Leg wounds healed, pain and edema was relieved, and life quality improved following stenting or venous valve reconstruction in patients with chronic venous insufficiency.
Chronic venous insufficiency can cause debilitating pain and ulcers. Interventions that open narrow and repair failing veins are good alternatives for selected patients, according to the doctoral thesis of Antonio Rosales at the University of Oslo.
The work of Rosales goes all the way back to 1993, when the first surgical reconstruction of failing vein valves was offered to patients at Aker University Hospital, Oslo. By 2004, 17 patients with primary venous insufficiency had received external venous valve plasty, whereas 32 patients with venous insufficiency following a deep vein thrombosis had received venous valve reconstruction. In both patient groups, a majority of ulcers healed within three months after surgery. Moreover, most patients stayed free of symptoms from venous insufficiency for several years.
Reconstruction of venous valves is not always an option for patients with damaged valves as a result of deep vein thrombosis. For these patients, the affected veins can be kept open by a metal stent. Between 2000 and 2009, this procedure was offered to 34 patients at Aker University Hospital. Seven of them had leg ulcers, and four of these ulcers healed after stenting. Recanalization of the affected veins was successful in 32 out of 34 patients, and a majority of the stents were still open after two years. Patients who received successful recanalization were free of pain and edema following the procedure.
Venous insufficiency is usually treated with compression stockings and surgery to remove superficial varicose veins. In selected patients not responding to these treatments, the doctoral thesis of Antonio Rosales suggests that reconstructive deep venous surgery and endovascular venous intervention should be considered as treatment options.
Thesis: Reconstructive deep venous surgery and endovascular venous intervention in the treatment of chronic venous insufficiency
Candidate: Antonio Rosales
Time and place: January 6, 2017, University of Oslo
Rosales, A., Slagsvold, C. E., Kroese, A. J., Stranden, E., Risum, Ø., & Jørgensen, J. J. (2006). External venous valve plasty (EVVP) in patients with primary chronic venous insufficiency (PCVI). European journal of vascular and endovascular surgery, 32(5), 570-576.
Rosales, A., Jørgensen, J. J., Slagsvold, C. E., Stranden, E., Risum, Ø., & Kroese, A. J. (2008). Venous valve reconstruction in patients with secondary chronic venous insufficiency. European Journal of Vascular and Endovascular Surgery, 36(4), 466-472.
Rosales, A., Sandbaek, G., & Jørgensen, J. J. (2010). Stenting for chronic post-thrombotic vena cava and iliofemoral venous occlusions: mid-term patency and clinical outcome. European Journal of Vascular and Endovascular Surgery, 40(2), 234-240.