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Alternative greater saphenous vein-sparing surgery: valvuloplasty combined with axial transposition of a competent tributary vein for the treatment of primary valvular incompetence---18-month follow-up.
Dermatol Surg. 2002 Feb; 28(2):162-7.DS

Abstract

BACKGROUND

The greater saphenous vein (GSV) is one of the best grafts for vascular reconstruction, and a variety of sparing methods in patients with primary varicose veins have been performed. Of these, valvuloplasty of the subterminal valve is useful, but reflux in the proximal GSV via a competent tributary vein still remains. To minimize the subsequent reflux, we propose a new method, "valvuloplasty combined with axial transposition of a competent tributary vein" for the treatment of GSV incompetence.

OBJECTIVE

To compare this new method with single valvuloplasty.

METHODS

Seventy-eight limbs in 65 patients with GSV incompetence were included. Of these limbs, 38 underwent angioscopic valvuloplasty of the subterminal valve alone (V group). The remaining 40 were treated by angioscopic valvuloplasty combined with axial transposition of a competent tributary vein (V + T group). A competent tributary vein was identified by duplex scan in the thigh before surgery. After angioscopic valvuloplasty had been done, a competent tributary vein was exposed, and was cut 1.5 cm distal to its insertion. The distal cut end of the vein was then transposed to the GSV and end-to-side anastomosis was performed using 8-0 nylon under magnification. The incompetent GSV was ligated between the insertion and the anastomosed region. Venous hemodynamic changes were analyzed using air plethysmography (APG). Values obtained by9 APG included venous volume (VV), venous filling index (VFI), ejection fraction (EF), and residual venous function (RVF). The follow-up period was 18 months. Intergroup differences were analyzed with the Wilcoxon ranked sum test for nonparametric distribution.

RESULTS

There were no statistical differences in age, gender, or clinical presentation between the two groups. In the V group, 27 limbs had reflux in the proximal GSV (67.4%). On the other hand, only 6 limbs (13.3%) showed minor reflux in the V + T group. A significant difference was seen in VFI at 1 year, and a continuous increase was observed in the V group during the follow-up examinations (P =.0035, VFI = 2.50 plus minus 1.21, 1.14 plus minus 0.42 at 18 months, respectively).

CONCLUSION

Valvuloplasty combined with axial transposition of a competent tributary vein gives a better result than valvuloplasty alone at the 18-month follow-up. A competent valve in this location can be expected to improve VFI to a normal range.

Authors+Show Affiliations

Department of Plastic and Reconstructive Surgery, Tokyo, Japan. yamaki@prs.twmu.ac.jpNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

11860429

Citation

Yamaki, Takashi, et al. "Alternative Greater Saphenous Vein-sparing Surgery: Valvuloplasty Combined With Axial Transposition of a Competent Tributary Vein for the Treatment of Primary Valvular Incompetence---18-month Follow-up." Dermatologic Surgery : Official Publication for American Society for Dermatologic Surgery [et Al.], vol. 28, no. 2, 2002, pp. 162-7.
Yamaki T, Nozaki M, Sasaki K. Alternative greater saphenous vein-sparing surgery: valvuloplasty combined with axial transposition of a competent tributary vein for the treatment of primary valvular incompetence---18-month follow-up. Dermatol Surg. 2002;28(2):162-7.
Yamaki, T., Nozaki, M., & Sasaki, K. (2002). Alternative greater saphenous vein-sparing surgery: valvuloplasty combined with axial transposition of a competent tributary vein for the treatment of primary valvular incompetence---18-month follow-up. Dermatologic Surgery : Official Publication for American Society for Dermatologic Surgery [et Al.], 28(2), 162-7.
Yamaki T, Nozaki M, Sasaki K. Alternative Greater Saphenous Vein-sparing Surgery: Valvuloplasty Combined With Axial Transposition of a Competent Tributary Vein for the Treatment of Primary Valvular Incompetence---18-month Follow-up. Dermatol Surg. 2002;28(2):162-7. PubMed PMID: 11860429.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Alternative greater saphenous vein-sparing surgery: valvuloplasty combined with axial transposition of a competent tributary vein for the treatment of primary valvular incompetence---18-month follow-up. AU - Yamaki,Takashi, AU - Nozaki,Motohiro, AU - Sasaki,Kenji, PY - 2002/2/28/pubmed PY - 2004/6/25/medline PY - 2002/2/28/entrez SP - 162 EP - 7 JF - Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.] JO - Dermatol Surg VL - 28 IS - 2 N2 - BACKGROUND: The greater saphenous vein (GSV) is one of the best grafts for vascular reconstruction, and a variety of sparing methods in patients with primary varicose veins have been performed. Of these, valvuloplasty of the subterminal valve is useful, but reflux in the proximal GSV via a competent tributary vein still remains. To minimize the subsequent reflux, we propose a new method, "valvuloplasty combined with axial transposition of a competent tributary vein" for the treatment of GSV incompetence. OBJECTIVE: To compare this new method with single valvuloplasty. METHODS: Seventy-eight limbs in 65 patients with GSV incompetence were included. Of these limbs, 38 underwent angioscopic valvuloplasty of the subterminal valve alone (V group). The remaining 40 were treated by angioscopic valvuloplasty combined with axial transposition of a competent tributary vein (V + T group). A competent tributary vein was identified by duplex scan in the thigh before surgery. After angioscopic valvuloplasty had been done, a competent tributary vein was exposed, and was cut 1.5 cm distal to its insertion. The distal cut end of the vein was then transposed to the GSV and end-to-side anastomosis was performed using 8-0 nylon under magnification. The incompetent GSV was ligated between the insertion and the anastomosed region. Venous hemodynamic changes were analyzed using air plethysmography (APG). Values obtained by9 APG included venous volume (VV), venous filling index (VFI), ejection fraction (EF), and residual venous function (RVF). The follow-up period was 18 months. Intergroup differences were analyzed with the Wilcoxon ranked sum test for nonparametric distribution. RESULTS: There were no statistical differences in age, gender, or clinical presentation between the two groups. In the V group, 27 limbs had reflux in the proximal GSV (67.4%). On the other hand, only 6 limbs (13.3%) showed minor reflux in the V + T group. A significant difference was seen in VFI at 1 year, and a continuous increase was observed in the V group during the follow-up examinations (P =.0035, VFI = 2.50 plus minus 1.21, 1.14 plus minus 0.42 at 18 months, respectively). CONCLUSION: Valvuloplasty combined with axial transposition of a competent tributary vein gives a better result than valvuloplasty alone at the 18-month follow-up. A competent valve in this location can be expected to improve VFI to a normal range. SN - 1076-0512 UR - https://www.unboundmedicine.com/medline/citation/11860429/Alternative_greater_saphenous_vein_sparing_surgery:_valvuloplasty_combined_with_axial_transposition_of_a_competent_tributary_vein_for_the_treatment_of_primary_valvular_incompetence___18_month_follow_up_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=1076-0512&date=2002&volume=28&issue=2&spage=162 DB - PRIME DP - Unbound Medicine ER -