Cochrane: Deep venous
incompetence (DVI) is a problem in the veins that can lead to leg
ulcers (sores), pain and swelling. It may be caused by a problem in the
valves of the vein, by a blockage of the veins or by a combination of
these events. For most people, wearing special compression stockings and
treating the ulcers is enough.
When this does not ease the problem, surgery is sometimes tried. This review includes four studies with a total of 273 participants. All included studies reported on outcomes following surgical repair of venous valves (valvuloplasty). We did not identify studies investigating other surgical procedures for the treatment of patients with DVI. All included studies investigated primary valve incompetence (when valves do not close properly because of laxity of the vein wall or valve cusps). We found no trials that investigated the results of surgery for secondary valvular incompetence (when valves do not close properly, for example, when valves are damaged as a result of deep vein thrombosis) or for the obstructive form of DVI. As different outcomes were reported, it was not possible to combine the results of these studies. The methodological quality of the included studies was low, mainly because information regarding allocation of treatment and blinding was missing, or because data were incomplete or were poorly presented. Ulcer healing and ulcer recurrence were not reported in one study, and the remaining three studies did not include patients with ulcers or active ulceration. Three studies reported no significant complications of surgery or no incidence of DVT during follow-up. One study did not report on the occurrence of complications.
Clinical changes were assessed by subjective and objective measurements, as specified in the clinical, aetiological, anatomical, and pathophysiological (CEAP) classification score. This requires vascular laboratory measurements of lower limb haemodynamics before and after surgery. Tests include an overall evaluation of venous function with venous refilling time (VRT) or ambulatory venous pressure (AVP). Results show improvement in clinical symptoms and muscle pumping function and significant improvement in the haemodynamic status of patients who had external valvuloplasty along with surgery to the superficial venous system. In patients who had surgery to the superficial venous system only, clinical symptoms improved, but no improvement in muscle pumping function was reported.
Evidence is not sufficient to show the effects of surgery on the treatment of patients with DVI. The individual trials included in this review have demonstrated possible long-term benefit in certain groups of patients, but these trials were small, used different methods of assessment and overall were of poor quality. They did not include patients with severe DVI. Trials investigating the effects of other surgical procedures on the deep veins are needed. Until evidence from such trials becomes available, conventional conservative measures, such as high compression therapy or elasticated hosiery, remain the treatments of choice.
When this does not ease the problem, surgery is sometimes tried. This review includes four studies with a total of 273 participants. All included studies reported on outcomes following surgical repair of venous valves (valvuloplasty). We did not identify studies investigating other surgical procedures for the treatment of patients with DVI. All included studies investigated primary valve incompetence (when valves do not close properly because of laxity of the vein wall or valve cusps). We found no trials that investigated the results of surgery for secondary valvular incompetence (when valves do not close properly, for example, when valves are damaged as a result of deep vein thrombosis) or for the obstructive form of DVI. As different outcomes were reported, it was not possible to combine the results of these studies. The methodological quality of the included studies was low, mainly because information regarding allocation of treatment and blinding was missing, or because data were incomplete or were poorly presented. Ulcer healing and ulcer recurrence were not reported in one study, and the remaining three studies did not include patients with ulcers or active ulceration. Three studies reported no significant complications of surgery or no incidence of DVT during follow-up. One study did not report on the occurrence of complications.
Clinical changes were assessed by subjective and objective measurements, as specified in the clinical, aetiological, anatomical, and pathophysiological (CEAP) classification score. This requires vascular laboratory measurements of lower limb haemodynamics before and after surgery. Tests include an overall evaluation of venous function with venous refilling time (VRT) or ambulatory venous pressure (AVP). Results show improvement in clinical symptoms and muscle pumping function and significant improvement in the haemodynamic status of patients who had external valvuloplasty along with surgery to the superficial venous system. In patients who had surgery to the superficial venous system only, clinical symptoms improved, but no improvement in muscle pumping function was reported.
Evidence is not sufficient to show the effects of surgery on the treatment of patients with DVI. The individual trials included in this review have demonstrated possible long-term benefit in certain groups of patients, but these trials were small, used different methods of assessment and overall were of poor quality. They did not include patients with severe DVI. Trials investigating the effects of other surgical procedures on the deep veins are needed. Until evidence from such trials becomes available, conventional conservative measures, such as high compression therapy or elasticated hosiery, remain the treatments of choice.
Authors' conclusions:
No evidence was found for benefit or harm of valvuloplasty in the treatment of patients with DVI secondary to primary valvular incompetence. The individual trials included in this review were small; they used different methods of assessment and overall were of poor quality. They did not include participants with severe DVI. Trials investigating the effects of other surgical procedures on deep veins are needed. Until the findings of such trials become available, the benefit of valvuloplasty remains uncertain.