Primary venous valve incompetence of the leg

• Published in: The American journal of surgery Vol. 140; no. 2; pp. 218 - 224
• Main Author: Kistner, Robert L.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.1980
• Subjects: Femoral Vein - physiopathology; Femoral Vein - surgery; Follow-Up Studies; Humans; Leg - blood supply; Leg Ulcer - etiology; Leg Ulcer - surgery; Male; Middle Aged; Venous Insufficiency - diagnosis; Venous Insufficiency - physiopathology; Venous Insufficiency - surgery
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/0002-9610(80)90010-0

Chronic venous insufficiency due to stretching of the venous valve cusp in the leg is described. Details of the pre- and postoperative clinical and radiographic features of this entity are presented. Hemodynamic findings are described. The surgical results show that permanent control of ulceration was achieved in all 18 limbs afflicted, severe aching was relieved in 80 percent and severe swelling was controlled in 70 percent. Follow-up extends to 10 years in some cases, and the average is 5 years. The importance of this entity is that it is one cause of the chronic venous insufficiency syndrome that can be corrected by reconstructive venous surgery. The occurrence of primary valve incompetence may be widespread and may be an important cause of varicose veins in the saphenous system. Its occurrence in the deep veins has been recognized by those who have performed descending venography, but the possibility of its pathologic significance was only advocated by Bauer [1] in 1948 and mentioned by Lockhart-Mummery and Smitham [2] in 1951. With the development of a surgical method of repair, the clinical benefit of repair of femoral vein incompetence can be assessed. Its frequency is yet to be determined. By adding surgical repair in the deep system of veins to conventional surgical methods in the saphenous and perforator veins, there is hope for relief of aching and suffering for many of those now afflicted with severe degrees of chronic venous insufficiency and of return of many disabled persons to full- or part-time work. The cost-effectiveness of this approach will depend on savings in both outpatient and inpatient care as well as return of persons to self-supporting work status.