[Valve repair at the level of the sub-inguinal deep venous plexus. Gadget technique or efficacious surgery?]

Between 1988 and 1990, the authors performed 35 valvuloplasties for major reflux syndrome involving the sub-inguinal deep venous system. Twenty two patients with a mean follow-up period of 23 months (1 year--3 years) were reviewed clinically and hemodynamically. Only one of the 10 patients with a chronic ulcer had developed a recurrence. This concerned the only postoperative thrombosis seen in this series. Results from a hemodynamic standpoint were as follows: Reflux evaluated preoperatively was Kistner type 4 with a popliteal venous reflux index (VRI) with a mean grade of 1.1. Postoperative evaluation (Duplex-Scan) showed the absence of reflux below the valvuloplasty in 86 p. cent of cases and VRI was normalised (less than 0.50) to the same extent. Mean venous filling time (PPG, peripheral pressure gradient measurement) after application of a supra-malleolar tourniquet was 8" (-8n + 4) preoperatively. It became normal in 13 patients and improved in 8 (mean of 82 p. cent). The results of valvuloplasty in this series confirm those published by other teams. They are notably superior to those offered by transposition and transplantation procedures. Unfortunately, this effective technique can only rarely be used in post-thrombotic syndromes and is useful essentially in Primary Deep Valve Insufficiency.