Our aim was to assess the hemodynamic and clinical responses associated with valve repair surgery in 37 patients with severe chronic venous insufficiency. Patients classified as C4–6EpASDPPR (primary venous dysfunction with skin changes with reflux of superficial, deep and perforating veins) were submitted to a novel procedure combining the closed technique described by Kistner with the Dacron sleeve technique described by Hallberg (mean follow-up = 24 months). A significant improvement in Valsalva test results (P < 0.0001), ambulatory pressure (P = 0.0099), venous refilling time (P < 0.0001). and reflux index (P < 0.0001) was observed. Postoperative reactive hyperemia and gradient tests confirmed absence of venous obstruction signs. On their last visit, 85.3% of the patients had no ulceration, and edema was absent or minimal in over 90%. About 70% of the patients referred partial or complete relief of pain in the affected limb. The combined surgical technique was effective to control venous reflux 24 months after the procedure. A longer follow-up would be necessary to assess long-term results.
MaffeiF.H.A., MagaldiC., PinhoS.Z., LastoriaS., PinhoW., YoshidaW.B. and RolloH.A., Varicose veins and chronic venous insufficiency in Brazil: prevalence among 1755 inhabitants of a country town. International Journal of Epidemiology, 1986, 15(20), 210–217.
2.
NegusD., Venous return to the lower limb: muscle pumps, normal and abnormal function. In Leg Ulcers: A Practical Approach to Management, ed. NegusD.. Butterworth-Heinemann, Oxford, 1995, pp. 30–41.
O'DonnellT.F., MackeyW.C., ShepardA.D. and CallowA.D., Clinical, hemodynamic and anatomic follow-up of direct venous reconstruction. Archives of Surgery, 1987, 122, 474–482.
5.
RajuS. and FredericksR., Valve reconstruction procedures for nonobstructive venous insufficiency: rationale, techniques, and results in 107 procedures with two to eight year follow-up. Journal of Vascular Surgery, 1988, 7, 301–310.
6.
ErikssonI., Reconstructive surgery for deep vein valve incompetence in the lower limb. European Journal of Vascular Surgery, 1990, 4, 211–218.
7.
SottiuraiV.S., Comparison of surgical modalities in the treatment of recurrent venous ulcers. International Angiology, 1990, 9, 231–235.
8.
PerrinM., HiltbrandB. and BayouJ.M., La reparation valvulaire ao niveau du reseau vein aux profond sous-inguinal Ganget technique na intervention efficace. Phlebology, 1991, 44, 649–660.
9.
RajuS., Venous insufficiency of the lower limb and stasis ulceration: changing concepts and management. Annals of Surgery, 1983, 197, 688–697.
10.
GloviczkiP., MerrelS.W. and BowerT.C., Femoral vein valve repair under direct vision without venotomy: a modified technique with use of angioscope. Journal of Vascular Surgery, 1991, 14, 645–648.
11.
JohnsonN.D., QueralL.A., FlinnW.R., YaoJ.S. and BerganJ.J., Late objective assessment of venous valve surgery. Archives of Surgery, 1981, 116, 1461–1466.
12.
FerrisE.B. and KistnerR.L., Femoral vein reconstruction in the management of chronic venous insufficiency: a 14 year experience. Archives of Surgery, 1982, 117, 1571–1579.
13.
BurnandK.G., O'DonnellT.F., Lea ThomasM. and BrowseN.L., Relationship between postphlebitic changes in the deep veins and results of surgical treatment of venous ulcers. Lancet, 1976, 1, 936–938.
14.
KistnerR.L., Surgical technique of external venous valve repair. Straub Foundation Proceedings, 1990, 55, 15–16
15.
RajuS., Multiple valve reconstruction for venous insufficiency: indications, optimal technique and results. In Current Critical Problems in Vascular Surgery, Vol. 4, ed. VeithF. J.. Quality Medical Publishing Inc., St Louis, 1992, pp. 122–125.
16.
HallbergD., A method for repairing incompetent valves in deep veins. Acta Chirurgica Scandinavica, 1972, 138, 143–145.
17.
LaneR.J., McMahonC. and CuzillaM., The treatment of varicose veins using the venous valve cuff. Phlebology, 1994, 9, 136–145.
18.
RajuS., Axillary vein transfer for postphlebitic syndrome. In Atlas of Venous Surgery, eds BerganJ. J. and KistnerR. L., W.B. Saunders Company, Philadelphia, 1992, pp. 147–152.
19.
PorterJ.M. and MonetaG.L., International Consensus Committee on chronic venous diseases: — reporting standards in venous disease: an update. Journal of Vascular Surgery, 1995, 21, 635–645.
20.
RajuS. and FredericksR., Hemodynamic basis of stasis ulceration a hypothesis. Journal of Vascular Surgery, 1991, 13, 491–495.
21.
Lea ThomasM. and McDonaldL.M., Complications of phlebography of the leg. British Medical Journal, 1978, 2, 307–315.
22.
KistnerR.L., FerrisE.B., RandhawaG. and KamidaC., A method of performing descending venography. Journal of Vascular Surgery, 1986, 4, 464–468.
23.
DanielW. W., Applied Nonparametric Statistics. Houghton-Mifflin, Boston, 1978.
24.
MasudaE.M. and KislnerR.L., Long-term results of venous valve reconstruction: a four to twenty-one-year follow-up. Journal of Vascular Surgery, 1994, 19, 391–403.
25.
CheatleT.R. and PerrinM., Venous valve repair: early results in fifty-two cases. Journal of Vascular Surgery, 1994, 19, 404–413.
26.
RajuS., FredericksR., NeglènP.N. and BassJ.D., Durability of venous valve reconstruction techniques for primary and postthrombotic reflux. Journal of Vascular Surgery, 1996, 23, 357–367.
27.
FletcherR. H., FletcherS. W. and WagnerE. H., Epidemiologia Clínica. Editora Artes Médicas, Porto Alegre, 1991, pp. 145–206.
28.
RajuS., Ambulatory venous pressure regulation and pressure measurements. In Surgical Management of Venous Disease, eds RajuS. and VillavicencioJ. L.. Williams and Wilkins, Baltimore, 1997, pp. 176–186.
29.
PorterJ.M., RutherfordR., ClagetG.P., CranleyJ.J., O'DonnellT.F., RajuS., ZierlerE., BrowseN. and NicolaidesA., Reporting standards in venous disease. Journal of Vascular Surgery, 1988, 8, 172–181.
