Long-term results of the monocusp valve formation in the common femoral vein in patients with avalvular deep veins of the lower extremities.

BACKGROUND: Aim of the study was to evaluate the long-term results of the monocusp valve formation in the common femoral vein (CFV) in patients with avalvular deep veins (ADV) of the lower extremities.

METHODS: A total of 36 patients (24 women and 12 men) at the age varying from 37 to 58 years old were given surgical treatment during the period from 2008 to 2014. Six patients presented with congenital ADV, while the remaining 30 ADV had a consequence of the post-thrombotic lesion in the valves with the complete recanalization and manifested deep venous axial reflux. In terms of CEAP clinical classification, the patients were categorized into the following groups: С4b (N.=11), C5 (N.=18), C6 (N.=7). All the patients underwent Duplex ultrasound (DUS) examination. Twelve patients were additionally examined by venography. Kistner grade IV reflux was diagnosed in all the patients. Twenty-eight patients had undergone surgical interventions on superficial and perforating veins before. The severe (C4b-C6) forms of chronic venous disease with manifested axial reflux in deep veins were regarded as an indication for surgery in the patients refractory to traditional treatment. The method described by Opie et al. was employed to construct the monocusp venous valve in the CFV.

RESULTS: The long-term results of the treatment were evaluated in 26 patients followed up during the period from 18 to 48 (mean 29.5±8.2) months. Cumulative clinical success rate at four years was 76.5%. Freedom from ulcer recurrence at four years was 83.4% (C6 patients). Cumulative competence rate of the neovalve was accomplished in 70.6%. The evaluation in two years based on the VCSS revealed the reduction in the severity of the manifestations of chronic venous insufficiency (P<0.01). The quality of life was improved, its index decreased from 60.6±18.7 to 40.7±12.8 (P<0.05). The circumference of the narrowest segment of the tibia decreased from 271.1±4.7 to 256.8±5.7 mm (P<0.05).

CONCLUSIONS: Formation of the monocusp valve in CFV makes it possible to eliminate pathological blood reflux from the inferior vena cava to deep veins of the lower extremities that is known to be one of the main factors in the appearance and progression of chronic venous insufficiency (CVI). The high effectiveness of this operation is confirmed by the well apparent clinical improvement in the state of the affected lower extremity and the quality of life of the patients.