Surgery for deep venous incompetence

Abstract

Background: Chronic deep venous incompetence (DVI) is a troublesome condition with a range of symptoms in the legs including recurrent ulcers, pain and swelling. It is caused by incompetent vein valves and/or the blockage of large-calibre leg veins.

Objectives: To establish the effectiveness of various surgical procedures for treating DVI.

Search strategy: Trials were identified from the Cochrane Peripheral Vascular Diseases Group's Specialised Trials Register, reference lists of relevant studies, and through contact with principal investigators of identified trials and world experts in deep venous surgery.

Selection criteria: Randomised controlled trials of surgical treatment for patients with DVI. Trials were selected by AA and checked by SCH.

Data collection and analysis: The reviewers extracted the data independently. A variety of outcome measures were reported including ambulatory venous pressure (AVP) and venous refill time (VRT).

Main results: Only one trial met the inclusion criteria, none was excluded. The trial compared external valvuloplasty using limited anterior plication (LAP) in combination with ligature of incompetent superficial veins (ligation and LAP) against ligation only. The trial participants had primary valvular incompetence with mild to moderate symptoms but no venous ulcers. Ligation and LAP produced significant improvement in AVP: the mean difference between the Ligation and LAP group and the Ligation only group was -15 torr (weighted mean difference [WMD] -20.9, -9.0, confidence interval [CI] 95% fixed) at one year and -15 torr (WMD -21, -8.9, 95% CI fixed) at two years. However, there was no statistically significant improvement in VRT, the mean difference between the groups at one year was 2 seconds (WMD -2.7, 6.7; 95% CI fixed) and at two years was 4 seconds (WMD -0.7, 8.7; 95% CI fixed). AVP values after surgery remained relatively high. Nine out of eleven valves repaired remained competent after two years of follow up. No complications occurred. The overall mean score for clinical outcome was +2 (moderate improvement) in the Ligation and LAP group. This compared with +1 (mild improvement) in the Ligation only group.

Reviewer's conclusions: The results of one small trial showed that ligation and LAP produced a moderate improvement for two years after surgery, in patients with mild to moderate DVI caused by primary valvular incompetence. However, there is not sufficient evidence to recommend the treatment to this subgroup of patients with DVI.