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

Area of Science:

• Vascular Surgery
• Venous Disease Management
• Surgical Outcomes

Background:

• The effectiveness of deep venous reconstructive surgery (DVRS) for venous reflux is debated.
• Post-thrombotic syndrome is a common cause of deep venous reflux (DVR), often overshadowing primary deep vein insufficiency.
• Clinical examination alone often fails to differentiate superficial from deep venous insufficiency or primary from secondary reflux.

Purpose of the Study:

• To review the diagnostic and surgical considerations for deep venous reconstructive surgery (DVRS) in managing deep venous reflux (DVR).
• To highlight the challenges in assessing DVRS outcomes due to combined procedures and the importance of etiology in surgical decisions.

Main Methods:

• Utilized duplex scanning, plethysmography, ambulatory venous pressure measurement, and venography for diagnosis.
• Discussed surgical techniques for DVR, emphasizing correction of superficial and perforator reflux alongside deep venous issues.
• Reviewed criteria for DVRS indication, including clinical, hemodynamic, and imaging factors, with etiology as a key decision driver.

Main Results:

• Duplex scanning offers comprehensive diagnostic information, while plethysmography assesses overall severity but struggles with combined insufficiencies.
• Ambulatory venous pressure measurement and venography are crucial complementary investigations when surgery is considered.
• Surgical success in DVRS is challenging to evaluate due to frequent combination with superficial and perforator vein procedures.

Conclusions:

• DVRS for DVR requires careful patient selection based on comprehensive diagnostics and consideration of etiology, favoring primary reflux.
• Correction of all reflux mechanisms (deep, superficial, perforator) is essential for reducing ambulatory venous pressure.
• DVRS should be performed in specialized centers by highly trained surgical teams.