Transcommissural valvuloplasty: technique and results

Abstract

Purpose: The purpose of this study was to describe the technique of a variation of closed external venous valve repair (transcommissural valvuloplasty), its complication rate, and duplex scan durability.

Methods: The "blind" transcommissural valve repair of the vein was performed by placing transluminal sutures along the valve attachment lines, which simultaneously closed the valve attachment angle and also tightened the valve cusps. A total of 179 successfully repaired valve sites of 141 limbs in 129 patients were followed up 1 to 42 months through clinical observation and with duplex Doppler ultrasound scan.

Results: Postoperative complications (< 30 days) occurred in 12 (9%) of 141 limbs: superficial (1) and deep (1) wound infection, large wound hematoma (4), seroma (1), and deep vein thrombosis (5), with associated pulmonary embolus in one patient. Seventy-eight percent (reflux time </= 0.5 seconds) and 81% (reflux time </= 1.0 seconds) of valve sites were competent. The cumulative competency rate at 30 months was 59% and 63%, respectively. The cumulative ulcer recurrence-free interval was 63% at 30 months (n = 92). The pain score and swelling grade substantially improved.

Conclusion: Transcommissural valvuloplasty is a safe procedure with low morbidity. It is relatively rapid and simple to perform, and its competency rates are comparable to those of internal valvuloplasty. Advantages over the internal repair are that venotomy is not required, repair can be extended to small-caliber veins, and multiple valve stations can be repaired in a single stage.