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A Journal on Phlebology
Acta Phlebologica 2000 December;1(2):51-8
External banding valvuloplasty of the proximal long saphenous vein. Ten years experience and follow-up
Corcos L. 1, Trignano M. 1, De Anna D. 2, Peruzzi G. 1, Procacci T. 1, Spina T. 3
1 Department of Surgical Pathology, Postgraduate School of Thoracic Surgery, University of Sassari, Italy;
2 Department of General Surgery, University of Udine, Italy;
3 Vascular Laboratory, Prosperius-Villa Cherubini Institute of Florence, Italy
BACKGROUND: 153 limbs affected with early insufficiency of the proximal long saphenous vein and of the sapheno-femoral junction were subjected from 1988 to 1998 to surgical treatment by the external banding valvuloplasty. Histological, diagnostic and surgical studies were carried out during the ten years experience. The studies performed reduced the indications and improved the results. Aim of the paper is to verify the proper indications and the long term efficacy of the procedure.
METHODS: 153 limbs of 150 patients (6 bilateral) were selected by Duplex examination and subjected to saphenous banding procedure, using different prosthetic materials and intraoperative instrumental monitoring. 150 limbs were followed up and controlled (3 not controlled) in different periods during ten years. The operations were divided into three sets: 72 (69 followed-up) during the first three years period, 57 in the second and 24 in the third. Follow-up at ten years was done on 22/24 limbs operated on between 1988 and 1989, belonging to the first set. The results obtained after ten years and during the three periods were compared.
RESULTS: The results obtained in the 22/24 limbs operated on ten years ago are the following: 15 (68 %) competent and asymptomatic, 7 (31,8%) recurrent, 2 (9%) postoperative explantations and stripping, 2 (9%) post-operative thrombosis, 1 (4.5%) foreign-body reaction. The final results obtained in 150/153 limbs during the ten years experience are the following: 120 (80%) competent, 131 (87.3%) asymptomatic, 26 (17.3%) recurrent, 8 (5.3%) postoperative explantations and stripping, 9 (6%) postoperative thrombosis, 17 (11.5%) foreign-body reactions and 2 (1.3%) infections.
CONCLUSIONS: The conclusions reached by the previous studies and the follow-up are the following: the terminal valve is responsible for 97% of the proximal saphenous insufficiency; recurrences are due to cusp hypotrophy and thrombosis; silicone is the most inert material used; indications are found in less than 8% of the cases with good results in more than 90%; no recurrences were due to collateral veins of the junction; progress in the diagnostic selection of the cases and of the materials used led to a significant improvement of the results obtained during the third three year period.