Deep venous reconstructions: long-term outcome in patients with primary or post-thrombotic deep venous incompetence

To evaluate long-term durability and clinical success of deep venous reconstruction for severe chronic venous insufficiency as a part of routine workload at a university vascular surgery department.

Retrospective analysis of clinical series.

Between 1996 and 2000, 43 patients underwent deep venous reconstruction, and 38 were available for follow-up. Of these, 29 had secondary valve disease. Median follow-up time was 4.5 years (range, 2-6.5). Preoperatively, 20 had active or healed ulcers.

Severity of the disease was assessed by the CEAP classification, clinical severity and disability scores, and duplex evaluation. Criteria for clinical success were the following: no or mild symptoms and ability to work for eight hours. Surgical reconstructions included 12 internal and seven external valvuloplasties, 14 vein transpositions, and 29 valve transplantations. Of the 38 patients, six needed at least one further reconstruction. Follow-up visits were set at one month, six months, and thereafter annually. Two independent examiners performed the final examination.

The overall cumulative clinical success rate at four years was 23%, and freedom from ulcer 54%. Valvuloplasties were the most durable techniques with a cumulative 4-year durability rate of 55%. The durability rate for transpositions was 43%, and for transplantations 16%. Of 13 reconstructions for primary insufficiency, nine were durable.

Overall results were unsatisfactory, although the durability of reconstructions for primary insufficiency were acceptable.