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DOI: 10.12687/phleb2185-1-2014
Reconstructive surgery for deep vein reflux
Wiederherstellungschirurgie bei tiefem VenenrefluxPublication History
Received:
20 December 2013
Accepted:
07 January 2014
Publication Date:
04 January 2018 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00034913/201401/lookinside/thumbnails/10-12687-phleb-2185-1-2014-1.jpg)
Summary
DVR is defined as a reflux affecting the deep venous system. DVR essentially arises from two etiologies, primary deep valve incompetence (PDVI) and posthrombotic syndrome (PTS), knowing that axial reflux is correlated with severe chronic venous insufficiency. DVR correction aims at reducing the increased ambulatory venous pressure, which results from reflux in deep veins in orthodynamic conditions.
The results of DVR surgery are not easy to assess, as it is mostly combined with surgery for superficial venous system and/or perforators insufficiency.
In cases of primary insufficiency, valvuloplasty, the operation of choice, is credited at 5 years follow-up with a 70 % success rate in terms of clinical outcome and improved hemodynamic performance. In PTS, a meta-analysis of transpositions and transplants at more than 5 years estimates successful clinical outcome and improved hemodynamic performance at approximately 50 %. The Maleti neovalve construction technique has achieved by far better results.
Indications for DVR surgery are based on clinical, hemodynamic and imaging data. Etiology is a decisive factor in the choice of the technique.
Zusammenfassung
Der tiefe venöse Reflux (DVR) ist definiert als ein Rückstrom im tiefen Venensystem. Ätiologisch beruht er auf einer primären Inkompetenz der tiefen Venenklappen oder einem postthrombotischen Syndrom (PTS), wobei der axiale Reflux mit einer schweren chronisch-venösen Insuffizienz korreliert.
Durch eine Korrektur des DVR soll der infolge eines Rückstroms aus den tiefen Venen unter orthodynamischen Bedingungen erhöhte ambulatorische Venendruck gesenkt werden. Die Ergebnisse einer DVR-Operation sind nicht leicht zu überprüfen, da sie meist mit Eingriffen am oberflächlichen Venensystem und/oder an insuffizienten Perforansvenen kombiniert wird.
Bei einer primären Insuffizienz wird für die Valvuloplastie, die Operation der Wahl, eine postoperative 5-Jahres-Erfolgsrate von 70 % in Bezug auf das klinische Ergebnis und die verbesserte hämodynamische Situation angenommen. Bei PTS wird das klinische und hämodynamische Ergebnis in einer Metaanalyse zu Transpositionen und Transplantationen in etwa 50 % als erfolgreich verbessert eingeschätzt. Mit der Schaffung einer Neoklappe (Technik nach Maleti) werden weitaus bessere Ergebnisse erzielt.
Die Indikationen für DVR-Operationen basie-ren auf klinischen, hämodynamischen und bildgebenden Daten. Die Ätiologie ist der entscheidende Faktor bei der Wahl der Technik.
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References
- 1 Kistner RL. Surgical repair of a venous valve. Straub Clin Proc 1968; 24: 41-43.
- 2 Eklöf B, Perrin M, Delis KT, Rutherford RB, Gloviczki P. VEINTERM Transatlantic Interdisciplinary Faculty. Updated terminology of chronic venous disorders: the vein-term transatlantic interdisciplinary consensus document. J Vasc Surg 2009; 49: 498-501.
- 3 Danielsson G, Eklöf B, Grandinetti A, Kistner RL, Masuda EM, Sato DT. Reflux from thigh to calf, the major pathology in chronic venous ulcer disease: surgery indicated in the majority of patients. Vasc Endovasc Surg 2004; 38: 209-219.
- 4 Maleti O. Venous valvular reconstruction in post-thrombotic syndrome. A new technique. J Mal Vasc 2002; 27: 218-221.
- 5 Kistner RL. Surgical repair of the incompetent femoral vein valve. Arch Surg 1975; 110: 1336-1342.
