Long-term results of minimally invasive deep reflux correction in patients with post-thrombotic disease

The OBJECTIVE was to trace the long-term results of the operation of a dosed narrowing of the femoral vein in the lower third of the thigh proposed by Professor P. G. Shvalb. METHODS AND MATERIALS. The study included 30 patients (20 men and 10 women) with post-thrombotic disease of the veins of the lower extremities of the recanalized form, C4–C6, who underwent surgical correction of deep reflux in the period from 2012 to 2013. In 23 patients, additional phlebectomy of superficial and perforating veins was performed. The research method was duplex scanning (DS). The ratio of antegrade and retrograde blood velocities was used to quantitatively characterize deep reflux. Additionally, the state of the popliteal-tibial segment of the deep veins was determined using the Psatakis reflux index. RESULTS. The positive effect of the operation was noted in 96.7 % of patients at a follow-up period of 4 years. During follow-up periods of up to 8 years, the numbers decreased to 60.7 %. Relapse of trophic ulcers occurred in 39.3 % of patients. However, all patients noted that ulcers were much smaller in size than before surgery. According to DS data, incompetent perforator veins were detected in 16 patients: in all nine patients with recurrent ulcers and in seven patients without worsening. Vein diameter, maximum and average velocities of retrograde blood flow were greater in patients with worsening: diameter – 4.2±0.5 mm, υ (m) 91.2±19.8 cm/s, υ (average) 90.5±18.5 cm/s versus a diameter of 2.9±0.5 mm, υ (m) 39±15.6 cm/s, υ (average) 35±9 cm/s (p<0.05). CONCLUSIONS. Operation of dosed narrowing of the femoral vein had good clinical results in 96.7 % of follow-up periods up to 4 years, 60.7 % – after 8 years. Isolated correction of deep reflux with the preservation of insufficient perforator veins can lead to recurrence of trophic ulcers.