External venous valve plasty (EVVP) in patients with primary chronic venous insufficiency (PCVI).
OBJECTIVE
To evaluate the patency of EVVP and its effect in symptom relief, ulcer healing and ulcer-free period in patients with PCVI.


METHODS
Between 1993 and 2004, 1800 patients with CVI were evaluated and seventeen with PCVI were selected for EVVP. They were all investigated with ambulatory venous pressure measurement (AVP), colour duplex ultrasound (CDU), ascending venography and descending video venography. The CEAP classification was used to group the patients. Six patients were C4, four C5 and seven C6. All had deep reflux and high levels of AVP.


RESULTS
All procedures were technically successful. The ulcer healing rate was 4/7 (57%) within 3 months. All C4 patients experienced symptom improvement postoperatively and had a median recurrence free period of 72 (range 60-122) months. The C5 group had an median ulcer free period of 61 months (12-72) and the C6 of median 48 (12-72) months. Single valve plasties (4) reached a median competence period of 48 months (12-72), 12 multiple valve plasties at the same level show a median 78 months (63-122) and 10 multilevel repairs median 54 months (12-96). Multiple valve plasties at the same level (multi-station plasties) performed on the C4 group seemed to yield the longest durability with a median of 103 months (84-122).


CONCLUSIONS
EVVP with an ulcer healing rate of 57% and satisfactory symptom improvement seems to be an alternative of surgical treatment for selected patients with PCVI. The durability of this technique seems to be related to clinical severity and the multiplicity of repairs.
Rosales
A
A
Oslo Centre for Vascular Surgery, Aker University Hospital, Oslo, Norway. antonio.rosales@aker-sykehus.no
Slagsvold
C E
CE
Kroese
A J
AJ
Stranden
E
E
Risum
Ø
Ø
Jørgensen
J J
JJ
D000328:Adult; D000368:Aged; D002908:Chronic Disease; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010690:Phlebography; D012720:Severity of Illness Index; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D014647:Varicose Ulcer / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D014654:Vascular Patency; D014656:Vascular Surgical Procedures; D014689:Venous Insufficiency / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D014690:Venous Pressure