Deep venous valve reconstruction for non‐healing leg ulcers: Techniques and results

Abstract

In a 2 year follow up, valvular reconstruction for refluxive disease is effective in healing venous ulcers that defy conservative management and superficial/perforator venous surgery. Furthermore, these procedures appear more promising for primary than for secondary incompetence. Multilevel or multivalve reconstructions yield superior results to single-level repairs in medium-term follow up.

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

“…Serial case series have demonstrated valve competency rates of 60% to 70% at 5 to 8 years and similar ulcer-free rates (Table X). 368,377,[391][392][393][394][395][396] Representative series of internal valvuloplasty interventions in patients with advanced disease show that most patients included in these studies had healed or active VLUs. Essentially all studies demonstrate durable results in patient with VLUs that have proved recalcitrant to healing with other forms of treatment.…”

“…Several case reports support ligation of the femoral vein as a method of eliminating physiologically significant reflux of the femoral vein when the collateral pathways of both great saphenous and deep femoral veins are patent and competent. [374][375][376][377] Several techniques are used to fashion an incompetent valve into a competent valve. External banding refers to a synthetic sleeve placed around the circumference of a valve to reduce the vein circumference and to produce a competent valve.…”

“…The long-term competency rate at 2 to 5 years is w50%, with a slightly higher freedom from ulcer recurrence rate. [359][360][361][362][363][364][365][366][367][368]377,405,406 vein wall inside the vein lumen to act as valve, with a synthetic patch used to replace the anterior wall; and dissection of the intimal-medial wall of the often postphlebitic vein to form a monocuspid or bicuspid valve, with proper sutures placed to form a functioning valve. Regarding the first three techniques, small case series have been reported, but they lack corroborative series from other surgeons.…”

“…Overall, this technique appears applicable and effective in select patients, with expectations of a 50% ulcer-free rate at 2 years. [377][378][379][380][383][384][385][386][387][388][389][390] Internal valvuloplasty is an anatomically precise technique that has been modified over time. Although internal valvuloplasty provides the longest durability, it is technically more demanding and highly operator dependent.…”

Mapping the future: Organizational, clinical, and research priorities in venous disease

“…Unfortunately, interventions aimed at restoring deep valve competence are less successful in secondary than in primary venous disease. 39 Furthermore, open interventions, such as venous bypass and valve repair, are performed only in highly specialized centers by experienced surgeons. However, minimally invasive techniques, potentially accessible to a broader group of specialists, have emerged in the past several years and their further development should be encouraged.…”