The Role of External Banding Valvuloplasty in the Surgical Management of Chronic Deep Venous Disease

Abstract

Objective: Correction of venous reflux by perivalvular banding in patients suffering from chronic venous stasis secondary to primary valvular incompetence. Design: Prospective study in a group of patients with severe venous insufficiency. One patient (one extremity) was lost to follow-up. Setting: Tertiary care teaching hospital. Patients: Twelve patients (13 extremities) with severe or moderate venous insufficiency. Interventions: Correction of valvular incompetence by narrowing a valvular ring with an external band. Twenty-seven bands were fitted to incompetent valves of 13 extremities. Main outcome measures: Abolition of reflux and improvement of muscle pump measured by clinical, plethysmographic and venographic criteria. Results: Symptomatic improvement was found in 10 extremities (77%) and complete correction of reflux on venography in eight extremities (67%). Plethysmographically measured reflux improved in 6 extremities (50%) and muscle pump function improved in 7 extremities (58%). No correlation was found between plethysmographic and clinical or venographic outcome. Conclusion: Perivalvular banding can correct reflux and alleviate clinical symptoms of chronic venous stasis in patients with primary valvular incompetence. Selection of patients, valves to be corrected, necessary degree of valvular ring narrowing and need for additional interventions should be further investigated.

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

“…On the other hand, since the GSV is the most appropriate source of grafts for vascular reconstruction, external valvu-loplasty can be attempted as an alternative for patients with saphenofemoral and proximal GSV incompetence. [1][2][3][4][5][6][7] However, many groups state that the risk of varicose vein recurrence increases if the GSV is not excised. [8][9][10] 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.…”

“…[1][2][3][4][5][6][7] However, many groups state that the risk of varicose vein recurrence increases if the GSV is not excised. The incompetent GSV was ligated between the insertion and the anastomosed region.…”

In vitro evaluation of a nitinol based vein cuff for external valvuloplasty

“…A lot of external valvuloplasties (EV) to treat early stages of primary valvular insufficiency of deep veins were performed based on this and satisfactory results have been published [15,17,19,30]. The rationale of the EV procedure is to restore valvular function by reducing the valvular annulus calibre bringing the valve cusps back to their correct positions restoring a sufficient valve closure.…”

“…This in turn may reduce ion diffusion from this material [40] as compared to conventional metals. Although nickel is an essential trace element within the body [8,10,13], the primary concern regarding nitinol relates to the high nickel content of the material and the possibility of hypersensitivity [17,19], and toxic [11,30] or carcinogenic [16,26] effects from increased nickel release into the body [13,33,40]. The chemical surface structure, the surface consistency, surface energy and corrosion resistance are therefore very important parameters defining implant biocompatibility [2].…”

Tissue Response to an Expanded Polytetrafluoroethylene External Valve Support Device: A Histologic Study in Dogs

“…2,[9][10][11][12][13][14] In 1983, we began to use expanded polytetrafluoroethylene (ePTFE) patches or tubes in external valvuloplasty. We have described our successful clinical experience with this technique in several reports.6-8 After external valvuloplasty in some patients, however, progressive dilatation of the femoral vein develops, causing recurrence of incompetence.…”