Dermatológia pre prax 1/2015

Surgical treatment of chronic venous insufficiency

Surgical treatment of chronic venous insufficiency (CHVI) is manifested in the lower extremities with valvular incompetency, venous reflux, venous hypertension and varicose veins. This failure of the microcirculation transfers likewise to the microcirculation and it causes trophic changes at the skin, initiates a cascade of inflammatory reactions that may progress to oedema, venous eczema, ankle skin hyperpigmentation, lipodermatosclerosis up to venous leg ulcer. The aim of surgical treatment is the abolition or the lowering of the venous hypertension, to remove the varicose veins of superficial venous system, the abolition of reflux locality at the level SFJ, SPJ and insufficient perforators. At the valvular incompetention of deep venous system is present the deep venous reflux (DVR), which arise from the primary valvular incompetence and posthrombolic syndrome (PTS). DVR correction aims at reducing the deep venous hypertension, which transfers at the superficial venous system across the insufficient perforators. There are: internal and external valvuloplasty, transposition operations, vein transplantat with competent valvulated vein, or the neovalve obtained by dissecting the vein wall to obtain a flop at PTS. Valvuloplasty estimates successful clinical outcome at more than 5 years 70 % and at PTS 50 % (51). Radical surgical treatment of CHVI going out from pathogenesis of the breaking venous hemodynamic has good long-term results.

Keywords: chronic venous insufficiency, venous valve incompetence, venous hypertension, surgical treatment.