The substitute "valve" operation by Technique II designed to overcome reflux in the popliteal vein was performed on 105 patients (119 limbs) with deep venous incompetence of the lower limb. There was a five-year follow-up on 101 of them (115 limbs) after operation by Technique II. Results were assessed clinically, by Doppler ultrasound, by venous pressure measurements, and by phlebography. Clinical improvement in 108 of 115 limbs was associated with a decrease in ambulatory venous pressure and prolongation of refilling time with interruption of the popliteal reflux by Doppler (96 limbs) and with phlebographic evidence of a functioning substitute "valve."

The substitute "valve" operation by Technique II using a silicone tendon designed to produce a valve-like mechanism on the popliteal vein is described. The results obtained in 55 limbs with chronic venous insufficiency due to reflux in the deep veins have been assessed by phlebography and by measurements of ambulatory venous pressure before and one week after the operation; 23 limbs were followed up two years after the operation. Clinical improvement in 50 of 55 limbs was associated with reduction in the ambulatory venous pressure and with phlebographic evidence of a functioning "substitute valve." After using the Doppler ultrasound the abolition of the popliteal reflux in 11 limbs after substitute valve operation by Technique II was studied; they had had a marked popliteal reflux and a high ambulatory venous pressure before the operation.

Investigation of the deep venous system of the lower limb must mainly aim to elucidate its capabilities. Because deep venous incompetence is necessarily con nected with a popliteal reflux accounted for by valvular incompetence of the popliteal vein, its presence must be clarified. An isolated valvular incompetence of the femoral vein without popliteal incompetence is of no clinical significance and should be disregarded. Only patients with popliteal reflux detected by Dop pler ultrasound require a further examination by venous pressure measure ments and by phlebography. An operation in the deep veins is admissible only when a popliteal reflux > 40%, and ambulatory venous pressure > 60 mmHg, a refilling time < 15 sec, a venous insufficiency > 20%, and a patency or recanalization of the deep venous > 70% have been confirmed. A correlation between venous pressure and Doppler recordings has been done.

Investigation of the deep venous system of the lower limb must mainly aim to elucidate its capabilities. Be cause deep venous incompetence is necessarily connected with a popliteal reflux accounted for by valvular in competence of the popliteal vein, its presence must be clarified. Only pa tients with popliteal reflux detected by Doppler ultrasound require a fur ther examination by venous pressure measurements and by phlebography. An operation in the deep veins is ad missible only when a popliteal reflux more than 40%, an ambulatory ve nous pressure more than 60 mmHg, a refilling time less than fifteen sec onds, a venous insufficiency more than 20%, and a patency or recanali zation of the deep veins more than 70% have been confirmed. The substitute "valve" operation by Technique II designed to overcome reflux in the popliteal vein was per formed on 170 patients (190 limbs) with deep venous incompetence of the lower limbs, primary or postthrom botic. Results were assessed clini cally, by Doppler ultrasound, by venous pressure measurements, and partially by phlebography. Clinical improvement in 181 of 190 limbs was associated with reduction of ambula tory venous pressure and prolonga tion of refilling time with interrup tion of the popliteal reflux by Dop pler (168 limbs) and with phlebographic evidence of a valve- like effect of the silastic tendon.

The conversion of the measured ambulatory venous pressure (AVP) to a value resulting from a resting venous pressure of 100 mmHg is significant for a standardized evaluation of the venous dynamics in different patients. By applying the formulas derived from the measured ambulatory and resting venous pressures, the venous insufficiency and the functional reserves can be calculated in percent. By combining the refilling time (RT) with the venous pressure index (VPI), the venous pressure hemodynamic index (VPHI) results, which is a very sensitive parameter also for minimal changes in the venous hemodynamic. Thus, the venous dynamics can be compared before and after a treatment in the same or in different persons.