Surgery for deep venous incompetence

Hardy SC, Riding G, Abidia A

Published Online:

January 21, 2009

Deep venous incompetence (DVI) is a problem in the veins that can lead to leg ulcers (sores), pain and swelling. It may be caused by a problem in the valves of the vein, or due to a blockage in the veins, or a combination of both. For most people special compression stockings and treating the ulcers is enough. When this does not ease the problem surgery is sometimes tried. The review found too little evidence from trials assessing the effects of surgery for DVI. However, there is some evidence that valve surgery together with ligation (tying the vein) may be better in the long term for some people. Not enough evidence on the effects of surgery for deep venous incompetence

Abstract (click to read)

Background:

Chronic deep venous incompetence (DVI) is caused by incompetent vein valves and/or the blockage of large calibre leg veins, with a range of symptoms including recurrent ulcers, pain and swelling.

Objectives:

To establish the effectiveness of various surgical procedures for treating DVI.

Search strategy:

Trials were identified through the Cochrane Peripheral Vascular Diseases Group's Trials Register, reference lists of relevant studies, and contact with principal investigators of identified trials and world experts in deep venous surgery.

Selection criteria:

Randomised controlled trials of surgical treatment for patients with DVI.

Data collection and analysis:

Reviewers extracted data independently. Outcome measures included ambulatory venous pressure (AVP) and venous refill time (VRT).

Main results:

Three trials involving 233 patients were included. Two of the trials compared external valvuloplasty using limited anterior plication (LAP) in combination with ligation (L) of incompetent superficial veins (L+LAP) against ligation only (L). The other trial compared external valvuloplasty and ligation (V+L) of incompetent superficial veins against ligation only (L). Trial participants had primary valvular incompetence with mild to moderate symptoms but no venous ulcers.

Ligation plus with limited anterior plication produced significant improvement in AVP: the mean difference between L+LAP and L groups was -15 mm Hg (95% confidence interval (CI) -20.9 to -9.0) at one year and -15 mm Hg (95% CI -21 to -8.9) at ten years.

Ambulatory venous pressure values after surgery remained relatively high. Nine of eleven valves repaired remained competent after two years of follow up. No complications occurred. The overall mean score for clinical outcome was +2 (moderate improvement) in the L+LAP group compared with +1 (mild improvement) in the L group.

Patients with deteriorating clinical dynamics over the five years preceding surgery had a significantly higher rate of improvement in clinical condition in V+L compared with L (81% versus 51%; P < 0.05) after seven years follow up. Patients with stable preoperative clinical dynamics demonstrated a similar rate of improvement in both groups (96% versus 90%; P > 0.1). Ambulatory venous pressures were not performed.

Authors' conclusions:

These results indicate that ligation and valvuloplasty may have produced a moderate and sustained improvement for seven to ten years after surgery in patients with mild to moderate DVI caused by primary valvular incompetence. However, there is insufficient evidence to recommend the treatment to this subgroup of patients, as the trials were small, used different methods of valvuloplasty and different methods of assessment.

This record should be cited as:

Hardy SC, Riding G, Abidia A. Surgery for deep venous incompetence. Cochrane Database of Systematic Reviews 2004, Issue 3. Art. No.: CD001097. DOI: 10.1002/14651858.CD001097.pub2

Assessed as up to date:

April 7, 2004

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Primary Review Group:

Peripheral Vascular Diseases Group

Health topics:

Heart & circulation > Peripheral vascular disease > Chronic venous insufficiency

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Surgery for deep venous incompetence

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