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THE JOURNAL OF CARDIOVASCULAR SURGERY
Rivista di Chirurgia Cardiaca, Vascolare e Toracica
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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ORIGINAL ARTICLES VASCULAR PAPERS
The Journal of Cardiovascular Surgery 1999 August;40(4):567-70
Venous hemodynamic changes after external banding valvuloplasty with varicosectomy in the treatment of primary varicose veins
Ik Kim D., Boong Lee B., Bergan J. J.*
From the Division of Vascular Surgery Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Korea
* Clinical Prof., Univ. Calif., San Diego, USA
Background. To evaluate venous hemodynamic changes after an external banding valvuloplasty in the treatment of primary varicose veins with saphenofemoral incompetence.
Methods. From June 1996 to December 1997, 79 limbs (10 male and 69 female, age 20-57 years) were treated for primary saphenofemoral incompetence by external banding valvuloplasty. Tightening of the banding was accomplished using a polyester-tailored mesh to narrow the terminal and/or subterminal valve areas of the dilated greater saphenous vein (GSV), same size as its minimum diameter during spasm. Evaluation was done through a pre- and postoperative color-flow duplex scanning and an air-plethysmography (APG).
Results. Sixty-three limbs (79.7%) remained patent and were competent. Fourteen limbs (17.7%) remained patent but showed reflux. Two limbs (2.5%) had thrombus within the GSV after surgery. The diameter of GSV of mid-thigh was 6.7±1.6 mm preoperatively and 4.1±0.9 mm postoperatively (p-value=7.04E-10). Reduction of the diameter was 61.4±12.3%. Venous volume was 136.1±59.8 ml preoperatively and 103.5±39.8 ml post- operatively (p-value=1.6E-20). Reduction of the venous volume was 12.9±17.0%. Venous filling index (VFI) was 6.6+11.3 ml/sec preoperatively and 1.9±3.3 ml/sec post- operatively (p-value=1.2E-10). Reduction of the VFI was 55.0±29.1%. Ejection fraction (EF) was 48.9±13.8% preoperatively and 60.1±17.2% postoperatively (p-va-lue=2.6E-17). Increase of EF was 29.4±43.5%. The residual volume fraction (RVF) was 42.1±13.9% preoperatively and 30.2±14.5% postoperatively (p-value=5.6E-19). Reduction of RVF was 17.6±43.6%.
Conclusions. Early evaluation of saphenofemoral external banding valvuloplasty confirms the satisfactory patency and improvement in venous hemodynamics. Long-term evaluation is clearly indicated but the early safety and efficacy of the procedure have been confirmed.