Chapter 159 - Deep vein valve reconstruction

Question 1

Rate of deep venous obstruction or reflux in all CVD

Answer 1

55%

Question 2

Primary venous insufficiency valves

Answer 2

1) floppy 2) redundant 3) elongated cusps 4) assymmetrical insertion 5) enlarged venous diameter

Question 3

Secondary venous insufficiency causes

Answer 3

DVT and post-thrombotic disease

Question 4

Cutoff for abnormal reversed flow (reflux) in femoropopliteal and deep femoral and tibial veins

Answer 4

1 sec for fem pop 0.5 s for profunda 0.4 s for tibial

Question 5

Signs of venous insufficiency on duplex

Answer 5

1) reflux 2) thickened scarred constricted vein 3) valves with poor flow 4) diminished augmentation 5) respiratory variation lost (local or proximal obstruction/stenosis)

Question 6

Air plethysmography cut off for venous insufficiency

Answer 6

Venous filling index > 2 ml/s Residual volume fraction > 35% Ejection fraction > 60%

Question 7

Ascending and descending venography uses

Answer 7

Ascending - define anatomy and eliminate obvious obstruction Descending - determine valve leaflet integrity, location and degree of reflux to each segment

Question 8

Treatment algorithm for venous ulcer

Answer 8

FIGURE 159.7

Question 9

Indication for deep vein valve repair CEAP class

Answer 9

C4b, C5 and C6

Question 10

Types of treatments for valve restoration

Answer 10

1) valve repair (internal/external valvuloplasty, banding) 2) valve transposition/transplantation 3) autologous valve substitute

Question 11

Location of AT vein in relation to closest muscle

Answer 11

Deep to anterior tibialis Anterior compartment

Question 12

Location of PT and peroneal vein in relation to closest muscle

Answer 12

Deep posterior compartment Covered by soleus and gastrocnemius - superficial posterior compartment

Question 13

Number of valves in paired tibial and peroneal veins

Answer 13

3-12 in each

Question 14

Number of valves in popliteal veins

Answer 14

1-3

Question 15

Number of valves in femoral vein

Answer 15

1-5 (>90%)

Question 16

Most constant valve location

Answer 16

proximal femoral vein 1-2 cm distal to confluence with profunda 90%

Question 17

Number of valves in profunda

Answer 17

1-4 (88%)

Question 18

Number of valves in CFV

Answer 18

>50% none can have 1-2 near inguinal ligament

Question 19

Strip test

Answer 19

milking blood antegrade past valve with inflow occluded then pressure retrograde to fill vein again (reflux)

Question 20

Internal valvuloplasty 4 exposure types

Answer 20

1) Kistner 1968 - longitudinal venotomy through valve commissure 2) Raju transverse venotomy supracommissural 2.5 cm above valve 3) Sottiurai combined approach T shape 4) Tripathi and Ktenidis trap door

Question 21

External valvuloplasty methods

Answer 21

1) Kistner 1990 - transmural suture through valve attachment lines 2) transluminal sutures 3) angioscopic guidance 4) Raju - transcommissural valvuloplasty 5) limited anterior plication

Question 22

External banding

Answer 22

External sleep of synthetic wrapped around vein at site of valve

Question 23

Valve transplantation key points

Answer 23

Taheri described it 2-3 cm UE vein with valve harvested Replaces most proximal segment of FV Proximal anast first to confirm valve competence

Question 24

Valve transposition key points

Answer 24

GSV, profunda and FV all can be used in various configurations

Question 25

Neovalve creation techniques

Answer 25

1) Autogenous vein as donor cusp 2) GSV placed inside femoral vein as cusp 3) cutting intimal/medial wall to create valve 4) endo valve creation 5) endo valve replacement

Question 26

Hematoma and seroma in valve repair

Answer 26

15%

Question 27

DVT after valve repair

Answer 27

10%

Question 28

Internal valvuloplasty long term competence

Answer 28

5 year 60-70%

Question 29

External valvuloplasty long term competence

Answer 29

3 year 64%; 5 year 52%

Question 30

External banding competency rate long term

Answer 30

78% at 50 months

Question 31

Clinical improvement after valve transplantation and transposition

Answer 31

50% in 8-10 years

Question 32

Neovalve long term competence

Answer 32

68% at 54 months