title: Popliteal vein external banding at the valve-free segment to treat severe chronic venous insufficiency.
abstract: OBJECTIVE
  Axial deep venous reflux causes skin changes or ulcers in patients with chronic venous insufficiency (CVI). The study aimed to review the results of correcting axial deep venous reflux using the novel valve-free popliteal vein external banding (PVEB) technique in patients with severe CVI.
  
  
  METHODS
  We retrospectively reviewed 1252 patients (1252 limbs) who underwent PVEB for treatment of severe CVI from 2000 to 2015. The number and position of popliteal vein valves (PVVs) and gastrocnemius vein entries were analyzed. Preprocedural and postprocedural intraluminal pressure and other hemodynamic parameters were measured and compared. Synchronous skin grafting was used for large ulcers. The healing time and ulcer and symptom recurrence rate were analyzed. Long-term Venous Clinical Severity Score was compared.
  
  
  RESULTS
  One pair of PVV leaflets, gastrocnemius vein entries proximal to the PVV, and PVV located in the distal-third popliteal vein segment were confirmed in 87.38% of cases in the venographic study. A total of 1252 patients underwent PVEB, and 1041 patients were followed up (mean follow-up, 55.12 months; range, 9-183 months). In the short term, limb swelling and pain were relieved in 1187 patients (94.81%) without use of compression therapy. The reflux time and reflux volume were significantly reduced (P < .001). All the ulcers were healed in an average of 18 days (95% confidence interval, 16.68-19.32). In the long term, the ulcer recurrence rate was 3.63%. The Venous Clinical Severity Score was significantly reduced (P < .001).
  
  
  CONCLUSIONS
  PVEB, which neither opens the vein wall nor relies on the existing vein valves, can promote venous return, improve hemodynamic status, and heal venous ulcer in <2 months, with low complication and symptom recurrence rates.
authors.affiliation: Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Ma
authors.affiliation: Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Weiguo
authors.initials: W
authors.lastname: Fu
authors.affiliation: Department of Vascular Surgery, Dalian Municipal Central Hospital, Dalian, China. Electronic address: vascmajie@163.com.
authors.forename: Jie
authors.initials: J
authors.lastname: Ma
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055109:Ankle Brachial Index; D002908:Chronic Disease; D005260:Female; D006439:Hemodynamics; D006801:Humans; D053208:Kaplan-Meier Estimate; D008026:Ligation; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D011152:Popliteal Vein / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014647:Varicose Ulcer / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D014689:Venous Insufficiency / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D014945:Wound Healing; D055815:Young Adult