New Horizons in the Operative Treatment of Deep Venous Incompetence of the Lower Limb

Abstract

Venous incompetence of the lower limb is necessarily connected with a popliteal reflux accounted for by valvular incompetence of the popliteal vein, the presence of which must be clarified. The investigation of the deep venous system will begin by Doppler ultrasound. Only patients with popliteal reflux de tected by Doppler ultrasound are furthered examined by venous pressure meas urements and by phlebography. An operation in the deep veins is admissible only when a popliteal reflux of more than 40%, an ambulatory venous pressure more than 60 mmHg, a refilling time of less than fifteen seconds, a venous insuffi ciency of more than 20%, and a patency or recanalization of the deep veins of more than 70% have been confirmed. In a series of 46 patients (61 limbs) operated on the last two years the selec tion for operation was successfully made only by Doppler ultrasound. The substitute "valve" operation by Technique II designed to overcome reflux in the popliteal vein was performed on 191 patients (221 limbs) with deep venous incompetence of the lower limbs, primary or postthrombotic. Results were as sessed clinically, by Doppler ultrasound, by venous pressure measurements, and partially by phlebography. In the above series of 46 patients (61 limbs) the results were assessed only by Doppler ultrasound, which correlated with the clinical con dition, consisting of abolition or minimizing of the popliteal reflux. In our pa tients clinical improvement in 209 of 221 limbs was associated with reduction of ambulatory venous pressure and prolongation of refilling time with interrup tion of the popliteal reflux as assessed by Doppler and by phlebographic evi dence of the valve-like effect of the silastic tendon on the popliteal vein.