Nine Years' Experience with the Valvular Substitution by Technique II in Deep Venous Insufficiency of the Lower Limb

Venous incompetence of the lower limb is necessarily connected with a popliteal reflux on account of a valvular incompetence of the popliteal vein; the presence of the reflux must be clarified, with initial investigation by Doppler ultrasound. Only patients with popliteal reflux of more than 40% can be fur ther examined by venous pressure measurements and by phlebography, if these are required. An operation in the deep veins is admissible only when a popliteal reflux of more than 40%, an ambulatory venous pressure of more than 60 mmHg, a refilling time of less than fifteen seconds, a venous insufficiency of more than 20%, and a patency or recanalization of the deep veins of more than 70% have been confirmed. In a series of 52 patients (68 limbs) operated on over the last two years the selection for operation was made successfully by Doppler ultrasound only. The substitute "valve" operation by Technique II designed to overcome reflux in the popliteal vein was performed on 197 patients (228 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 first-mentioned series of 52 patients (68 limbs) the results were assessed only by Doppler ultrasound and correlated with the clinical condition, consist ing of abolition or minimizing of the popliteal reflux. Clinical improvement in 216 of 228 limbs was associated with reduction of ambulatory venous pressure and prolongation of refilling time with interruption of the popliteal reflux (Dop pler ultrasound) and with phlebographic evidence of the valve-like effect of the silastic tendon on the popliteal vein.