Effect of external valvuloplasty of the deep vein in the treatment of chronic venous insufficiency of the lower extremity.
OBJECTIVE
This study was conducted to verify the efficacy of external valvuloplasty of the femoral vein in the treatment of primary chronic venous insufficiency (PCVI).


METHODS
Forty patients with PCVI of the bilateral lower extremities were enrolled at the time of surgical management. All 80 limbs were classified as CEAP C2 to C4, with moderate incompetence of the deep vein. The limbs of each patient were randomized into one of two groups according to the operative method, so that when one limb was randomized to group A, regardless of whether it was the right or left limb, the other limb was assigned to group B. In group A, external valvuloplasty of the femoral vein was combined with surgery of the superficial venous system; in group B, surgery of the superficial venous system alone was performed. The therapeutic effects between the limbs in groups A and B were compared by color duplex scanning, a color Doppler velocity profile, air plethysmography (APG), and a CEAP severity score at 1 month, 1 year, and 3 years postoperatively.


RESULTS
Within each group of limbs, no significant differences were found in the average operative time within each group of limbs. The varicose veins resolved, there were no deep vein thromboses, and the wounds healed well postoperatively in all cases. Leg heaviness was relieved completely in 90% of group A limbs (36/40) and 55% of group B limbs (22/40). Venous valve competence was achieved in 100%, 98.1%, and 90.9% of group A limbs at 1 month, 1 year, and 3 years postoperatively, respectively. The amount of venous reflux, APG indices, and CEAP severity scores were not significantly different between the two groups preoperatively (P > .05). The amount of venous reflux, reflux indices, CEAP severity scores, and muscle pumping indices improved markedly in group A limbs postoperatively compared with group B limbs (P < .01); muscle pumping indices did not improve significantly in group B limbs postoperatively (P > .05). There were significant differences in the amount of venous reflux, reflux indices, and CEAP severity scores between group A and B limbs at 1 month and 1 year postoperatively (P < .01). There were significant differences in all parameters assessed between group A and B limbs 3 years postoperatively (P < .05).


CONCLUSIONS
External valvuloplasty of the femoral vein combined with surgical repair of the superficial venous system improved the hemodynamic status of the lower limbs, restored valvular function more effectively, and achieved better outcomes than surgical repair of the superficial venous system alone.
Wang
Shen-Ming
SM
Department of Vascular Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Peoples Republic of China. ShenmingWang@sohu.com
Hu
Zuo-Jun
ZJ
Li
Song-Qi
SQ
Huang
Xue-Ling
XL
Ye
Cai-Sheng
CS
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001783:Blood Flow Velocity; D002908:Chronic Disease; D005260:Female; D005268:Femoral Vein / Q000503:physiopathology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010991:Plethysmography; D011446:Prospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D014648:Varicose Veins / Q000503:physiopathology / Q000601:surgery*; D014654:Vascular Patency; D014656:Vascular Surgical Procedures; D014680:Veins / Q000601:surgery; D014689:Venous Insufficiency / Q000503:physiopathology / Q000601:surgery*