Asymmetric Valve Reconstruction Surgery for Severe Chronic Lower Extremity Venous Insufficiency Caused by...

Severe chronic lower extremity venous insufficiency caused by post-thrombotic syndrome (PTS) remains a challenging clinical condition. Femoral venous valve reconstruction offers potential therapeutic options, yet comparative data on different surgical approaches are limited. This study investigated the efficacy and safety of asymmetric femoral venous valve reconstruction in patients with severe chronic lower extremity venous insufficiency caused by PTS.

This study was a historical cohort study. Patients with PTS at the Clinical-Etiological-Anatomical-Pathophysiological classification C4 or higher were enrolled consecutively. All patients underwent femoral vein exploration for asymmetric valve reconstruction; if reconstruction was impossible or failed, valve transplantation or transposition was performed instead. Patients were grouped according to their final surgical procedure. The primary outcome was the Venous Clinical Severity Score (VCSS) during the 3-year follow-up period, and secondary outcomes were operative time, intraoperative pressure injury risk, ulcer healing status, and venous reflux.

The asymmetric valve reconstruction group consisted of 11 individuals, while the venous valve transplantation/transposition group comprised 10. Compared with valve transplantation/transposition, from month 3 to month 24 after surgery, asymmetric valve reconstruction was associated with higher VCSS compared to the other group (P < 0.05), while after 30 months, there were no significant differences between the 2 groups (P > 0.05). Asymmetric valve reconstruction was associated with a shorter operative time (P < 0.001) and a lower intraoperative pressure injury (Stage I in the sacrococcygeal region) risk (P = 0.035). All venous ulcers healed (mean healing time: 5.1 months asymmetric reconstruction group versus 3.6 months transplantation/transposition group; Log-rank test, P = 0.068). Eight (72.7%) in the asymmetric reconstruction group and four (40%) in the transplantation/transposition group experienced recurrence of severe femoral venous reflux in the first 12 months (mean time free from severe reflux: 8.7 months vs. 10.8 months; Log-rank test, P = 0.097).

For severe PTS patients failing nonsurgical therapy, femoral vein exploration with attempted asymmetric valve reconstruction may be prioritized over valve transplantation/transposition, offering comparable outcomes and better perioperative safety.