The effect of pregnancy on venous valve repair to the sapheno-femoral junction for varicose veins
| Autor: | Rodney J. Lane, Nyan Y. Khin, Stuart Hazelton, Martijn L. Dijkstra, John Christopher Coroneos |
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| Rok vydání: | 2014 |
| Předmět: | |
| Zdroj: | Obstetric Medicine. 7:84-89 |
| ISSN: | 1753-4968 1753-495X |
| Popis: | Objectives: Pregnancy represents a special situation where both the mechanical and hormonal instigating factors of varicose veins are reversible with the venous valve cusps preserved. Exostent venous valve repairs are a physiological alternative which minimises stimulus to collateral growth (recurrence). The study purpose was to assess the effect of pregnancy on the durability of valve repairs. Methods: In a prospective study of 36 limbs, 20 young females (30 ± 4.7 years) had an exostent implanted to the terminal valve of the saphenofemoral junction for varicose veins. At routine long-term follow up (9.7 ± 3.8 years), 38 pregnancies were completed (mean: 1.8, range: 1–4). The controls were a non-pregnant group of limbs ( n = 386). Results: At 9.7 years, the internal diameter of the greater saphenous vein (GSV) changed from 7.8 ± 2.8 mm preoperatively to 4.5 ± 1.4 mm post-operatively. Recurrence was associated with reflux, preoperative deep system and ovarian vein involvement. Pregnancy induced 33.3% recurrences compared with non-pregnant controls (4.7%) similarly treated or 22.8% compared with non-pregnant ablative controls. At 9.7 years, symptomatic improvement continued with significantly better CEAP status (described later) (31CSEAP preoperative to 6CSEAP) with no further truncal ablation (strip, laser) required. Conclusions: Venous valve repairs can withstand the special stresses of pregnancy. There is no need to ablate the GSV. This approach is contrary to the traditional dictum; the treatment of varicose veins should be delayed until the family is completed. |
| Databáze: | OpenAIRE |
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