External valvuloplasty of the great saphenous vein. Reparative therapy of truncular varicosis

Background. The great saphenous vein is still an indispensable replacement material for vessels in cardiac and vascular surgery. Therefore, treatment strategies in which insufficient veins can be preserved for a possible vascular reconstruction at a later date deserve attention. The procedure of external valvuloplasty (eVp) is the most widely used procedure for reparative therapy of an insufficiency of the great saphenous vein. In a systematic review the main question was whether long-term preservation is feasible. Method. The electronic databases medline and web of science were systematically searched for articles in German and English in which the eVp was used for the treatment of varicose vein disease. In addition, the abstract collections from the annual meetings of vascular medical societies over the past 3 years and published in German journals were analyzed. Results. Out of 62 screened abstracts 25 were considered relevant and included in the analysis. In the long-term most patients showed an improvement in venous hemodynamics and therefore also a reduction in the diameter of the veins. The recurrence rate of varicosis was 46.9% in 10 years and 3.7-15.6% of the initially reparative treated patients had to be treated again with an ablative procedure. Postoperative phlebitis affected the treatment results in 0-9.6% of cases. Conclusion. In selected patients with mobile valve cusps but enlarged diameter of valve bearing segments, preservation of the great saphenous vein is possible in the long-term. Organ-preserving treatment of varicosis should be provided for patients with a high risk profile of developing atherosclerotic vascular diseases whenever possible.