- 6 Lurie F, Kistner RL, Eklof B, Kessler D. Mechanism of venous valve closure and role of the valve in circulation. A new concept. J Vasc Surg 2003; 38: 955-961.
- 7 Neglen P, Raju S. Intravascular ultrasound scan evaluation of the obstructed vein. J Vasc Surg 2002; 35: 694-700.
- 8 Kistner RL, Ferris EB, Randhawa G, Kamida C. A method of performing descending venography. J Vasc Surg 1986; 4: 464-468.
- 9 Sottiurai VS. Technique in direct venous valvuloplasty. J Vasc Surg 1988; 8: 646-648.
- 10 Kistner RL, Sparkuhl MD. Surgery in acute and chronic venous disease. Surgery 1979; 85: 31-43.
- 11 Maleti O. Venous valvular reconstruction in post-thrombotic syndrome. A new technique. J Mal Vasc 2002; 27: 21821
- 12 Maleti O, Lugli M. Neovalve construction in postthrombotic syndrome. J Vasc Surg 2006; 43: 794-799.
- 13 Kistner RL. Surgical technique of external venous valve repair. Straub Clin Proc 1990; 55: 15-16.
- 14 Raju S, Berry MA, Neglen P. Transcommissural valvuloplasty: technique and results. J Vasc Surg 2000; 32: 969-976.
- 15 Dalsing MC. Artificial venous valves. In: Gloviczki P. editor. Handbook of venous disorders. cap. 43. Hodder Arnold; 2009: 483-490.
- 16 Lethola A, Oinonen A, Sugano N, Alback A, Lepantalo M. Deep venous reconstructions:long-term outcome in patients with primary or post-thrombotic deep venous incompetence. Eur J Vasc Endovasc Surg 2008; 35: 487-493.
- 17 Masuda EM, Kistner RL. Long-term results of venous valve reconstruction: a four to twenty-one year follow-up. J Vasc Surg 1994; 19: 391-403.
- 18 Perrin M. Reconstructive surgery for deep venous reflux. A report on 144 cases. Cardiovasc Surg 2000; 8: 246-e55.
- 19 Raju S, Fredericks R, Neglen P, Bass JD. Durability of venous valve reconstruction for primary and post-thrombotic reflux. J Vasc Surg 1996; 23: 357-367.
- 20 Raju S, Berry MA, Neglen P. Transcommissural valvuloplasty: technique and results. J Vasc Surg 2000; 32: 969-976.
- 21 Rosales A, Slagsvold CE, Kroese AJ, Stranden E, Risum O, Jorgensen JJ. External venous valveplasty (EVVp) in patients with primary chronic venous insufficiency (PVCI). Eur J Vasc Endovasc Surg 2006; 32: 570-576.
- 22 Sottiurai VS. Current surgical approaches to venous hypertension and valvular reflux. Int J Angiol 1996; 5: 49-54.
- 23 Tripathi R, Sieunarine K, Abbas M, Durrani N. Deep venous valver reconstruction for non healing ulcers: techniques and results. ANZ J Surg 2004; 74: 34-39.
- 24 Rosales A, Slagsvold CE, Kroese AJ, Stranden E, Risum O, Jorgensen JJ. External venous valveplasty (EVVp) in patients with primary chronic venous insufficiency (PVCI). Eur J Vasc Endovasc Surg 2006; 32: 570-576.
- 25 Wang SM, Hu ZJ, Li SQ, Huang XL, Ye CS. Effect of external valvuloplasty of the deep vein in the treatment of chronic venous insufficiency of the lower extremity. J Vasc Surg 2006; 44: 1296-1300.
- 26 Akesson H, Risberg B, Bjorgell O. External support valvuloplasty in the treatment of chronic deep vein incompetence of the legs. Int Angiol 1999; 18: 233-238.
- 27 Lane RJ, Cuzilla ML, McMahon CG. Intermediate to long-term results of repairing incompetent multiple deep venous valves using external stenting. ANZ J Surg 2003; 73: 267-274.
