Femoral vein reconstruction in the management of chronic venous insufficiency. A 14-year experience.

Clinical, hemodynamic, and venographic studies were performed on 46 patients undergoing reconstruction of the incompetent femoral vein and followed up for 13 years. Operations included 32 valve repairs and 14 vein segment transpositions. Twenty-four patients had perforator vein interruption in addition to valve surgery; 16 had only valve procedures; and six had had previous perforator surgery. The results indicate that ambulatory venous pressure is the most reliable hemodynamic test; it is sensitive but not specific. Descending venography proved the durability of valve repair up to 12 years. Perforator interruption improved the clinical and the hemodynamic outcomes. Good to excellent long-term results were found in 83% of the patients operated on for ulceration and, of those with recurrence, all were seen within the first four postoperative years. Restoration of competence in the femoropopliteal segment produces a long-term favorable effect. Optimal clinical, venographic, and hemodynamic results occur when all abnormal venous divisions (saphenous, perforating, and deep) are corrected.