Angioscopic External Valvuloplasty in the Treatment of Varicose Veins

Abstract

Objective: To report on the surgical treatment of varicose veins by angioscopic valvuloplasty to preserve the long saphenous vein (LSV) and the efficacy of this method compared with conventional stripping and high ligation. Methods: A total of 306 limbs in 187 patients with reflux at the sapheno-femoral junction to below knee level were operated on using intraoperative angioscopy to diagnose valve insufficiency. Angioscopic external valvuloplasty was attempted for the subterminal valves in the LSV by three techniques: total plication of the dilated annulus by running polypropylene sutures (technique 1), plication by autogenous femorofascial sleeve or Dacron-reinforced silicone (technique 2), and plication of the commissure with shortening of the cusps from outside the vein wall (technique 3). Partial stripping or segmental ligation was performed for varicose veins below knee level and the incompetent perforating veins were treated simultaneously by suprafascial ligation. Results: The subterminal valves were classified as follows: valves with elongated and atrophic cusps – type I, 136 (44%); valves with expanded and depressed commissures with cusp changes – type II, 108 (35%); valves that had cusps with other deformities – type III, 38 (13%); and absence of valves between the saphenofemoral junction and mid-thigh level, 24 limbs (8%). Valvuloplasty of the LSV was successfully performed in 62 limbs (20%). There were two cases with occlusion of the LSV (3%) and four with recurrence of varicose veins (6%) at 2–89 (mean 55, SD 21) months follow-up. Conclusions: Angioscopic external valvuloplasty is effective in the treatment of varicose veins to preserve the LSV. Further data are needed for complete evaluation of this procedure.

The Treatment of Varicose Veins with External Stentding to the Saphenofemoral Junction

“…There are discrepancies in the literature relating to the applicability of the technique. 12 Corcos et al13 found that the valvuloplasty technique was applicable in only 8.2% of varicose vein cases and 63.3% of early varicose veins. This may be explained by patient selection.…”

Great Saphenous Vein Sparing Surgery by Angioscopic Valvuloplasty Combined with Axial Transposition of a Competent Tributary Vein – 5-Year Follow-Up

“…14,15 The patients comprised 28 males and 60 females, ranging in age from 29 to 79 years (mean 55.8 years). 14,15 The patients comprised 28 males and 60 females, ranging in age from 29 to 79 years (mean 55.8 years).…”

“…Angioscopic valvular incompetence was classified into three types and valvuloplasty was applied in valves with type I or type II: 14,15 Type I: valves with elongated and atrophic cusps. A bloodless field was obtained by manually flushing normal saline through a flush channel.…”

Preliminary Report of a New Approach to Sparing the Greater Saphenous Vein for Grafting: Valvuloplasty Combined with Axial Transposition of a Competent Tributary Vein

“…A bloodless field was obtained by manually flushing normal saline through a flush channel. Angioscopic external valvuloplasty was performed as described by Hoshino et al, 14,15 with plication of the commissure from outside the vein wall using 7-0 polypropylene (Fig. 1).…”