In the claudicating sportsperson, where there are no well characterised specific anatomical abnormalities, the syndrome can be characterised by provocative clinical (particularly hopping) and non-invasive tests. A positive clinical outcome with surgery can be predicted by abnormal pre-surgical ultrasonic investigations and confirmed later by a similar normal post surgical study. Concomitant venous compression may occur while standing with both syndromes related to muscle hypertrophy.

Presented are the experiences with 1,516 external valvular stents (Venocufft and Venocuff II) implanted at the saphenofemoral junction (SFJ) between 1985 and 2000. To assess the applicability of the procedure it was found that the appropriate implantation was performed in 34% of 310 consecutive venous procedures. To assess patient preference between external valvular stenting and simultaneous contralateral stripping, 56 consecutive patients were followed up at 3 months postoperatively. Four percent preferred stripping, 4% had no preference, and 92% preferred Venocuff IItrade mark implantation. Competence at the SFJ with specific duplex ultrasound indicators was 94% at 3 months (n = 100) and 90% at 4.8 years (n = 107). Minimal residual reflux (less than 50 mL/minute with maximum Valsalva) was present in the remainder but did not produce symptoms and very rarely progressed over the mean time of 5 years. The internal diameter (ID) of the long saphenous vein (LSV), 3 cm distal to the SFJ, changed from 7.6 +/- 2.3 mm to 4.9 +/- 1.1 mm (p < 0.001) and at the knee from 6.9 +/- 1.9 mm to 3.7 +/- 1.0 mm (p < 0.001). Patients presenting with underlying deep venous disease began with significantly higher ID, ie, 9.0 +/- 2.1 mm at the upper end of the LSV and 7.1 +/- 2.0 mm at the knee, but postoperatively the IDs reverted to those of postoperative patients with a normal deep venous system. To assess patients with recurrences, 366 limbs had simultaneous stripping and contralateral SFJ repair with the Venocuff II. Of these 33 (9%) had recurrences at 4.9 years, 82% of them on the stripping side, and on the repair side half of the recurrences had a competent SFJ (9%). Limbs with an incompetent lateral or anterior accessory system, with an incompetent SFJ (168), were compared with 11 matched randomized controls where stripping was performed. The recurrence rate was 1.2% versus 36% on the strip side. The follow-up for these cases was 6.4 years. Pregnancy (n = 14) produces a high recurrence rate, but stripping and valve repairs were not significantly different, ie, despite small numbers, there was a very strong tendency toward higher recurrence rates on the stripped side. The complication rate was small and the cost of the device is low. The method allows a repairable nonablative approach that can be offered in patients where no other surgical treatment can or should be offered. External stenting to the SFJ is the preferred option for early to moderate varicose veins involving the LSV where the clinical and ultrasonic indicators have been fulfilled.

Objective: To assess the safety and efficacy of venous valve cuffing for the treatment of varicose veins. Design: Three prospective studies were performed. The first study was the subjective and objective evaluation of venous valve cuffing in a series of unselected patients with varicose veins. Indications for use of the technique were defined in the first study, and applied in the second study, which focused on an evaluation of objective outcome criteria. The third study was an evaluation of the long-term effect of venous valve cuffing. Setting: Royal North Shore Public Hospital, Mater Private Hospital and Peninsula Private Hospital (Sydney, Australia). Patients: In the first series there were 93 limbs in 72 unselected patients with varicose veins. The second series consisted of 78 limbs in 62 patients who were selected based on the indications established in the first study. A third series of 100 limbs in 75 patients, selected at random, was reviewed to assess the long-term subjective and objective outcome. Measurements: All clinical outcome variables were observed subjectively. Photoplethysmographic recovery times and reflux at the sapheno-femoral junction (SFJ), at the knee, and below the knee were measured. Vein diameters at the groin and at the knee were measured pre- and postoperatively. Results: Unselected patients have a good clinical outcome, but approximatley one-third have residual venous reflux at the SFJ. Selected patients with mild to moderate varicose veins have an excellent result in all criteria investigated. Conclusions: After competence is restored to the SFJ, the saphenous vein decreases in size and achieves physiological one-way flow. Venous valve cuffing demonstrates a low incidence of symptoms and recurrence in both the short and long term.

Multiple deep venous valve repairs are appropriate and the best form of treatment for specifically selected individuals with primary deep venous incompetence.