ORIGINAL ARTICLES  VASCULAR SECTION 

The Journal of Cardiovascular Surgery 2001 August;42(4):529-35

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Femoral vein valve repair with angioscopy-assisted anterior valve sinus plication. Early results

Nishibe T., Kudo F., Flores J., Miyazaki K., Yasuda K.

From the Department of Cardiovascular Surgery Hokkaido University School of Medicine Sapporo, Japan

Back­ground. The effi­ciency of angios­copy-­assisted ante­rior ­valve ­sinus pli­ca­tion for pri­mary ­deep ­venous insuf­fi­ciency was eval­u­ated.
­Methods. Experi­mental ­design: ret­ro­spec­tive, clin­ical ­study ­with ­short ­follow-up. Set­ting: insti­tu­tional prac­tice. ­Patients: 15 ­limbs in 12 ­patients had ­class 4 or ­higher dis­ease (SVS/­ISCVS clas­sifi­ca­tion). ­Descending venog­raphy ­showed ­class 3 or 4 ­reflux in all ­patients. ­Venous ­refilling ­time (VRT) was ­abnormal (<15 sec­) in all of the nine ­limbs in ­which pho­to­ple­thys­mog­raphy was con­ducted. The ­limbs ­were ­treated ­with angios­copy-­assisted ante­rior ­valve ­sinus pli­ca­tion of the super­fi­cial ­femoral ­vein. Post­op­er­a­tive ­descending venog­raphy was per­formed ­between the ­first and ­third day ­after oper­a­tion. Clin­ical eval­u­a­tion and VRT meas­ure­ment ­were ­repeated ­when the ­patients ­were dis­charged and ­checked at the out­pa­tient ­office.
­Results. ­Mean ­follow-up was 22 ­weeks ­with a ­range of 1 to 70 ­weeks. At post­op­er­a­tive ­descending venog­raphy, the ­reflux of the super­fi­cial ­femoral ­vein was sig­nif­i­cantly ­improved. At ­final ­follow-up, all ­patients ­reported ­greater or ­lesser ­relief of sub­jec­tive symp­toms. In four ­limbs ­with ­class 6 dis­ease, ­ulcers ­healed and did not ­recur. In one ­limb ­with ­class 5 dis­ease, ­ulcers did not ­recur. In the ­other 10 ­limbs ­with ­class 4 dis­ease, a dis­tinct clin­ical improve­ment ­occurred ­with res­o­lu­tion of ­skin ­changes. VRT was ­normal in 11 of the 12 ­limbs exam­ined.
Con­clu­sions. Our pre­lim­i­nary expe­ri­ence dem­on­strates ­that angios­copy-­assisted ante­rior ­valve ­sinus pli­ca­tion ­gives ­early ­good clin­ical and hemo­dy­namic improve­ment in ­patients ­with pri­mary ­deep ­venous insuf­fi­ciency.