Claude Juhan

Classification and Grading of Chronic Venous Disease in the Lower Limbs-A Consensus Statement-

Classification and grading of chronic venous disease in the lower limbs : A consensus statement

Recurrent Varicose Veins

We report our experience of 93 patients with recurrent varicose veins. Doppler ultrasound and ascending phlebology were routinely performed, with descending or popliteal phlebography in some patients, as a means of evaluating recurrence. Early recurrence was found in a few cases due to incorrect diagnosis. Late recurrence, in the majority of cases, was due to incorrect surgery or the overlooking of gastrocnemius vein incompetence. In some cases deep reflux, soleal arch compression or left iliac vein compression was found to be a possible cause of recurrence. Extensive evaluation of the venous disorder and the ligation of every site of deep to superficial reflux are the first steps in preventing recurrence. The rules and pitfalls of surgical treatment are stressed. On recurrence, Doppler ultrasound is accurate in deep venous assessment and in demonstrating leaking perforators. Ascending phlebography is the method of choice in the investigation of the deep veins and in confirming perforating vein incompetence. We have used popliteal phlebography to demonstrate incompetence of the LSV junction, SSV junction, gastrocnemius vein and mid-thigh and popliteal fossa perforators. When necessary, surgery for recurrent varicose veins must be carefully carried out according to certain basic principles.

Patency after Iliofemoral and Iliocaval Venous Thrombectomy

Between 1981 and 1984, 42 iliac venous thrombectomies were performed in 41 patients with recent iliofemoral venous thromboses. Of the 42 thromboses, 18 extended into the inferior vena cava. In 31 cases a temporary arteriovenous fistula was constructed and in 21 cases the inferior vena cava was partially interrupted. Early postoperative venography was performed in 40 of 42 thrombectomy cases. One or more late venograms were done one to four years postoperatively. None of the patients died during the hospital stay, and there were no cases of intraoperative or early postoperative pulmonary embolism. Six postoperative hematomas were evacuated. Patency of the iliac veins was maintained in 93% of cases. When performed with care venous iliac thrombectomy associated with a temporary arteriovenous fistula appears to be the appropriate treatment for iliofemoral or iliocaval thromboses less than ten days old.

The Venous Valve and Its Reconstruction

Since Kistner’s pioneering report in 1968 on valvuloplasty for deep venous insufficiency, this controversial field of vascular surgery has developed rapidly. Available data of the different reconstruc