Popliteal vein external banding at the valve-free segment to treat severe chronic venous insufficiency Tao Ma, MD, Weiguo Fu, MD, Jie Ma, MD Journal.

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Presentation transcript:

Popliteal vein external banding at the valve-free segment to treat severe chronic venous insufficiency Tao Ma, MD, Weiguo Fu, MD, Jie Ma, MD Journal of Vascular Surgery Volume 64, Issue 2, Pages 438-445.e1 (August 2016) DOI: 10.1016/j.jvs.2016.03.412 Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 1 Popliteal vein external banding (PVEB). A, The popliteal vein (PV) is externally encircled with a piece of vascular graft, the size of which is 1 cm in breadth and one-third circumference of the PV in length. B, Typical location of PV valve (PVV) and gastrocnemius vein (GV) entries. PVEB is performed on the valve-free segment proximal to the GV entries. The dashed line at the level of the upper margin of the patella indicates the typical PVEB position on the vein. C, Postprocedural venography shows an increased venous return at the PVEB segment. The limb under investigation is kept relaxed without excessive strain or calf muscle contraction, with a tourniquet around the ankle. Journal of Vascular Surgery 2016 64, 438-445.e1DOI: (10.1016/j.jvs.2016.03.412) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 2 Kaplan-Meier analysis of ulcer healing for the C6 patients (N = 193). PVEB, Popliteal vein external banding. Journal of Vascular Surgery 2016 64, 438-445.e1DOI: (10.1016/j.jvs.2016.03.412) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 3 Preprocedural and postprocedural pictures. A, Preprocedural large ulcers with a 32-year chronic history. B, Ulcers healing at 28 days after popliteal vein external banding (PVEB) and synchronous skin grafting. C, At 1 year, the ulcers remained cured, and they did not recur within the 52-month follow-up. The patient wears no compression stockings. Journal of Vascular Surgery 2016 64, 438-445.e1DOI: (10.1016/j.jvs.2016.03.412) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Supplementary Fig 1 (online only) Pressure measurement catheter used in tibial veins and peritoneal veins. A, The catheter reached as far as 20 cm in distal veins. B, Pressure measurement using the catheter. Journal of Vascular Surgery 2016 64, 438-445.e1DOI: (10.1016/j.jvs.2016.03.412) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Supplementary Fig 2 (online only) Postoperative ascending venography of a patient with chronic venous insufficiency (CVI). The patient sat in a chair with his knee joint bent. The examination was performed with both normal breathing and a Valsalva maneuver, and no reflux was seen, which was consistent with the postoperative color duplex ultrasound (CDU) results. A, The calf muscles were relaxed, and the contrast medium moved through the popliteal vein external banding (PVEB). B, The patient performed the Valsalva maneuver, and the contrast medium stopped returning but did not flow back into the calf vessels. Journal of Vascular Surgery 2016 64, 438-445.e1DOI: (10.1016/j.jvs.2016.03.412) Copyright © 2016 Society for Vascular Surgery Terms and Conditions