The Non-Invasive Substitute "Valve" Operation by Technique II in Chronic Venous Insufficiency of the Lower Limb

Abstract

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.

Is the Problem of the Postthrombotic Syndrome Reality or Myth?

“…Adequate length and freedom from, or the minimizing of, adhesions of the silastic tendon, which slides in a tendon-like sheath, have led to solution of the problem. [12][13][14][15][16][20][21][22][23] Thus, the Technique II devised by Dimitrios N. Psathakis could decisively achieve the formation of an efficient substitute &dquo;valve&dquo; on the popliteal vein.…”

“…Accordingly, without popliteal reflux, a chronic venous insufficiency is not imaginable. 8,15,16,22,23 Preoperative Phlebography Ascending three-phase-phlebography9 was used to study the morphology of the venous system and the changes as a result of the postthrombotic syndrome. This method, described elsewhere, consists of the tilt phase (phase 1), the dynamic phase (phase 2), and the functional phase (phase 3) 9', [14][15][16]22,23 Postoperative Phlebography Postoperative phlebography was made on the tenth postoperative day or later.…”

“…causes distress to the patient. [11][12][13][14][15][16][17][18][19][20][21] Because the venous system is a low-pressure system, reconstructive venous procedures have not led to the solution of this problem. Besides, these procedures are intravasal, and with the risk of thrombosis or bleeding, they have a restricted indication and their results are not convincing.…”

“…Details are found elsewhere. [14][15][16][17][18][19][20][21][22][23] Venous Pressure Models By venous pressure models&dquo;-'9 the measured ambulatory venous pressure can be converted to a value corresponding to a resting venous pressure (RVP) of 100 mmHg, called Pg. The perform now a horizontal S-shaped incision in the popliteal fossa.…”

“…This method, described elsewhere, consists of the tilt phase (phase 1), the dynamic phase (phase 2), and the functional phase (phase 3) 9', [14][15][16]22,23 Postoperative Phlebography Postoperative phlebography was made on the tenth postoperative day or later. It was similar to the preoperative phlebography (phases 1 and 2), with modified phase 2 consisting of two active plantar flexions of the foot followed by flexion of the knee.9,IO, [14][15][16] Venous Pressure Measurements Venous pressures were recorded by a scalp vein butterfly needle inserted into a vein on the dorsum of the foot. It was connected to a transducer, an amplifier, and finally to a penrecorder.…”