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Long-term results of venous valve reconstruction: a four- to twenty-one-year follow-up.

Identifieur interne : 00B418 ( Ncbi/Merge ); précédent : 00B417; suivant : 00B419

Long-term results of venous valve reconstruction: a four- to twenty-one-year follow-up.

Auteurs : E M Masuda [États-Unis] ; R L Kistner

Source :

RBID : pubmed:8126852

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English descriptors

Abstract

The purpose of this study is to describe the very long-term clinical, hemodynamic, and imaging results of venous valve reconstruction for reflux disease in patients with chronic venous insufficiency.

PubMed: 8126852

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pubmed:8126852

Le document en format XML

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<title xml:lang="en">Long-term results of venous valve reconstruction: a four- to twenty-one-year follow-up.</title>
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<term>Bandages</term>
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<term>Femoral Vein (physiopathology)</term>
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<term>Hematoma (etiology)</term>
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<term>Life Tables</term>
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<term>Postphlebitic Syndrome (surgery)</term>
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<term>Varicose Ulcer (diagnostic imaging)</term>
<term>Varicose Ulcer (physiopathology)</term>
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<term>Venous Insufficiency (surgery)</term>
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<term>Bandages</term>
<term>Complications postopératoires</term>
<term>Débit sanguin régional (physiologie)</term>
<term>Humains</term>
<term>Hématome (étiologie)</term>
<term>Insuffisance veineuse ()</term>
<term>Insuffisance veineuse (imagerie diagnostique)</term>
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<term>Maladie chronique</term>
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<term>Hematoma</term>
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<term>Insuffisance veineuse</term>
<term>Syndrome post-phlébitique</term>
<term>Ulcère variqueux</term>
<term>Veine axillaire</term>
<term>Veine fémorale</term>
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<term>Femoral Vein</term>
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<term>Venous Insufficiency</term>
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<term>Saphenous Vein</term>
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<term>Bandages</term>
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<term>Humans</term>
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<term>Reoperation</term>
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<term>Complications postopératoires</term>
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<front>
<div type="abstract" xml:lang="en">The purpose of this study is to describe the very long-term clinical, hemodynamic, and imaging results of venous valve reconstruction for reflux disease in patients with chronic venous insufficiency.</div>
</front>
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<Month>04</Month>
<Day>14</Day>
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<DateCompleted>
<Year>1994</Year>
<Month>04</Month>
<Day>14</Day>
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<DateRevised>
<Year>2016</Year>
<Month>11</Month>
<Day>23</Day>
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<Month>Mar</Month>
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<Title>Journal of vascular surgery</Title>
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<ArticleTitle>Long-term results of venous valve reconstruction: a four- to twenty-one-year follow-up.</ArticleTitle>
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<Abstract>
<AbstractText Label="PURPOSE" NlmCategory="OBJECTIVE">The purpose of this study is to describe the very long-term clinical, hemodynamic, and imaging results of venous valve reconstruction for reflux disease in patients with chronic venous insufficiency.</AbstractText>
<AbstractText Label="METHODS" NlmCategory="METHODS">There were 51 extremities (48 patients) with follow-up of 4 to 21 years with a mean of 10.6 years. Clinical severity was graded as asymptomatic (class 0), mildly symptomatic (class 1), moderately symptomatic but without ulceration (class 2), or severely symptomatic with or without ulceration (class 3). Preoperative and postoperative evaluation consisted of history and physical examination, ascending venography (preoperative only), ambulatory venous pressures or photoplethysmography, and descending venography or duplex scanning.</AbstractText>
<AbstractText Label="RESULTS" NlmCategory="RESULTS">Before surgery, 49 (96%) of 51 limbs demonstrated severe, class 3 disease, and two limbs were classified as class 2 disease. After venous valve reconstruction by either direct femoral vein valve repair, transposition, or transplantation, long-term clinical success of achieving a class 0 or 1 result (by life-table analysis) was 60% at 10 years. Thirty-three percent demonstrated a class 0 result in which the limbs were free from symptoms and had no need for long-term elastic support. After 6 years clinical results were stable and did not deteriorate. Incompetent perforators were identified in 31 cases and were treated selectively. Three disease patterns of chronic venous insufficiency were identified: primary valve insufficiency 43%, postthrombotic syndrome 31%, and a group consisting of both primary valve insufficiency of the superficial femoral vein and postthrombotic syndrome of the calf veins (primary valve insufficiency-postthrombotic syndrome) 26%. Ten-year cumulative clinical success was clearly superior in limbs with primary valve insufficiency corrected by valve repair (73%) as opposed to those with postthrombotic syndrome treated by either valve transposition or transplantation (43%) (p = 0.029). Clinical outcome correlated strongly with postoperative imaging results, and durability of valve repair was confirmed by demonstrating competence up to 16 years after the operation. Significant improvement in ambulatory venous pressure (mean percentage of pressure fall and refill time) was found in limbs with class 0 or 1 outcome; however, values did not reach "normal" levels in all cases. Recurrent ulcerations after the operation were attributed to failed reconstructions (10), incompetent profunda femoris veins (three), incompetent perforators (three), and concomitant lymphedema (one).</AbstractText>
<AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">This report highlights a difference found in very long-term prognosis of surgical treatment of primary valve insufficiency as opposed to postthrombotic syndrome. Long-term elimination of symptoms of chronic venous insufficiency is achieved by valve repair for primary valve insufficiency beyond 10 years, whereas late results of treatment of postthrombotic syndrome in this study was accompanied by high recurrence rates and warrants further investigation.</AbstractText>
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