[Surgical treatment of deep venous reflux. Techniques, indications and results]

Abstract

Introduction: complications of deep venous insufficiency can lead to surgery if one fails with medical treatment. The etiology can be primitive or secondary, the symptoms are identical. They go from heaviness of the legs to chronic leg ulcers. Indication and technic of surgery depend on the etiology and the preoperative evaluation.

Preoperative evaluation: it has to be anatomical and functional. Invasive investigations as venous blood pressure, ascending and descending venography, and non invasive investigations as duplex or triplex Doppler and plethysmography are used. TECHNICS: one can use three techniques. Valvuloplasty with or without venotomy, and with or without Dacron cuff. Transplantation of an axillary valvulated venous segment to femoral or popliteal vein. Transposition to a valvulated and competent great saphenous vein or deep femoral vein.

Indications: one can propose transplantation or transposition for secondary deep venous insufficiency, and valvuloplasty for primary deep venous insufficiency. Stage 2 or 3 can be a clinical indication for surgery.

Results: valvuloplasty has good results with 60 to 80% free of clinical recurrence at 2 years. The results of the other technics seem to be less good.

Conclusion: the fair results of surgery allow the use of it for some patients with a good evaluation. The improvement of the surgical results lie on the development of paraclinical evaluation and research on venous valvular hemodynamic.