Direct reconstructive venous surgery.

Unilateral occlusions of the pelvic veins may be corrected by a Palma operation. In the classic Palma operation the contralateral long saphenous vein is suprapubicly led to the opposite side and is anastomosed end-to-end or end-to-side with the common femoral vein of the occluded side. Just lately, spirally wall reinforced PTFE grafts showed more favourable results than Palma grafts. Circumscribed occlusions of the superficial femoral vein can be interposed by the May-Husni operation. Thereby the ipsilateral long saphenous vein is implanted end-to-side into the popliteal vein. We perform the Palma operation as well as the May-Husni operation under the protection of a temporary av-fistula. The ascending venography only permits to make a statement on the morphological operability, whereas the functional operability is indicated by means of phlebodynamometry. Phlebodynamometry and plethysmography are the best means to judge the functional result of the operation which is of importance for the patient. The results of the Palma operation can be regarded as very satisfactory, provided that the morphological and functional indication for the operation was correct. The use of the endothelium protective operative technique by Robert Mays as well as the application of a temporary av-fistula yield a success that is above 80 p.c. As against that, the May-Husni operation achieves less than 50 p.c. success, even if a temporary av-fistula is established in the area of the ancle. Less favourable are the results obtained by direct restorative interventions on the subclavian vein, so that these operations should only be indicated in exceptional cases.