[Surgery for postthrombotic syndrome of the lower limbs]

Advances have been made in surgery of the post-thrombotic syndrome of the lower limbs with work involving the pathophysiology of the syndrome. It can now be imputed to superficial venous insufficiency involving the saphenous network and (or) perforating veins of the leg, or to deep venous insufficiency which requires careful analysis of its obstructive and reflux components. Surgery addresses only clinical manifestations that are not managed by conservative treatment. In these cases, in superficial venous insufficiency, it appears preferable to excise the saphenous network and (or) to ligate the perforating veins using a subfascial approach, which gives favorable long-term results in 45 to 98% of cases. In deep venous insufficiency, surgery can either by pass the obstructive lesions, or valve transposition or transplantation can be performed at the sites of reflux. Results are less satisfactory, however, leading to healing of recurring ulcers (the reference criterium) in 42 to 60% of the cases. In all cases, surgical results will be better maintained with continued medical treatment, especially compression.