ORIGINAL ARTICLES   

Acta Phlebologica 2000 December;1(2):51-8

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: English

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.