Venous hemodynamic changes after external banding valvuloplasty with varicosectomy in the treatment of primary varicose veins.

摘要

BACKGROUND: To evaluate venous hemodynamic changes after an external banding valvuloplasty in the treatment of primary varicose veins with saphenofemoral incompetence. METHODS: From June 1996 to December 1997, 79 limbs (10 male and 69 female, age 20-57 years) were treated for primary saphenofemoral incompetence by external banding valvuloplasty. Tightening of the banding was accomplished using a polyester-tailored mesh to narrow the terminal and/or subterminal valve areas of the dilated greater saphenous vein (GSV), same size as its minimum diameter during spasm. Evaluation was done through a pre- and postoperative color-flow duplex scanning and an air-plethysmography (APG). RESULTS: Sixty-three limbs (79.7%) remained patent and were competent. Fourteen limbs (17.7%) remained patent but showed reflux. Two limbs (2.5%) had thrombus within the GSV after surgery. The diameter of GSV of mid-thigh was 6.7+/-1.6 mm preoperatively and 4.1+/-0.9 mm postoperatively (p-value=7.04E-10). Reduction of the diameter was 61.4+/-12.3%. Venous volume was 136.1+/-59.8 ml preoperatively and 103.5+/-39.8 ml postoperatively (p-value=1.6E-20). Reduction of the venous volume was 12.9+/-17.0%. Venous filling index (VFI) was 6.6+11.3 ml/sec preoperatively and 1.9+/-3.3 ml/sec postoperatively (p-value=1.2E-10). Reduction of the VFI was 55.0+/-29.1%. Ejection fraction (EF) was 48.9+/-13.8% preoperatively and 60.1+/-17.2% postoperatively (p-value=2.6E-17). Increase of EF was 29.4+/-43.5%. The residual volume fraction (RVF) was 42.1+/-13.9% preoperatively and 30.2+/-14.5% postoperatively (p-value=5.6E-19). Reduction of RVF was 17.6+/-43.6%. CONCLUSIONS: Early evaluation of saphenofemoral external banding valvuloplasty confirms the satisfactory patency and improvement in venous hemodynamics. Long-term evaluation is clearly indicated but the early safety and efficacy of the procedure have been confirmed.