A Rational Approach to Surgery of the Chronic Venous Stasis Syndrome

Ambulatory venous pressure (AVP) and ascending and retro-grade phlebography have been used to elucidate the precise pathogenetic factors in cases of venous stasis. On the bases of this information, procedures aimed at the correction of the particular pathophysiological alterations were carried out. Fifty-two lower extremities in 49 patients suffering from chronic venous statis were studied. The AVP was performed by having the patient walk in place for 15 seconds without tourniquet and with one or two tourniquets at different levels of the extremity. The per cent drop of pressure in a foot vein during exercise and the time to return to standing pressure were used to determine a venous sufficiency index. Four distinct factors or groupings could be distinguished: incompetent perforators (31), deep vein incompetence (14), incompetence of the saphenous vein (3), and obstruction of deep veins (4). Six types of surgical procedures were done: ligation of perforators (25), superficial femoral valvuloplasty (3), segmental venous transposition (1), ligation of the superficial femoral vein (1), cross femoral venous bypass (1) and high ligation and stripping of the long saphenous vein (3). Three patients had skin sloughing after perforator ligation, and one patient developed a hematoma requiring evacuation following segmental venous transfer. Post-operative AVP evaluation in 11 patients after perforator ligation, two patients following superficial femoral valvuloplasty, one patient after segmental venous transfer, and one patient after cross femoral venous bypass showed significant improvement. Early follow-up results are very satisfactory.