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Online ISSN 1827-1847
Camilli D. 1, Camilli S. 2
1 Vascular Surgery Department, St. Andrea Hospital “La Sapienza” University, Rome, Italy
2 Vascular Surgery, Private Practice, Rome, Italy
In varicose veins (VV), the current ablative techniques show mid-term and late failure in 20% to 50% of cases, depending on many factors but also ‑ at least in part ‑ on the greater saphenous vein (GSV) ablation per se. Restorative techniques by valvuloplasty are a possibility with positive outcome in more than 70% of cases, but various suggested techniques did not spread, mainly because of a lack of a proper technique or device. To achieve better results the external stretching valvuloplasty (ESV) has been developed, which is useful in restoring competence on deep and/or superficial venous system. The ESV is an innovative working concept. It aims to give a stretching action on the opposite intercommissural walls to modify the circular cross-section into an oval shaped one, so that the cusp’s free edge extra-length is retrieved. A related new device has been developed, which operates as a surgical implant around the incompetent valve; this is an oval shaped external support (OSES), made by a Nitinol net-like framework, available in different sizes. The stretching action is obtained by securing the proper sized device to the opposite apices of the valve commissures by surgical stitches. Laboratory tests and preclinical trials were done. Some Pts have been elected for the ESV and OSES device temporary assembly on GSV junctional valve, thereafter a routine surgical treatment was done. The inter-commissural diameter’s elongation of about 30% showed valve function recovery in most cases. The ESV feasibility and immediate OSES efficacy were demonstrated. The ESV seems to be very effective and might be carried out, virtually, at any peripheral venous valve site. The ESV could be useful in the present patients with mild to moderate varicose disease showing US-visible and mobile valve leaflets, but all new patients ‑ namely those with early stage of CVI ‑ may benefit of it. Large clinical trial is needed; it might show that ESV improves the results of valve repair operation, leading to reduce relapsing veins and to spare the most GSV as arterial conduit.