The use of external banding increases the durability of transcommissural external deep venous valve repair

Abstract

Background: The use of external banding during transcommissural external valvuloplasty has the theoretical advantage of increasing the durability of surgical procedure. The aim of this study was to assess the durability of this combined approach and compare its long-term results with those of external valvuloplasty procedure applied alone.

Methods: We retrospectively reviewed data on 144 patients with combined superficial and deep venous reflux who underwent transcommissural external valvuloplasty procedure alone or transcommissural external valvuloplasty plus external banding procedure over a 7-year period from September 1998 to November 2005. The clinical study included only the patients who have completed at least 48 months of follow-up period. Seventy-six patients who have completed the necessary follow-up period were divided into 2 groups according to the surgical procedure performed. Group A consists of 40 patients in whom transcommissural external valvuloplasty was the procedure of choice and Group B consists of 36 patients in whom an external banding has been added to external valvuloplasty repair. The outcomes assessed are venous clinical severity scores of patients, ulcer recurrence and competency rates.

Results: In both groups, median preoperative Venous Clinical Severity Scores were 3. The severity scores improved in both groups during the postoperative follow-up period. However, although the scores of Group B patients at 12 and 24 months were lower than those of Group A, the difference was not statistically significantly at these time points; but, reached a statistical significance at the end of 36 months. Ulcer-freedom rates at 48 months for groups A and B were 72% and 96%, respectively. The cumulative competency rates of 40 Group A patients were 85% at 6 months, 77.5% at 12 months, 69% at 24 months, 58% at 36 months, 55% at 48 months, and 48.5% at 60 months. The cumulative competency rates of 36 patients in Group B were 88% at 6 months, 80% at 12 months, 75% at 24 months, 71.5% at 36 months, 69% at 48 months, and 69% at 60 months.

Conclusions: Although external valvuloplasty procedure is an acceptable technique that can be used in patients with deep venous reflux, our study revealed that its durability may be limited and decreases over time. The addition of external banding provides more durable results with a lesser incidences of ulcer recurrence and valve incompetence.