Long term results of vein valve transplants placed in the popliteal vein for intractable post-phlebitic venous ulcers and pre-ulcer skin changes.

Most patients with chronic venous ulceration or severe pre-ulcer damaged skin have incompetent popliteal valves and a high ambulant venous pressure (AVP). Competency can be restored by a vein valve transplant taken from the arm and placed in the popliteal fossa, with subjective and objective improvement. In this study 23 patients with post-phlebitic syndromes received 25 vein valve grafts as part of management. Seventeen patients had large recurrent ulcers after unsuccessful venous surgery: 6 patients had extensive pre-ulcer skin damage. Fifteen of 17 patients healed their ulcers, and all 6 patients with skin damage showed rapid improvement with relief of symptoms. Falls in the AVP, ranging from 10 to 40 mmHg occurred in 19 patients. All vein valve transplants were patent, after 18 months, but 5 grafted valves have evidence of venous reflux. These results suggest a functioning valve replacement in the popliteal fossa may lower the AVP sufficiently to heal intractable venous ulcers or severely damaged skin. Vein valve transplants function well long term, and the falls in the AVP are usually maintained. The popliteal fossa may be the ideal site since a component popliteal valve has been shown to limit adverse post-phlebitic changes.