Australia & New Zealand Society of Vascular Surgeons

Background Deep venous reflux is responsible for considerable morbidity in the form of venous leg ulceration and remains a very significant health problem. Deep venous reconstructions have been looked upon as controversial in the past. To clarify the role of deep vein valve reconstructions in chronic venous insufficiency, we report the lessons learned from clinical and imaging results of a five year surgical experience. Material and Methods From 1994 to 1999, 137 patients (169 limbs) underwent deep vein valve reconstructions for non-healing venous leg ulceration CEAP C6 class, as a last resort treatment. End points of the study were: leg ulcer healing, valve station patency and competency. All end points were looked up on follow-up of minimal 2 year period following the valve reconstructions. Results External valvuloplasty showed ulcer healing in 50% of the limbs with maintenance of competency at only 31% of valve stations. Internal valvuloplasty was the most durable valve repair procedure with leg ulcer healing rate of 67% and valve station competency of 79%. For secondary incompetency valve transplants showed a significant deterioration in valve patency of 58% and competency of 47% with 55% ulcer healing. Single level repairs or single valve transplants have much lower ulcer healing rates than multiple level repairs or valve transplants with multiple valve stations. Important lessons learned from this study are 1. Valvular reconstruction for refluxive disease is effective in healing venous ulcers that defy conservative management and superficial/perforator venous surgery. 2. These procedures appear more promising for primary than secondary valvular incompetence. 3. Multiple level or multiple valve reconstructions yield superior results to single level repairs, challenging the “gatekeeper” concept.