Reconstructive surgery for deep venous reflux: a report on 144 cases.

Area of Science:

• Vascular Surgery
• Venous Disease Management
• Surgical Innovation

Background:

• Deep venous reflux affects numerous patients, often leading to severe clinical manifestations like venous ulcers.
• Restoring venous valvular function is a key goal in managing chronic venous insufficiency.
• Both primary and secondary (post-thrombotic syndrome) venous diseases require effective treatment strategies.

Purpose of the Study:

• To evaluate the efficacy of different surgical techniques for deep venous reflux.
• To compare clinical and hemodynamic outcomes based on etiology and surgical procedure.
• To establish a correlation between valvular reconstruction success and clinical improvement.

Main Methods:

• Retrospective analysis of 144 lower extremities (133 patients) undergoing surgery for deep venous reflux.
• Surgical procedures included valvuloplasty, transposition, transplantation, and Psathakis' technique II.
• Postoperative venography assessed segmental thrombosis; clinical and hemodynamic results were evaluated over 12-168 months.

Main Results:

• Segmental thromboses occurred in 20.3% of cases, significantly higher in secondary (32.3%) versus primary (8.8%) venous disease.
• Valvuloplasty demonstrated satisfactory valvular reconstruction (P=0.005), particularly for primary venous insufficiency.
• Overall outcomes were superior in primary venous insufficiency compared to post-thrombotic syndromes (P=0.03).

Conclusions:

• Surgical restoration of venous valvular function is feasible, with valvuloplasty showing promising results for primary venous insufficiency.
• Post-thrombotic syndrome presents a greater challenge, with higher rates of thrombosis and less favorable outcomes.
• Procedure selection should consider etiology and technique feasibility for optimal patient results.