[Surgery for deep venous reflux in the lower limb].

Area of Science:

• Vascular Surgery
• Venous Disease Management
• Surgical Interventions

Context:

• Deep venous reflux (DVR) is a significant factor in chronic venous insufficiency (CVI), often associated with superficial reflux or perforator incompetence.
• Post-thrombotic syndrome is the most common cause of DVR, accounting for a majority of CVI cases.
• Despite its effectiveness, deep reconstructive surgery for DVR remains controversial and is performed infrequently worldwide.

Purpose:

• To review the surgical techniques, indications, and outcomes for deep venous reflux (DVR) in the lower limb.
• To assess the effectiveness of various surgical interventions for primary and secondary DVR.
• To provide recommendations for the management of DVR in patients with chronic venous insufficiency (CVI).

Summary:

• Surgical techniques for DVR include valvuloplasty, transposition, and transplantation, with varying success rates.
• Valvuloplasty is the most common procedure for primary deep reflux, achieving good results in approximately 70% of cases.
• For secondary reflux, particularly post-thrombotic syndrome, outcomes are less favorable, with good results in about 50% of cases, and higher failure rates.

Impact:

• Better outcomes are observed in primary reflux treatment compared to secondary reflux.
• DVR surgery is indicated for severe CVI (grades C4-C6) and requires careful patient selection based on clinical severity, hemodynamics, and imaging.
• The procedure should be performed in specialized centers due to its complexity and the need for high surgical expertise.