Repair and replacement of deep vein valves in the treatment of venous insufficiency

Venous insufficiency is a widespread condition, the prevalence of venous ulceration being 0.5-1.0 per cent in Western populations. A principal abnormality causing venous insufficiency is deep venous reflux, usually resulting from post-thrombotic valve destruction. Patients undergoing treatment for venous insufficiency should have all venous abnormalities investigated, defined and corrected where possible. Although treatment for superficial and communicating vein incompetence is available, correction of deep vein reflux has been neglected until recently. Deep vein valve physiology, the selection of patients for deep vein valve surgery and methods of valve repair and replacement are reviewed.