[Surgical reconstruction in deep venous insufficiency]

Deep venous insufficiency is present clinically in post-phlebitis syndrome (PPS), above all at the stage of incompetence, after venous recanalisation, and in primary deep venous insufficiency (PDVI). Its different anatomical and pathological patterns lead to a varied management approach. Venous bypass procedures (using the techniques of Palma, Warren-Hushi, etc.) have been used in PPS at the obstructive stage but have now been virtually abandoned. In PPS at the stage of incompetence, after recanalisation, transposition of the incompetent vein to a competent vein has been suggested together with the grafting of a segment of valve-bearing vein. This is associated with many technical difficulties. In contrast, venous reconstruction surgery appears more promising in the case of PDVI. At the first stage, with a dilated vein and valve borders merely detached, it has been possible to obtain good results from external valvuloplasty by bandaging of the vein. The authors' experience at this stage involves a series of 54 operations with a follow-up of 4 to 63 months. At the late stage of PDVI, with frankly prolapsed valve borders, very useful results have been obtained form internal valvuloplasty, using various methods. Authors have recently been working on the artificial venous valve (Spiegowski, Taheri, Garcia-Rinaldi and ourselves) with uncertain results. We are currently studying a heterologous (metal and/or polymer) prosthetic device.