title: The effect of pregnancy on venous valve repair to the sapheno-femoral junction for varicose veins.
abstract: OBJECTIVE
  Pregnancy represents a special situation where both the mechanical and hormonal instigating factors of varicose veins are reversible with the venous valve cusps preserved. Exostent venous valve repairs are a physiological alternative which minimises stimulus to collateral growth (recurrence). The study purpose was to assess the effect of pregnancy on the durability of valve repairs.
  
  
  METHODS
  In a prospective study of 36 limbs, 20 young females (30 ± 4.7 years) had an exostent implanted to the terminal valve of the saphenofemoral junction for varicose veins. At routine long-term follow up (9.7 ± 3.8 years), 38 pregnancies were completed (mean: 1.8, range: 1-4). The controls were a non-pregnant group of limbs (n = 386).
  
  
  RESULTS
  At 9.7 years, the internal diameter of the greater saphenous vein (GSV) changed from 7.8 ± 2.8 mm preoperatively to 4.5 ± 1.4 mm post-operatively. Recurrence was associated with reflux, preoperative deep system and ovarian vein involvement. Pregnancy induced 33.3% recurrences compared with non-pregnant controls (4.7%) similarly treated or 22.8% compared with non-pregnant ablative controls. At 9.7 years, symptomatic improvement continued with significantly better CEAP status (described later) (31CSEAP preoperative to 6CSEAP) with no further truncal ablation (strip, laser) required.
  
  
  CONCLUSIONS
  Venous valve repairs can withstand the special stresses of pregnancy. There is no need to ablate the GSV. This approach is contrary to the traditional dictum; the treatment of varicose veins should be delayed until the family is completed.
authors: Dalcross Adventist Hospital, Sydney, Australia; Macquarie University Hospital, Sydney, Australia.
authors: Martijn L
authors: ML
authors: Dijkstra
authors: Australian School of Advanced Medicine, Macquarie University, Sydney, Australia.
authors: Nyan Y
authors: NY
authors: Khin
authors: Dalcross Adventist Hospital, Sydney, Australia.
authors: John C
authors: JC
authors: Coroneos
authors: Dalcross Adventist Hospital, Sydney, Australia.
authors: Stuart
authors: S
authors: Hazelton
authors: Dalcross Adventist Hospital, Sydney, Australia; Macquarie University Hospital, Sydney, Australia; Australian School of Advanced Medicine, Macquarie University, Sydney, Australia; Royal North Shore Hospital, Sydney, Australia.
authors: Rodney J
authors: RJ
authors: Lane
keywords: cardiovascular; multiple pregnancy