External valvuloplasty of the Sapheno-Femoral junction versus high ligation or disconnection: Comparison of preliminary results between two groups of patients

L. Corcos, T. Procacci, G. Peruzzi, C. Macchi, D. De Anna

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Abstract

Since 1989 several authors performed external valvuloplasty (EV) of the sapheno-femoral junction (SFJ) using different prosthetic materials in a number of selected patients suffering from varicose veins of the lower limbs (WLL). Encouraging results were obtained. The Veno Cuff Procedure with the application of Silicone prosthesis was previously proposed in 1986 for the treatment deep venous insufficiency and in 1992 was employed in our centres for the surgical correction of early sapheno-femoral junction insufficiency (SFJ). At the present time the main questions are, if, when and how to perform the EV instead of high ligation or disconnection (HL-D) in the treatment of early and/or limited WLL. The purpose of the study is answer these questions. Material and methods: Patients were selected on the basis of the following criteria: early WLL - reflux in the SFJ - visible cusps in dilated valves observed with HR echography - no thrombotic risk - no major pathology. 36 randomized limbs were subjected to two different procedures. 18 EV were performed in limbs with trophic cusp in the sapheno-femoral valves using of the Veno Cuff automatic device and valvular function was intraoperatively tested by Doppler and/or Angioscopy. 18 limbs with unsatisfactory echographic visualization of the valve cusp or patient's refusal to undergo EV, were subjected to ligation or disconnection of the SFJ. Non invasive preoperative and postoperative venous pressure measurements (VP) and PPG examination of Refilling Time after 10 exercises (ERT) were performed. Peripheral insufficencies and varices were treated by ligatures and/or varicectomies in both groups. Clinical and instrumental results were compared. Patients were postoperatively followed up every 4 months until the 12th month. Results: Overlapping clinical results were observed in the two groups. Normal flow restored in the LSV by the EV, while a reverse flow was observed in all the patent LSV after HL-D. Thrombotic occlusion of the LSV was higher in the HL-D group and postoperative patency of the LSV was higher in the EV group (significant results). The postoperative deep and superficial ambulatory VP mean decrease and ERT mean increase were significantly higher in the EV group. Hemodynamic studies still in progress seem to confirm that salvaging the SFJ, when possible, is better than the elimination.

Original languageEnglish
Pages (from-to)2-10
Number of pages9
JournalPhlebologie
Volume25
Issue number1
Publication statusPublished - Feb 1996

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Keywords

  • Varicose veins
  • Venous insufficiency
  • Venous valves

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Gastroenterology

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