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Dedicated to improving the treatment of venous disease

Volume 8, Number 01

www.venousdigest.com

January 2001

Copyright 1995 John J. Bergan, MD, Inc.

1 of 7

Venous Digest, 2329 Barley Drive, Vista, CA 92083 USA (760) 599-9725

EXTERNAL SUPPORT VALVULOPLASTY

IN THE TREATMENT OF CHRONIC DEEP

VEIN INCOMPETENCE OF THE LEGS

Akesson H, Risberg B, Bjorgell O.

Int Angiol 1998; 18:233-38

ABSTRACT AND COMMENTARY BY:

Robert L. Kistner, MD

Straub Clinic and Hospital

Honolulu, Hawaii

This report is important because the patients chosen were

failures of conventional vein surgery and were then successfully

treated by deep venous valve banding.

External valvuloplasty was performed in 20 patients, 7 with

primary disease and 13 with postthrombotic secondary disease.

All had been previously treated for saphenous and perforator

disease as needed and were failures or recurrences after conven-

tional treatment. Three of the primary cases and seven of the

secondary cases had ulceration. The remainder had swelling as

the main clinical problem. Surgery consisted of a Venocuff to

provide external compression at valve sites in the superficial

femoral vein, the profunda femoris vein, and the popliteal vein

depending on the sites of reflux. Followup in all cases was

between 5 and 32 months. Ulcers and swelling disappeared in

all patients. Postoperative duplex showed disappearance of

reflux in all primary cases and in 10/13 postthrombotic cases.

Data is provided for changes in ambulatory venous pressures and

in return times.

The authors point out that the results are very encouraging

in primary cases where all reflux was abolished and that

symptoms were resolved in all cases. In postthrombotic patients,

10/13 had correction of the reflux but clinical results were less

favorable than in the primary cases because two ulcers persisted,

two extremities had thrombosis in the veins, and three had

persisting symptoms. The authors conclude that the valve

correction was worthwhile in both primary and secondary cases.

COMMENTARY

This is a favorable report of the early results following

banding of the superficial femoral vein and, in a few cases, of the

popliteal vein in both primary and secondary disease. The

morbidity of the procedure seems acceptable although there were

three conversions of these refluxing veins to occluded veins in

20 cases. This represents a high thrombosis rate (15%) in the

TABLE OF CONTENTS

External Support Valvuloplasty in the Treatment of

Chronic Deep Vein Incompetence of the Legs

Akesson H, Risberg B, Bjorgell O.

Abstracted by: Robert Kistner, USA

Angioscopic External Valvuloplasty in the Treatment of

Varicose Veins

Satokawa H, Hoshino H, Takase S, Ogawa T.

Abstracted by: Marc Cairols, Spain

Optimizing of Varicose Vein Surgery by Employment of

a Roll-on Tourniquet (

in German)

Lahl W, Albrecht HG.

Abstracted by: Reinhard Fischer, Switzerland

Endoscopic Subfascial Ligature of the Perforating Veins

of the Femoral Canal or of Dodd Veins

Bourez J, Desmyttere J.

Abstracted by: Reinhard Fischer, Switzerland

Endovascular Sclerotherapy, Surgery, and Surgery Plus

Sclerotherapy in Superficial Venous Incompetence: A

Randomized, 10-Year Followup Trial ? Final Results

Belcaro G, Nicolaides AN, Ricci A, et al.

Abstracted by: J. Jerome Guex, France

Editor

John J. Bergan, MD, FACS

jbergan@ucsd.edu

Editorial Office

2329 Barley Drive

Vista, CA 92083, USA

mrv2@ix.netcom.com