Trapdoor internal valvuloplasty - A new technique for primary deep vein valvular incompetence

Abstract

Objectives: to describe a new technique of exposure of the valve commissure, called the "Trapdoor" Internal Valvuloplasty (TIV), to treat primary deep vein valvular incompetence. Material and Methods: the TIV method involves partial transverse incisions which are joined together by a vertical incision to create a virtual "trapdoor" at the target vein valve, providing optimum access to repair the insufficient valve. In 17 consecutive patients (25 limbs) TIV has been successfully employed for 41 valvular repairs since August 1999. All patients had open non-healing or recurrent venous ulcers. Results: on mean follow-up of six months (clinical assessment of venous ulcer healing and by colour-coded Duplex scans at 1, 3, 6, 9 and 12 months), of the 41 valves repaired by TIV technique, 39 valves (95%) maintained full patency. Thirty-four valves (85%) achieved primarily a VCT <0.5 s without reflux at the target valves on Valsalva manoeuvre in the upright position. Eighty-four percent of all ulcers (n=25) healed within 8 weeks of surgery without recurrence during the follow-up period. Conclusion: the Trapdoor Internal Valvuloplasty (TIV) represents a novel technique, which has the advantages of being both technically less demanding and anatomically better defined. Furthermore, TIV is physiologically acceptable and enables accurate localisation of valve cusp defects while allowing comprehensive, anatomical repair of valvular deficiencies.