The Treatment of Varicose Veins Using the Venous Valve Cuff

Abstract

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.

In vitro evaluation of a nitinol based vein cuff for external valvuloplasty

“…A lot of external valvuloplasties (EV) to treat early stages of primary valvular insufficiency of deep veins were performed based on this and satisfactory results have been published [15,17,19,30]. The rationale of the EV procedure is to restore valvular function by reducing the valvular annulus calibre bringing the valve cusps back to their correct positions restoring a sufficient valve closure.…”

“…For EV, cuffs made of silicon, polyethylene terephtalate (PET, also known as Dacron ® ) and expanded polytetrafluoroethylene (ePTFE, also known as Gore-Tex ® ) were used [2,5,9,14,17]. PET and ePTFE are processed as spin-fibers into tapes with a size adapted to the blood vessel diameter.…”

“…This in turn may reduce ion diffusion from this material [40] as compared to conventional metals. Although nickel is an essential trace element within the body [8,10,13], the primary concern regarding nitinol relates to the high nickel content of the material and the possibility of hypersensitivity [17,19], and toxic [11,30] or carcinogenic [16,26] effects from increased nickel release into the body [13,33,40]. The chemical surface structure, the surface consistency, surface energy and corrosion resistance are therefore very important parameters defining implant biocompatibility [2].…”

Preservação da veia safena magna na cirurgia de varizes dos membros inferiores

“…Nos últimos 30 anos, diversas técnicas vem sendo propostas visando preservar a VSM [9][10][11][12][13][14][15] , mesmo quando essa apresenta alguma alteração. Na maioria das vezes, as alterações varicosas que acometem a VSM são causadas pelo refluxo na junção safeno-femoral (JSF) por insuficiência da valva ostial, que se prolonga para o seu tronco e muitas vezes transfere-se para suas veias colaterais superficiais, as quais se tornam varicosas, mantendo a VSM em si pouco alterada 16 .…”

“…As principais técnicas cirúrgicas para tratamento das varizes primárias com preservação da VSM que têm sido propostas e com resultados publicados na literatura são: ligadura da junção safeno-femoral (JSF), sem as ligaduras das veias tributárias da crossa 11,32 ; ligadura e secção da JSF (crossectomia) + ligadura das tributárias da crossa 10,12,33-39 ; valvoplastia das valvas ostial e sub-ostial da VSM, sem a ligadura da JSF 13 ; e colocação de cuff (manguito) de politetrafluoretileno (PTFE) ou teflon envolvendo as valvas ostial e subostial, sem a ligadura da JSF 14,15,40 .…”