Axillary vein transfer in trabeculated postthrombotic veins

This study assessed whether axillary vein transfer can be successfully performed in trabeculated veins and whether patients with this severe form of postthrombotic syndrome can be helped by an aggressive approach.

A total of 102 axillary vein transfer procedures were carried out in 83 limbs with trabeculated veins. More than one venous segment was repaired in 38 limbs with a second axillary valve in 19, and a different technique was used in the remainder. The superficial and deep femoral veins were the most common target sites. "Bench repair" of leaky axillary valves was performed before the transfer in 32 cases. Venous stasis dermatitis or ulceration was present in 90% of the limbs. The operability rate and chance of successful valve reconstruction was high, even in the presence of severe venographic appearance.

The actuarial transplant patency rate was 83% at 10 years. The actuarial freedom from recurrent ulceration rate was more than 60% at 10 years, similar to the results obtained in a matched group of axillary vein transfers to nontrabeculated veins. Severe preoperative ambulatory venous hypertension (venous filling time [VFT] of less than 5 seconds), which was present in 67% of patients, did not adversely affect outcome, but short VFTs that persisted after surgery did. VFT and VFI90 (venous filling index, air plethysmography) improved after valve transfer. Swelling disappeared or was significantly reduced in 55% of patients (11 of 20 patients) who had moderate or severe preoperative swelling. In 82% of patients (31 of 37 patients) who had mild or no preoperative swelling, the swelling remained stable after surgery, and in 18% of patients (6 of 37 patients), it became worse. Pain was significantly diminished in 70% of patients; 23% of patients with severe pain had complete resolution.

Axillary vein transfer, in combination with other antirefluxive procedures when indicated, is safe, effective, and durable in patients with trabeculated veins and severe forms of postthrombotic syndrome. It may be considered as an option when conservative therapy or other types of surgery fail.