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[Theory and practice of hemodynamic treatment of deep venous insufficiency caused by valve absence]
1Hôpital Henri Mondor, Creteil.
Insights
Surgical treatment for deep venous insufficiency (HDDVI) uses selective ligatures to block reverse blood flow in incompetent veins. This novel approach aims to restore normal circulation by targeting key deep veins.
Area of Science:
- Vascular Surgery
- Venous Physiology
Background:
- Deep venous insufficiency (HDDVI) results from valve absence, causing reverse circulation and increased pressure.
- Ineffective veins develop collateral circulation, which is neutralized by the diseased vein forming a retrograde shunt.
Purpose of the Study:
- To introduce a novel surgical theory for treating HDDVI using selective ligatures.
- To address the anatomical and functional basis of HDDVI and propose a targeted treatment strategy.
Main Methods:
- Selective ligation of incompetent main deep veins (popliteal, femoral, external iliac) with minimal collaterals.
- Utilizing orthostatic duplex Doppler to create a hemodynamic map of deep veins.
- Evaluating the strategy based on physical, anatomical, and functional clinical arguments.
Main Results:
- The proposed theory is supported by initial case treatments.
- Demonstrated the potential of selective ligatures to correct retrograde shunting in HDDVI.
Conclusions:
- HDDVI surgical treatment can be effectively managed by targeting specific incompetent deep veins.
- The novel theory provides a sound basis for treating deep venous insufficiency with selective ligatures.
Abstract:
HDDVI is a form of surgical treatment which, using a series of selective ligatures, is aimed at curing deep venous insufficiency due to valve absence. There are two fundamental principles: an incompetent vein ensures no venous return in standing position and is the site of reverse circulation; this ineffective vein develops a collateral circulation because of the increased pressure which it produces. However, this parallel circulation is in fact neutralised by the diseased vein which forms a retrograde shunt. Section ligatures are suggested taking into account single main veins with minimal collaterals (popliteal vein, femoral vein, external iliac vein) for which patency is essential. This novel theory is based upon physical, and anatomical and functional clinical arguments. The strategy is discussed in terms of the hemodynamic map of the deep veins obtained by orthostatic duplex Doppler. Confirmation that the theory is well-founded appears to be provided by the first cases treated.