How to Select and Operate on Patients with Deep Venous Insufficiency of the Lower Limb

Abstract

Investigation of the deep venous system of the lower limb must mainly aim to elucidate its capabilities. Be cause deep venous incompetence is necessarily connected with a popliteal reflux accounted for by valvular in competence of the popliteal vein, its presence must be clarified. Only pa tients with popliteal reflux detected by Doppler ultrasound require a fur ther examination by venous pressure measurements and by phlebography. An operation in the deep veins is ad missible only when a popliteal reflux more than 40%, an ambulatory ve nous pressure more than 60 mmHg, a refilling time less than fifteen sec onds, a venous insufficiency more than 20%, and a patency or recanali zation of the deep veins more than 70% have been confirmed. The substitute "valve" operation by Technique II designed to overcome reflux in the popliteal vein was per formed on 170 patients (190 limbs) with deep venous incompetence of the lower limbs, primary or postthrom botic. Results were assessed clini cally, by Doppler ultrasound, by venous pressure measurements, and partially by phlebography. Clinical improvement in 181 of 190 limbs was associated with reduction of ambula tory venous pressure and prolonga tion of refilling time with interrup tion of the popliteal reflux by Dop pler (168 limbs) and with phlebographic evidence of a valve- like effect of the silastic tendon.