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

Abstract

Valvuloplasty combined with tributary vein transposition gives a better result than valvuloplasty alone at 1 year. This new treatment option may be useful for both reducing the rate of varicose veins and sparing the GSV for grafting.

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

“…We believe that "axial transposition of a competent tribu-tary vein" converts this source of reflux to a segment of the competent saphenous vein and that this approach is more logical than valvuloplasty alone. 13 In conclusion, valvuloplasty combined with axial transposition of a competent tributary vein resulted in significant hemodynamic improvements at the 18-month follow-up. A competent valve in this location can be expected to improve VFI to a normal range.…”

“…External valvuloplasty was performed as described by various authors. [13][14][15] Plication of the commissure to shortening of the cusps was performed from the outside of the vein wall using 7-0 polypropylene (Figure 2), after which the vein wall was wrapped with adjacent fascia to prevent subsequent dilation. After valvuloplasty was completed, patients in the V ϩ T group underwent axial transposition of the competent tributary vein.…”

“…11,12 Therefore we have recently applied a new option, known as "axial transposition of a competent tributary vein," to convert this source of reflux to a competent segment of the GSV and reported our preliminary results. 13 The purpose of this study was to compare the midterm results of hemodynamic changes between angioscopic external valvuloplasty and valvuloplasty combined with axial transposition of a competent tributary vein in patients with superficial venous incompetence.…”

Alternative Greater Saphenous Vein–Sparing Surgery

“…A 1.5 cm incision was made to expose the SFJ and the angioscope was inserted through one of the groin tributary veins. External valvuloplasty was performed as described by various authors 13–15 . Plication of the commissure to shortening of the cusps was performed from the outside of the vein wall using 7‐0 polypropylene (Figure 2), after which the vein wall was wrapped with adjacent fascia to prevent subsequent dilation.…”

“…Recent duplex examinations have raised awareness of the persistent reflux in the GSV via a competent tributary vein after high‐flush ligation of the GSV 11,12 . Therefore we have recently applied a new option, known as “axial transposition of a competent tributary vein,” to convert this source of reflux to a competent segment of the GSV and reported our preliminary results 13 . The purpose of this study was to compare the midterm results of hemodynamic changes between angioscopic external valvuloplasty and valvuloplasty combined with axial transposition of a competent tributary vein in patients with superficial venous incompetence.…”