Longevity and Outcomes of Axillary Valve Transplantation for Severe Lower Extremity Chronic Venous Insufficiency

Objective: To assess the efficacy of axillary vein transplantation in the treatment of severe chronic venous insufficiency (CVI).
Methods: Among 151 complex venous reconstructions preformed between 1992-2007 for CVI, 18 patients underwent upper extremity to lower extremity venous valve transplantation without external wrapping. An upper extremity valve was transplanted to the popliteal vein in 11 cases, the common femoral vein (CFV) in 6 cases and the saphenous-femoral junction in 2 cases. One patient had both legs operated on and two patients had repeat operations for a total of 21 procedures. All patients had follow-up with duplex scanning to assess valve competency and clinical visits to assess clinical improvement.
Results: Mean patient age was 44 years (range 29-62) and 57% were male. Clinically, 57% (12/21) of the limbs were CEAP class C5-C6. The mean preoperative Venous Disability Score (VDS) was 2.95 (range 2-3). Most of the patients (12/18 -66%) had post-thrombotic valvular dysfunction. Seven patients had iliac vein re-canalization prior to our operation. At the time of valve transplantation there was no proximal venous obstruction documented. A successful operation defined as a competent valve at the end of the case was achieved in 20/21 (95%) of the patients. Eight patients had a perioperative complication.
The best mean VDS score post operatively was 2.65 (p=0.007) and this increased to 2.75 (p=0.08) at the last post operative visit. Median time to return of symptoms was 12 months (Graph 1), and Median reflux-free survival was 15 months.
Conclusion: Despite initial technical and symptomatic success with venous valve transplantation, there is a poor long term valve competency rate, and poor long term symptomatic control. This data suggests better therapy needs to be found for the treatment of severe CVI.