- 28 Camilli S, Guarnera G. External banding valvuloplasty of the superficial femoral vein in the treatment of primary deep valvular incompetence. Int Angiol 1994; 13: 218-222.
- 29 Raju S, Fredericks R, Neglen P, Bass JD. Durability of venous valve reconstruction for primary and post-thrombotic reflux. J Vasc Surg 1996; 23: 357-367.
- 30 Cardon JM, Cardon A, Joyeux A, Mangialardi N, Noblet D, Nguyen T. et al. (in French) La veine saphène interne comme transplant valvulé dans l’insuffisance veineuse post-thrombotique: résultats à long terme. Ann Chir Vasc 1999; 13: 284-289.
- 31 Johnson ND, Queral LA, Flinn WR, Yao JS, Bergan JJ. Late objective assessment of venous valve surgery. Arch Surg 1981; 116: 1461-1466.
- 32 Bry JD, Muto PA, O’Donnell TF, Isaaacson LA. The clinical and hemodynamic results after axillary-to-popliteal valve transplantation. J Vasc Surg 1995; 21: 110-119.
- 33 Rosales A, Jorgensen JJ, Slagsvold CE, Stranden E, Risum O, Kroese AJ. Venous valve reconstruction in patients with secondary chronic venous insufficiency. Eur J Vasc Endovasc Surg 2008; 36: 466-472.
- 34 Eriksson I, Almgren B. Influence of the profunda femoris vein on venous hemodynamics of the limb: experience from thirty one deep vein valve reconstructions. J Vasc Surg 1986; 4: 390-395.
- 35 Mackiewicz Z, Molski S, Jundzill W, Stankiewicz W. Treatment of postphlebitic syndrome with valve transplantation: 5 year experience. Eurosurgery ’95. Bologna Monduzzi 1995; 305-310.
- 36 Nash T. Long-term results of vein valve transplants placed in the popliteal vein for intractable post-phlebitic venous ulcers and pre-ulcer skin changes. J Cardiovasc Surg 1988; 29: 712-716.
- 37 Kabbani L, Escobar GA, Mansour F, Wakefield TW, Henke PH. Longevity and Outcomes of Axillary Valve Transplantation for Severe Lower Extremity Chronic Venous Insufficiency. Annals of Vascular Surgery 2011; 25: 496-501.
- 38 Lugli M, Guerzoni S, Garofalo M, Smedile G, Maleti O. Neovalveconstruction in deep venous incompetence. J Vasc Surg 2009; 49: 156-162.
- 39 Plagnol P, Ciostek P, Grimaud JP, Prokopowicz SC. Technique de reconstruction valvulaire autogéne dans le syndrome de reflux postphlébitique. Ann Chir Vasc 1999; 13: 339-342.
- 40 Opie JC. Monocusp-novel common femoral vein monocusp surgery uncorrectable chronic venous insufficiency with aplastic/ dysplastic valves. Phlebology 2008; 23: 158-171.
- 41 Pavcnik D, Uchida B, Kaufman J, Hinds M, Keller FS, Rösch J. Percutaneous management of chronic deep venous reflux: review of experimental work and early clinical experience with bioprosthetic valve. Vasc Med 2008; 13: 75-84.
- 42 Maleti O, Perrin M. Reconstructive Surgery for Deep Vein Reflux in the Lower Limbs: Techniques, Results and Indications. Eur J Vasc Endovasc Surg 2011; 41: 837-848.
- 43 Raju S, Darcey R, Neglen P. Unexxpected major role for venous stenting in deep reflux disease. J Vasc Surg 2010; 51: 401-409.
- 44 Taheri SA, Heffner R, Bodd T, Pollack LH. Five years experience with vein valve transplant. World J Surg 1986; 10: 935-937.
- 45 Maleti O, Lugli M, Perrin M. Chirurgie du reflux veineux profond. EMC (Elsevier Masson SAS, Paris), Techniques chirurgicales – Chirurgie vasculaire 2009; 43-163.