Journal of Vascular Surgery
Volume 34, Issue 2 , Page 374, August 2001

Regarding “Does surgical correction of the superficial femoral vein valve change the course of varicose disease?”

Department of Vascular Surgery, Istituto Dermopatico dell'Immacolata, Rome, Italy

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To the Editors: 

We read with interest the article by Lurie et al (J Vasc Surg 2001;33:361-8). We agree with the conclusion that the presence of superficial femoral vein (SFV) incompetence is associated with a more severe chronic venous insufficiency, and we believe that a primary deep venous insufficiency (PDVI) is involved in the pathogenesis of a relevant number of both primary and recurrent varicose veins. In the control group, the authors found 11% recurrent varicosities, and we found a PDVI in 28% of 246 extremities affected by recurrent varicose veins.1

Concerning the discordance about the observations that superficial venous surgery abolishes the deep venous reflux, we feel that this finding is correlated above all to the reflux grade. In our experience a third- to fourth-grade reflux cannot be abolished by saphenous surgery, but a first- to second-grade can, which is in accordance with the overload theory.2 In this paper the authors do not refer to the reflux grade (even if in 86 patients a retrograde venography was performed). However, the affirmation that only 12 extremities demonstrated popliteal vein incompetence makes us think that the majority of patients were only affected by a second-grade reflux. With this hemodynamic pattern, an internal valvuloplasty seems to have been excessive, requiring a venotomy and anticoagulant therapy. The technique for deep vein reconstructive surgery is related to an intraoperative milking maneuver.3 Valvular prolapse is probably a multiphase process: in the first stages, a correction may be obtained by a banding and external valvuloplasty, which are easier and more rapid procedures and do not need venotomy or anticoagulant therapy.4

Moreover, I disagree with the authors' view that it was not necessary to examine the profunda femoris vein (PFV) for valvular dysfunction: the PFV incompetence could prejudice the results of an SFV valvuloplasty.5, 6

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References 

  1. Guarnera G, Furgiuele S, Di Paola FM, Camilli S. Recurrent varicose veins and primary deep venous insufficiency: relationship and therapeutic implications. Phlebology. 1995;10:98–102
  2. Walsh JC, Bergan JJ, Beeman S, Comer TP. Femoral venous reflux abolished by greater saphenous vein stripping. Ann Vasc Surg. 1994;8:566–570
  3. Raju S, Frederikssen CKR. Valve reconstruction procedures for non-obstructive venous insufficiency: rationale, techniques and results in 107 procedures with 2-8 years follow-up. J Vasc Surg. 1988;7:301–310
  4. Camilli S, Guarnera G. External banding valvuloplasty of the superficial femoral vein in the treatment of primary deep valvular incompetence. Int Angiol. 1994;13:218–222
  5. Eriksson I, Almgren B. Influence of the profunda femoris vein on venous haemodynamics of the limb. J Vasc Surg. 1986;4:390
  6. Guarnera G, Furgiuele S, Camilli S. Profunda femoris vein incompetence and varicose veins. Proceedings of the European Congress of the International Unino of Phebology; 1994 Sep 6-10; Budapest In: Brentwood, Essex: Multi-Science; 1993;p. 221–230

PII: S0741-5214(01)70059-6

Journal of Vascular Surgery
Volume 34, Issue 2 , Page 374, August 2001

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