RECONSTRUCTIVE SURGERY OF DEEP VEIN VALVE INSUFFICIENCY IN POSTTHROMBOTIC DISEASE

I.M. Ignatjev, S.A. Obydennov, M.N. Malinovsky
Republican Center of Microsurgery,
Kazan, Russia

A survey of 105 surgical interventions in patients with postphlebitic disease of lower extremities is given. Valvular function was restored by anastomoses of great saphenous vein preserving competent valves and deep veins (femoral or popliteal – 59 procedures); femoral and deep femoral veins (5 procedures), by transplantation of free valve-bearing au-tografts to recanaliyd veins (35 procedures), by intravas-cular valvuloplasty (4 procedures) and extravasal valve correction (2 procedures). In 10 patients these procedures were combined with arteriovenous anastomoses in the lower one-third of a leg. Frame spiral implants were used to prevent autograft ectasia. Microsurgical technique was widely applied for anastomosis formation. Surgical interventions were carried out in 68 patients for saphenous, perforating and posterior tibial veins. Authors employed an original method of valve au-totransplantation into dilated and lacked in valves great saphenous vein bed with subsequent conjunction of the graft with deep leg vein, as well as a method ofmicrosurgical anastomoses of transplanted valvular sinus influx and recipient venae comitantes. Long-term results (up to 9 years) were obtained in 72 patients. Authors believe that the most reliable and steady function of transplant valves is achieved by procedure of anastomosing great saphenous vein and deep leg vein. In 32 from 42 patients (76%) phlebography and duplex scanning demonstrated good valve function in transposed veins. Favourable results were registered in restorative operations combined with distal arteriovenous anastomoses. The efficiency of the described procedures was proved by noninva-sive examination of venous flow.

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