Reconstructive surgery for deep vein reflux

M. Perrin

doi:10.12687/phleb2185-1-2014

Phlebologie, Table of Contents

Phlebologie 2014; 43(01): 23-31
DOI: 10.12687/phleb2185-1-2014

Review

Schattauer GmbH

Reconstructive surgery for deep vein reflux

Wiederherstellungschirurgie bei tiefem Venenreflux

M. Perrin

¹Unité de pathologie vasculaire Jean Kunlin, Lyon, France

› Author Affiliations

Abstract

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.

Keywords

Deep venous surgery - venous valve incompetence - chronic venous insufficiency - venous reflux - post-thrombotic syndrome

Schlüsselwörter

Chirurgie der tiefen Venen - Inkompetenz der Venenklappen - chronisch-venöse Insuffizienz - venöser Reflux - postthrombotisches Syndrom

Full Text

References

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