17.2%) limbs. In contrast, only 2 (7.1%) limbs showed reflux in the valvuloplasty + transposition group. There were no significant differences in EF and RVF between the groups before or after the operation, although a significant di fference was seen in VFI at 1 year (p = 0.005, Wilcoxon rank sum test). Conclusions: Valvuloplasty combined with tributary vein transposition gives a better result than valvuloplasty alone at 1 year. This new treatment opt ion may be useful for both reducing the rate of varicose veins and sparing the GSV for grafting.