External valvuloplasty for primary valvular incompetence of the lower limbs using angioscopy

Abstract

The morphology of 145 vein valves of venous stasis syndrome was studied and classified into three types by means of angioscopy. External valvuloplasty for primary valvular incompetence (PVI) was performed in 21 highest valves of the superficial femoral vein and 46 subterminal valves of the long saphenous vein under direct vision using angioscopy. Within external valvuloplasty, Technique I is total plication of the dilated vein annulus by running a suture around the vein; Technique II is plication by placing an autogenous femorofascial band; and Technique III is direct suture of valve commissure including the leading edge of the cusp from the outside vein wall using horizontal mattress suture with pledgets. Venous regurgitation was reduced from grade III–IV to grade 0–1 in descending phlebography after external valvuloplasty. Ambulatory venous pressure improved from 42% to 54% postoperatively. Reflux volume by Duplex scanning was significantly decreased after external valvuloplasty and maintained a reduced level. Surgical results of external valvuloplasty using angioscopy are satisfactory in all cases of the superficial femoral vein and in 91% of the long saphenous vein in 2–4-year follow-up. External valvuloplasty using angioscopy is a simple and reliable surgical technique. It is necessary to have a longer follow-up in order to fully evaluate the value of these external valvuloplasty techniques.