Reconstructive Surgery for Deep Vein Reflux in the Lower Limbs: Techniques, Results and Indications

Abstract

Deep venous reflux (DVR) is defined as a reflux affecting the deep venous system. DVR essentially arises from two aetiologies, primary deep valve incompetence (PDVI) and post-thrombotic syndrome (PTS), and it is correlated with severe chronic venous insufficiency. DVR correction aims at reducing the increased ambulatory venous pressure, which results from reflux in deep veins in orthodynamic conditions. The results of DVR surgery are not easy to assess, as it is mostly associated with surgery for insufficiency in the superficial venous system and/or perforators. In cases of primary insufficiency, valvuloplasty, the operation of choice, is credited at 5 years follow-up with a 70% success rate in terms of clinical outcome and improved haemodynamic performance. In PTS, a meta-analysis of transpositions and transplants at more than 5 years estimates successful clinical outcome and improved haemodynamic performance at 50%. The Maleti neovalve construction technique has achieved better results. Indications for DVR surgery are based on clinical, haemodynamic and imaging data. Aetiology is a decisive factor in the choice of the technique.

Management of venous leg ulcers: Clinical practice guidelines of the Society for Vascular Surgery® and the American Venous Forum

“…There was a 95% ulcer healing rate and two recurrent ulcers. 409,410 These techniques are performed in cases that are highly selected and have no other known valvular restorative potential. The procedures must be considered technically challenging and still in need of corroborative data before wider dissemination.…”

Thinking Outside the Heart

“…8,12,14,50 These studies suggest that a finite number of VEHTCs can make a difference in a patient’s outcome.…”

Venous intervention in chronic venous ulcer treatment and recurrence avoidance

“…And a Grade 1C recommendation is given for venous balloon angioplasty and stenting for treatment of non-thrombotic and post-thrombotic IVC obstructions in patients with lower extremity pain or edema affecting QOL not palliated by compression and for patients with impending or active lower extremity venous leg ulceration. (27) With regard to surgical treatment for patients with post-thrombotic syndrome (PTS), Oscar Maleti and colleagues report their experience with endophlebectomy and valvuloplasty (first described by Kistner [28]) and neo-valve reconstruction or saphenous vein transposition in patients with infra-inguinal venous obstruction/incompetence (29). At a mean of 28.5 months follow up, ulcer recurrence was 17 % and hemodynamic improvement (by ambulatory venous pressure and venous refill time measurements) was 100 % with a bicuspid neovalve reconstruction.…”