Longevity and outcomes of axillary valve transplantation for severe lower extremity chronic venous insufficiency

To assess the efficacy of axillary vein transplantation in the treatment of severe chronic venous insufficiency (CVI).

Among 139 complex venous reconstructions performed between 1991 and 2007 for CVI, 18 patients underwent upper extremity to lower extremity venous valve transplantation. An upper extremity valve was transplanted to the popliteal vein in 13 cases, to the common femoral vein in six cases, and to the saphenofemoral junction in two cases for a total of 21 procedures. All patients had follow-up with duplex scanning to assess valve competency and clinical visits to assess clinical improvement. Mean follow-up period was 37 months.

Mean patient age was 44 years, and 57% were men. Clinically, 57% of the limbs were Clincal (C) class C5-C6. The mean preoperative venous disability score was 2.95. Most of the patients (66%) had post-thrombotic valvular dysfunction. At the time of valve transplantation, there was no proximal venous obstruction documented. A successful operation was defined as a competent valve at the end of the procedure and was achieved in 20 of 21 (95%) patients. Eight patients had at least one postoperative complication, primarily bleeding. The mean postoperative venous disability score was 2.65 and this increased to 2.75 (p = not significant as compared with baseline) at the last postoperative visit. Median time to return of symptoms was 12 months, and median reflux-free survival period was 15 months.

Despite initial technical and symptomatic success with venous valve transplantation, there is a poor long-term valve competency rate and symptomatic control. These data suggest that a better understanding and therapy for severe CVI associated with valvular incompetence needs to be found.