CLINICAL-RESULTS OF DEEP VENOUS VALVULAR REPAIR FOR CHRONIC VENOUS INSUFFICIENCY

OBJECTIVE: To evaluate the results of venous valvular repair in the tr eatment of 16 cases of chronic venous insufficiency (CVI). DESIGN: A r etrospective analysis of 16 venous valve repair operations (15 patient s) with a minimum followup of2 years. SETTING: A 650-bed university-af filiated teaching hospital. PATIENTS: Fifteen consecutive referred pat ients who had CVI had deep vein valve surgery. All cases were refracto ry to prolonged conservative care and removal of incompetent superfici al and perforating veins. Investigation included ascending and descend ing venography, air plethysmography (APG) and colour flow duplex scann ing (CFDS), All patients had class 4, 5 or 6 CVI and all demonstrated deep venous reflux from the groin to below the knee on descending veno graphy. INTERVENTIONS: Superficial femoral vein valvuloplasty (12 oper ations) and venous valve transfer from the axillary vein to the above- knee popliteal vein (4 operations). MAIN OUTCOME MEASURES: Healing of ulcers, relief of edema and improvment in symptoms were clinical crite ria of success. An attempt was made to correlate preoperative and post operative APG, CFDS and descending venography. RESULTs: Ninety-two per cent of the valvuloplasty patients and 75% of the valve transfer patie nts were clinically improved. In this series no statistical associatio n existed between preoperative and postoperative changes noted on APG. CONCLUSION: This series suggests that deep vein valvular reconstructi on for CVI refractory to conservative management and superficial surge ry offers a good chance of clinical improvement.