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The clean blood that our arteries take to tissues and organs is returned to the heart with veins (venous). There are two vein systems in the leg, superficial and deep. The deep vein system carries 90% of the rotating blood. These veins contain valves that prevent blood from escaping only, which ensures the flow of blood to the heart. Venous insufficiency is called when these valves reclaim blood.
Venous valves consist of two thin leaflets and meet in the middle for proper closure. Although venous valves have a similar structure to the heart valve, they are much thinner and on a smaller scale. In the deep vein system that provides dirty blood flow from the leg to the heart, the valves are located from the foot to the groin area. There may be deficiencies due to many reasons (escapes) especially in the lids of the deep veins in the groin area.
Due to this escape, high venous pressure occurs in the ankle area. Accordingly, problems such as severe edema in the leg, skin hardening in the wrist area, darkening in color, ulcer, necrosis, and infection develop.
Deep venous insufficiencies are often accompanied by superficial venous insufficiencies. In these patients, after superficial venous insufficiency is treated, deep venous insufficiency is expected to decrease. If there is no reduction, no improvement in problems despite compression socks and medical treatment, deep venous surgery is applied as a last resort.
DIAGNOSIS IN DEEP VENOUS FAILURE
In patients with deep venous insufficiency, detailed information about the history of the disease is required. The main purpose here should be revealed by your doctor whether reflux or valve insufficiency develops primarily in genetic defect in the valve tissue or secondary as a result of a thrombosis that has been previously experienced. Approximately half of the patients are found to have valve damage after primary disease or thrombosis (blood clotting). In a good physical examination, the effects of venous insufficiency on your leg are determined. These patients often have varicose veins, edema and skin changes or ulcers.
With the Doppler ultrasound study to be performed after these evaluations, the diameter of all veins, wall structure, the structure of the valves and the severity of the repl are evaluated. As a further examination, an air plethysmography device is used to evaluate changes in the leg while standing and walking. In patients with serious insufficiency in deep veins in the examinations, it will be useful to evaluate whether there is a tendency to have a genetic coagulation.
SURGICAL OPTIONS IN DEEP VENOUS FAILURE
In venous surgery, the main purpose is to transfer valve from another vein for the elimination of leakage or repair the leak with sutures if the valve is intact. Various studies have shown that vein transfer (or groin) with intact valve yields good results. Firstly, in 1968, Dr. Direct fixing of the valve in the repair method described by Kistner is very successful and its long-term results are good. Venous valve repair is a very challenging task that needs microscopic magnification and to be done perfectly. Dr. In Kistner's repair technique, after opening the deep vein, after evaluating the leaflets to be normal, a narrowing process is started to reduce leakage. For this process, very thin seams are placed, which prevent the valve from fixing and the vein from expanding due to pressure. With these processes, proper closure is provided and back flow of blood in the vein is prevented.
During the operation, the movement of blood back and forth from the valve should be evaluated. When compressed from below after the procedure performed, there should be no strain on the passage of blood and there should be no escape when compressed from above. During the surgery, the patient is given a blood thinner (heparin) to prevent clots from forming in the vein and is continued for a short period of time in the hospital. Then, anticoagulants (warfarin: coumadin) are given orally for 8-12 months.
Sometimes, in patients where repair is not possible, the deep vein can be transferred under a superficial vein with a firm valve. This may cause enlargement and leakage in the transferred vessel in the following years.
In 1981, Dr. Axillary vein valve transfer described by Raju is used in cases where direct valve repair or displacement surgery is not possible. The axillary vein under the armpit is sized by femoral veins in the thigh. An axillary vein segment with a well-functioning valve is removed through a small incision under the armpit. This vascular segment is then placed on both ends of the vascular system where the lower leg is insufficient.
Removal of the axillary vein from the arm causes surprisingly minor problems in most cases. There are many veins in the arm that allow blood to be transferred from the arm without significant swelling or pain. Rarely, swelling can be seen in the arm, which is removed from the vessel, but it is controllable.
DEEP VENOUS FAILURE SURGERY AND COMPLICATIONS
Depending on the surgical operation, bleeding from the surgical site or the formation of a clot that compresses around it may be seen. In addition, the most feared complication after these operations is the formation of a clot in the vein. This condition occurs in about five percent of patients despite anticoagulant therapy.
DEEP VENOUS INSUFFICIENCY SURGERY RESULTS
The factors that determine the result are the condition of the disease, the surgeon's experience and the surgical technique to be applied. In patients with venous reflux due to primary valve dysfunction, 60-80% of patients may experience improvement in symptoms such as pain and swelling. In most patients, the drug and compression stockings may not be needed after successful operation. However, the results of surgical treatment applied to patients who have previously experienced deep vein thrombosis and developed deep venous insufficiency are not very satisfactory. However, it can be seen that two-thirds of these patients also had full ulcer healing in twelve years following successful surgery.