External Femoral Vein Valvuloplasty with Limited Anterior Plication (LAP): A 10-Year Randomized, Follow-up Study

Abstract

The aim of this study was to evaluate the effects after 10 years of external valvuloplasty of the femoral vein (limited anterior plication or LAP). After informed consent patients with venous hypertension due to deep and superficial venous incompetence were randomized into two treatment groups. Both groups were treated with superficial vein surgery (ligation and section of the major incompetent superficial veins). Group 2 was treated with the same procedure and with LAP. External valvuloplasty of the superficial femoral vein was performed with plication of the anterior vein wall after limited dissection of the vein. Results were evaluated with color-duplex scanning and ambulatory venous pressure (AVP) measurements. Endpoints were AVP, refilling time (RT), presence/absence of reflux at the superficial femoral vein, the variation in the diameter of the vein, and quality of life score (QLS). No complications were observed. All femoral veins treated with LAP were competent after 10 years. Significantly lower AVP and longer RT were observed in the LAP group. Also the average diameter of the vein was smaller in the LAP group. Moreover, QLS was significantly better in the LAP group after 10 years. In conclusion, in selected subjects, with moderate deep venous incompetence, functional cusps, or incompetence mainly due to relative enlargement of the femoral vein, LAP may be an effective alternative to external valvuloplasty.

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

“…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.…”

Postthrombotic Syndrome: Surgical Possibilities

“…Several modifications have been introduced since long-term results have shown it to be less durable repair. Limited anterior plication involves continuous mattress suturing from a point 3 to 4 mm proximal to the valve cusp insertion lines up to the angle of valve cusp insertion [43]. The aim was to reduce the amount of vein dissection and reducing the risk of progressive venous dilatation which occurs in some cases of valvuloplasty.…”

“…The aim was to reduce the amount of vein dissection and reducing the risk of progressive venous dilatation which occurs in some cases of valvuloplasty. It has promising long-term follow-up results in terms of improved venous refilling and decreased ambulatory venous pressure [43]. In 1991, Gloviczki and colleagues [44] described femoral vein valve repair under angioscopic guidance without performing a venotomy.…”

Treatment of chronic venous insufficiency

“…However, there is minimal success with valve transplantation especially in patients with post-thrombotic valve incompetence [53]. Standard procedure Vein valvuloplasty, either external or angioscopic, involves the placement of sutures within the femoral vein valve itself or at the insertion sites with subsequent shortening of the valve reducing valve prolapse or narrowing the widened valve angle, both with improvement of reflux [54,55]. Transplantation of venous valves is accomplished by end-to-end anastomosis of the appropriately sized allograft containing a variable number of valve stations to the common femoral, femoral, profunda, or popliteal veins [53].…”