Surgical treatment of postphlebitic syndrome with vein valve transplant.

Sequelae of the postphlebitic syndrome can new be treated by direct valve surgery. The present surgical treatment of stasis ulcer, including removal of the incompetent perforators, ulcer excision, and skin grafting, remains essential. Excision of perforators and ulcer care are effective but are associated with a high rate of ulcer recurrence. Experimental studies to restore venous valve function include autogenous or homologous vein valve transplantation, valvuloplasty, and valve transposition. In 23 cases of vein valve transplantation and two transpositions, a normal autogenous vein valve from the arm was used to restore a normal functioning venous valve in the leg. Pre- and postoperative noninvasive and invasive testing indicates hemodynamic improvement of venous function in these legs. Follow-up direct venous pressure measurements did not show normalization and may indicate that more than one competent valve is necessary. Changes in muscle structure may play a role in the maintenance of venous pressure.