Valve reconstruction procedures for nonobstructive venous insufficiency: rationale, techniques, and results in 107...

Among 211 limbs with nonobstructive chronic venous insufficiency, valve reflux of the deep system was the predominant (more than 70%) pathologic condition. Superficial venous or perforator incompetence when present invariably occurred in combination with valve reflux of the deep veins, suggesting that the latter is a common denominator for symptom production. Single level-single system reflux was only occasionally symptomatic (10%), whereas the incidence of single level-multisystem reflux (25%) and multilevel-multisystem reflux (65%) in symptomatic limbs was much higher. Our experience with 107 venous valve reconstructions with a 2- to 8-year follow-up is described. Different techniques of valve reconstruction employed are detailed. The most common pathologic feature is a redundant valve with malcoaptation probably of nonthrombotic origin. Valsalva foot venous pressure elevation is a useful hemodynamic technique for assessing surgical results. Valvuloplasty may be superior to other reconstruction techniques in relieving symptoms of stasis, including stasis ulceration.