Vascular surgical society of great britain and ireland: new technique of in situ autogenous venous valve construction using varicose vein and bench hydrostatic testing of its properties in vitro.

Abstract

BACKGROUND: Long-term results of valve transposition and autogenous valve grafts (from axillary and brachial vein) for chronic venous insufficiency due to post-thrombotic valve destruction are poor. Attempts at constructing in situ autogenous venous valves using varicose veins have been ongoing since 1953 but have been unsuccessful. A technique has been developed to create new autogenous in situ valve. METHODS: Varicose long saphenous veins were obtained following stripping during routine varicose vein surgery. A longitudinal elliptical segment of vein wall was excised from opposite sides; this effectively reduces the diameter of the vein. Polypropylene sutures were applied on each side, starting at the centre of the elliptical defect, and brought out proximally. After closing the elliptical defects, gentle traction was applied to the initial sutures and they were tied causing invagination of the vein wall. Both ends of the vein were connected to pressure transducers and a standard pressure monitoring device. Normal saline was pumped at various pressures through the valve-bearing segment while pressures were recorded simultaneously. RESULTS: Fourteen constructed valves were tested for their bench hydrostatic properties. Mean(s.d.) minimum opening pressure of the valves was 5. 3(2.4) mmHg. The valves were competent at a minimum pressure of 2. 7(0.6) mmHg. They sustained sudden pressures of up to 139.0(13.8) mmHg and remained competent at a maximum pressure of 260 mmHg. CONCLUSION: This technique produces a competent one-way valve capable of sustaining high back pressures, while allowing forward flow with minimal resistance.