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Corcos L. 1, Cavina C. 2, Peruzzi G. 2, Procacci T. 2, Spina T. 2, De Anna D. 3
1 Master in Phlebolymphology, University of San Marino and Ferrara;
2 Prosperius Institute for Clinical Research, Firenze;
3 Department of General Surgery, University of Udine
Several reports indicate the reliability of deep intravenous valvuloplasty (IVV) however none of them give information about the surgical treatment for atypical morphologic conditions of venous valves. The authors described 4 cases affected with deep venous insufficiency (DVI) of the lower limbs due to various atypical alterations of venous valves and the role of atypical intravenous valvuloplasties (AIVV). Four patients were selected by duplex, Doppler venous pressure index, photoplethysmography and ascending phlebography. Case 1: Female of 52 years, right limb: symptoms from primary DVI, early distrophy and 3 cm aneurysm of the popliteal V. Aneurysm resection and tricuspid valve reconstruction (8 years follow-up.) Case 2: female of 48 years, left limb: symptoms from primary DVI and 4.5 cm aneurysm of the common femoral V containing a monocuspid valve. Aneurysm resection, monocuspid valve reconstruction (7 years follow-up). Case 3: male of 28 years, left limb: symptoms from secondary DVI, distrophy, 2 cm ulcer; popliteal V insufficiency with one atrophic cusp. Monocuspid valve reconstruction (4 year follow-up). Case 4: male of 45 years, right limb: symptoms from secondary DVI, distrophy, healed ulcer; popliteal V insufficiency. Tricuspid valve reconstruction (3 years follow-up). All the postoperative controls were performed by noninvasive examinations. Clinical improvement and valvular patency were obtained in all the cases; reflux elimination in cases 1, 2, and reduction in case 3, 4; haemodynamic normalization in cases 1, 2, 3, case 4 unchanged; stable ulcer healing in case 3; distrophies improvement in cases 2, 3, 4. Deep AIVV can be effectively performed in atypical cases affected with primary and secondary DVI of the lower limbs.