Popliteal Valvular Construction Using a Silastic Sling (Technique II) for Deep Venous Insufficiency of the Lower Limb

Abstract

Objective:

To establish the safety and efficacy of a silastic sling procedure for reconstructing popliteal vein.

Design:

Prospective survey of patients undergoing surgical treatment for popliteal vein reflux.

Setting:

Department of Surgery, County Hospital, Bad Karlshafen, Germany.

Patients:

209 patients undergoing surgery for popliteal vein incompetence.

Interventions:

Silastic sling procedure (Technique II) for correction of popliteal vein incompetence.

Main outcome measures:

Continuous wave Doppler ultrasound examination of popliteal vein, ambulatory foot vein pressure measurements, lower limb venography.

Results:

One week following surgery 202 patients (of 209) reported relief of pain and reduction of limb oedema. 77 patients with ulcers (of 85) healed following the surgical procedure. Ambulatory venous pressure improved from 71 SD 11 mmHg to 36 SD 17 mmHg. There was prolongation of the venous refilling time from 9 SD 5 seconds to 27 SD 17 seconds. Postoperative phlebography in 92 patients was performed on the tenth post-operative day and in no patient was deep vein thrombosis observed. In 82 of these patients phlebography demonstrated that the constructed popliteal valve was patent.

Conclusions:

Construction of a popliteal valve using the author's silastic sling technique is a satisfactory method for managing patients with otherwise uncontrolled popliteal vein reflux due to either primary valvular failure or previous deep vein thrombosis.

Keywords

Chronic venous insufficiency Popliteal valve substitution

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References

Andalon

A Alcocer

Arvizu

A Laga

Jimenez

H Alvarez

. Insufficientia venosa cronica: Valvuloplastias venosas, operacion de Psathakis o injerto venosa libre. Tribuna Medica (Mex) 1981; 40: 36–41.

Andalon

A Alcocer

. La plastic valvulaire dans l'insuffiscance veineuse profonde. J des Mald Vascul (Paris) 1982; 7: 201–3.

Ferris

Kistner

. Femoral vein reconstruction in the management of chronic venous insufficiency. Arch Surg 1982; 117: 1571–9.

Huse

Nabsetz

Busch

, Direct venous surgery for venous valvular insufficiency of the lower extremity. Arch Surg 1983; 118: 719–23.

Kistner

. Surgical repair of the incompetent femoral vein valve. Arch Surg 1975; 110: 1336–42.

Kistner

. Transvenous repair of the incompetent femoral valve. In: Bergan

Yao

JSJ

, Editors. Venous problems. Chicago, London: Year Book Medical Publishers, 1978: 493–509.

Raju

. Venous insufficiency of the lower limb and stasis ulceration. Ann Sur 1983; 197: 688–97.

Jonson

Queral

Flinn

, Late objective assessment of venous valve surgery. Arch Surg (1981); 116:1461–6.

Queral

Whitehouse

AMJ

Flinn

, Surgical correction of chronic deep venous insufficiency by valvular transposition. Surgery 1980; 87: 688–95.

10.

Taheri

Lazar

Elias

, Vein valve transplant. Surgery 1982; 91: 28–33.

11.

Taheri

Lazar

Elias

. Status of valve transplant after 12 months. Arch Surg 1982; 117: 1313.

12.

Psathakis

. Tactics on investigation of the venous dynamics and their validation before and after operations in the deep veins of the lower limb. Vasc Surg 1987; 21: 192–207.

13.

Psathakis

. Direct popliteal valve substitution by Technique II and its efficacy in deep venous insufficiency of the lower limb. J Cardiovasc Surg 1987; 28: 678–87.

14.

Psathakis

. Surgical treatment of deep venous insufficiency of the lower limb. Surg Gynec Obstet 1988; 166: 131–41.

15.

Psathakis

. Is the problem of the post thrombotic syndrome reality or myth? Vasc Surg 1988; 22: 1–17.

16.

Psathakis

. A new rational operative treatment for the insufficiency syndrome of the deep veins of the lower extremity. Vasc Dis 1964; 1: 261–6.

17.

Psathakis

. Perfected technique by the “substitute valve operation on the popliteal vein; comparative venous pressure measurements before and after the operation and results of 11 years follow-up. Vasa 1975; 4: 299–307.

18.

Psathakis

. Technik II der Ersatzklappenoperation der V. Popliteal und pra- und postoperative periphere Venen-Druckmessungen bei postthrombotischem Syndrom. Phlebol und Proktol 1982; 11: 291–302.

19.

Psathakis

. Traitment du syndrome post thrombotique par la Technique II de substitution valvulaire a la vein poplitee. Resul tats compares de mesures de pression veineuse periphereque avant et apres intervention. Phlebologie 1983; 36: 225–64.

20.

Psathakis

. The substitute “valve” operation by Technique II in patients with postthrombotic syndrome. Surgery 1984; 95: 542–8.

21.

Psathakis

. Rationale of the substitute “valve” operation by Technique II in the treatment of chronic venous insufficiency. Int Angiol 1985; 4: 397–412.

22.

Psathakis

. The non-invasive substitute “valve” operation by Technique II in chronic venous insufficiency of the lower limb. Vasc Surg 1985; 19: 421–34.

23.

Psathakis

. Further experience with the substitute “valve” operation by Technique II in post thrombotic syndrome. Int Angiol 1985; (Suppl 4): 95–7.

24.

Psathakis

. Vergleichende Venendruckmes-sungen vor und nach Ersatzklappenoperation mit der Technik II beim postthrombotischen Syndrom. Phlebol und Proktol 1986; 15: 80–6.

25.

Psathakis

. Rationale and efficacy of the substitute “valve” operation by Technique II in deep venous insufficiency of the lower limb. Vasc Surg 1986; 20: 211–24.

26.

Psathakis

. How to select and operate on patients with deep venous insufficiency of the lower limb. Vasc Surg 1989; 23: 102–21.

27.

Psathakis

. Die Valvulare Substitution der Vena poplitea bei tiefer Veneninsuffizienz der unteren Extremitat. Zentbl Chir 1986; 11: 1337–53.

28.

Psathakis

. New horizons in the operative treatment of the deep venous incompetence of the lower limb. Vasc Surg 1992; 26: 165–85.

29.

Psathakis

. Nine years' experience with the valvular substitution by technique II in deep venous insufficiency of the lower limb. Vasc Surg 1991; 25: 374–95.

30.

Psathakis

. Die Wipp-dynamisch-funktionelle Phlebographie als Grundlage neuer diagnostischer Konzeptionen und einer zweckmaBigen Behandlung der Venenerkrankung der unteren Extremitaten. Zbl Chir 1964; 90: 14–49.

31.

Jian-Min

Sun

Pei-Hua

Zhang

. The substitute valve operation on the popliteal vein in the treatment of deep venous incompetence of the lower extremity. Vasc Surg 1987; 21: 17–27.