Chapter 159 - Deep vein valve reconstruction Flashcards

1
Q

Rate of deep venous obstruction or reflux in all CVD

A

55%

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2
Q

Primary venous insufficiency valves

A

1) floppy 2) redundant 3) elongated cusps 4) assymmetrical insertion 5) enlarged venous diameter

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3
Q

Secondary venous insufficiency causes

A

DVT and post-thrombotic disease

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4
Q

Cutoff for abnormal reversed flow (reflux) in femoropopliteal and deep femoral and tibial veins

A

1 sec for fem pop 0.5 s for profunda 0.4 s for tibial

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5
Q

Signs of venous insufficiency on duplex

A

1) reflux 2) thickened scarred constricted vein 3) valves with poor flow 4) diminished augmentation 5) respiratory variation lost (local or proximal obstruction/stenosis)

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6
Q

Air plethysmography cut off for venous insufficiency

A

Venous filling index > 2 ml/s Residual volume fraction > 35% Ejection fraction > 60%

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7
Q

Ascending and descending venography uses

A

Ascending - define anatomy and eliminate obvious obstruction Descending - determine valve leaflet integrity, location and degree of reflux to each segment

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8
Q

Treatment algorithm for venous ulcer

A

FIGURE 159.7

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9
Q

Indication for deep vein valve repair CEAP class

A

C4b, C5 and C6

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10
Q

Types of treatments for valve restoration

A

1) valve repair (internal/external valvuloplasty, banding) 2) valve transposition/transplantation 3) autologous valve substitute

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11
Q

Location of AT vein in relation to closest muscle

A

Deep to anterior tibialis Anterior compartment

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12
Q

Location of PT and peroneal vein in relation to closest muscle

A

Deep posterior compartment Covered by soleus and gastrocnemius - superficial posterior compartment

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13
Q

Number of valves in paired tibial and peroneal veins

A

3-12 in each

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14
Q

Number of valves in popliteal veins

A

1-3

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15
Q

Number of valves in femoral vein

A

1-5 (>90%)

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16
Q

Most constant valve location

A

proximal femoral vein 1-2 cm distal to confluence with profunda 90%

17
Q

Number of valves in profunda

18
Q

Number of valves in CFV

A

>50% none can have 1-2 near inguinal ligament

19
Q

Strip test

A

milking blood antegrade past valve with inflow occluded then pressure retrograde to fill vein again (reflux)

20
Q

Internal valvuloplasty 4 exposure types

A

1) Kistner 1968 - longitudinal venotomy through valve commissure 2) Raju transverse venotomy supracommissural 2.5 cm above valve 3) Sottiurai combined approach T shape 4) Tripathi and Ktenidis trap door

21
Q

External valvuloplasty methods

A

1) Kistner 1990 - transmural suture through valve attachment lines 2) transluminal sutures 3) angioscopic guidance 4) Raju - transcommissural valvuloplasty 5) limited anterior plication

22
Q

External banding

A

External sleep of synthetic wrapped around vein at site of valve

23
Q

Valve transplantation key points

A

Taheri described it 2-3 cm UE vein with valve harvested Replaces most proximal segment of FV Proximal anast first to confirm valve competence

24
Q

Valve transposition key points

A

GSV, profunda and FV all can be used in various configurations

25
Neovalve creation techniques
1) Autogenous vein as donor cusp 2) GSV placed inside femoral vein as cusp 3) cutting intimal/medial wall to create valve 4) endo valve creation 5) endo valve replacement
26
Hematoma and seroma in valve repair
15%
27
DVT after valve repair
10%
28
Internal valvuloplasty long term competence
5 year 60-70%
29
External valvuloplasty long term competence
3 year 64%; 5 year 52%
30
External banding competency rate long term
78% at 50 months
31
Clinical improvement after valve transplantation and transposition
50% in 8-10 years
32
Neovalve long term competence
68% at 54 months