Transcommissural valvuloplasty: technique and results.

Area of Science:

• Vascular Surgery
• Surgical Techniques
• Venous Disease Management

Background:

• Venous valve insufficiency is a common condition leading to chronic venous disease.
• Surgical repair of venous valves aims to restore normal venous function and prevent disease progression.
• Traditional methods like internal valvuloplasty have limitations, necessitating alternative approaches.

Purpose of the Study:

• To describe the technique of transcommissural valvuloplasty, a variation of closed external venous valve repair.
• To evaluate the complication rate associated with this procedure.
• To assess the durability of the repair using duplex scan follow-up.

Main Methods:

• Transcommissural valvuloplasty was performed by placing transluminal sutures to close the valve attachment angle and tighten cusps.
• A total of 179 valve sites in 141 limbs of 129 patients were repaired.
• Follow-up ranged from 1 to 42 months, involving clinical observation and duplex Doppler ultrasound.

Main Results:

• Postoperative complications occurred in 9% of limbs within 30 days, including infections, hematomas, seroma, and deep vein thrombosis.
• Valve competency rates were 78% (reflux ≤ 0.5s) and 81% (reflux ≤ 1.0s) at follow-up.
• Cumulative competency reached 59-63% at 30 months, with a 63% ulcer recurrence-free interval and significant improvement in pain and swelling.

Conclusions:

• Transcommissural valvuloplasty is a safe procedure with low morbidity, comparable competency rates to internal valvuloplasty.
• Advantages include no requirement for venotomy, applicability to small veins, and suitability for single-stage, multi-station repairs.
• The technique offers a rapid, simple, and effective option for venous valve repair.