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

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

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


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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.

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