External banding valvuloplasty for incompetence of the great saphenous vein: 10-year results

Internal valvuloplasty combined with sleeve wrapping in the treatment of severe great saphenous vein insufficiency: A report of two cases

BACKGROUND

Great saphenous vein (GSV) valve incompetence is one of the most common manifestations of chronic venous insufficiency (CVI) in the lower limbs. There have been no reported attempts to repair the valve prior to the appearance of varicose morphology.

METHOD

We describe two cases. Before surgery, the male patient had obvious pigmentation in the ankle area, and the female patient had obvious pain and swelling in the lower limbs after prolonged standing. Neither patient has obvious varicose veins. After retrograde venography, both patients were found to have severe reflux of the GSV valves (Kinster IV). We performed internal valvuloplasty and sleeve wrapping in two patients.

RESULTS

After surgery, both patients had a significant improvement in symptoms and no particular complaints. Vascular ultrasound also suggested a good outcome.

CONCLUSION

This surgery is safe and feasible in the treatment of early GSV incompetence, with good short-term results; long-term results remain to be seen.

Functional repair of the great saphenous vein by external valvuloplasty reduces the vein's diameter: 6-month results of a multicentre study

Objectives

External valvuloplasty (eVP) is a reconstructive surgical method to repair the function of the terminal and preterminal valves. We evaluated the 6-month outcomes of eVP regarding the diameter of the great saphenous vein (GSV).

Methods

Patients from five vein centres were included in this observational study. Follow-up involved detailed duplex sonography of the GSV. The venous clinical severity score (VCSS) and the C class of the clinical, aetiologic, anatomic and pathophysiologic (CEAP) classification were recorded.

Results

We enrolled 210 patients, with a follow-up rate of 58%; eVP was sufficient in 95.24% of the patients. The GSV diameters decreased significantly from 4.4 mm (standard deviation (SD): 1.39) to 3.9 (SD: 1.12), 4 cm distal to the saphenofemoral junction (SFJ); from 3.7 mm (SD: 1.10) to 3.5 mm (SD: 1.02) at the mid-thigh; from 3.6 mm (SD: 1.14) to 3.3 mm (SD: 0.94) at the knee and from 3.1 mm (SD: 0.99) to 2.9 mm (SD: 0.78) at the mid-calf. VCSS decreased significantly from 4.76 (SD: 2.13) preoperatively to 1.77 (SD: 1.57) 6 months postoperatively.

Conclusions

GSV function can be restored by eVP; diameters over the total length of the GSV decreased significantly.

External valvuloplasty of the saphenofemoral junction in insufficient great saphenous veins - six weeks results of a prospective multicentre trial

Background: Varicosis of the great saphenous vein (GSV) is a common disease. Most of the therapeutic concepts attempt to remove or destroy the truncal vein. However, the absence of the GSV could be harmful for further treatments of artherosclerotic disease as the GSV is often used as bypass graft in lower extremity or coronary artery revascularisations. External valvuloplasty (EV) is one of the vein-sparing treatment options. The aim of this clinical study was to describe the outcome, safety and complications of this procedure in a prospective multicentre trial. Patients and methods: The function of the terminal and preterminal valve was restored by external valvuloplasty. Furthermore, multiple phlebectomies of tributaries were performed. Patients were reinvestigated six weeks after surgery. Primary endpoint was the function of the external valvuloplasty measured by diameter of the GSV and the prevalence of reflux in the GSV. The eligibility of the vein as a potential bypass graft was noticed. CEAP class and VCSS scores were analysed. Results: A total of 359 patients were included in the study. After six weeks 297 patients could be reinvestigated. The function of the external valvuloplasty was sufficient in 284 patients (95.6%). Treatment failed in 8 patients (2.6%) due to an occlusion or junctional reflux despite valvuloplasty. The GSV was estimated as suitable as a bypass graft in 261 patients (87.8%). Reflux at the saphenofemoral junction was significantly reduced after treatment and the diameter of the GSV near the saphenofemoral junction significantly decreased from 4.4 mm to 3.8 mm (p < 0.05). The VCSS was significantly reduced from 4.6 preoperatively to 2.6 postoperatively. Conclusions: External repair of the great saphenous vein can reduce venous symptoms and may preserve the great saphenous vein as a bypass graft. Nevertheless, this treatment option is only suitable for a limited number of patients.

Long-term results of external valvuloplasty in adult patients with isolated great saphenous vein insufficiency

Objective

The aim of this study is to present our 7-year results of external valvuloplasty for isolated great saphenous vein (GSV) insufficiency.

Methods

External valvuloplasty was applied in 83 patients with isolated GSV insufficiency. Follow-up consisted of venous color duplex scanning performed on the first postoperative day, the first postoperative month, and then annually. Valvular insufficiency, venous reflux, and venous thrombosis formation in the saphenofemoral junction were the main outcomes.

Results

A complete clinical and radiological healing was observed in 50 patients (60%). In 13 cases (15.6%), a secondary surgical treatment was performed consisting of vena saphena magna high ligation/stripping and varicose vein excisions, mainly due to severe and progressive vena saphena magna valvular insufficiency and clinical persistence of symptoms. Eight patients (9.6%) developed superficial vein thrombosis, and only one patient (1.2%) developed deep vein thrombosis. Contact was lost from 32 patients (38.5%) for different reasons.

Conclusion

External valvuloplasty is an effective surgical technique for selected cases of isolated GSV insufficiency without extensive varicose dilatations. This alternative method can be safely administered as an alternative to high ligation and conventional GSV stripping.

Thinking Outside the Heart: Use of Engineered Cardiac Tissue for the Treatment of Chronic Deep Venous Insufficiency

This article considers the use of autologous stem cell-derived cardiomyocytes as a novel means to aid venous return. The approach consists of creating external cuffs of engineered heart tissue around vein segments with incompetent or poorly competent valves. The engineered heart tissue cuff prevents distention of the impaired vein segments and aids unidirectional flow by its rhythmic contractions. There appear to be no fundamental limitations to this approach as feasibility of all of the individual components has already been shown. Here, we underline the clinical need for novel ways to treat chronic deep venous insufficiency, review previous research that enabled this approach, consider potential designs of engineered heart tissue cuffs, and outline its advantages and future challenges.

An alternative therapy for recurrent stasis ulcers in chronic venous insufficiency: venocuff

Chronic venous insufficiency may cause stasis ulcers that significantly impact on the quality of life. Many methods have been described for preventing or treating these ulcers. However, stasis ulcers often recur as a result of continuing venous insufficiency. Here we report a 30-year-old male patient with chronic venous insufficiency. He was admitted to the hospital owing to recurrent stasis ulcers. He had a history of various flavonoid drug usage and compression therapies over the previous six years. Venous Doppler sonography revealed combined saphenofemoral and deep femoral venous insufficiency. Venocuff was applied to the prejunctional and postjunctional parts of the femoral vein and the saphenofemoral junction. The patient was discharged on the postoperative second day, and a low-molecular-weight heparin dressing composed of calcium alginate was applied to the ulcer wound for one week after the operation. The stasis ulcer wound was totally healed after one month. The patient was followed up six months after the operation, and no postoperative complications or new ulceration was observed. Recurrent stasis ulcers are major reasons for hospitalization in patients with chronic venous insufficiency. Venocuff application for reducing venous insufficiency may be a good option for adjunctive ulcer therapy and for preventing recurrences of the problem.