Venous valve repair surgery

Since the late 1980s, a vein surgery procedure has been available through which the mouth of the great saphenous vein (vena saphena magna) can be repaired.

At the point where the superficial great saphenous vein (= anterior, long superficial truncal vein) enters the deep vein (femoral vein of the leg), there is a valve which is particularly important for the development of varicose veins: generally, the pathological reflux of the blood flow downward into the great saphenous vein occurs because this valve leaks.

As a result, a pathological dilatation of the relatively thin vessel occurs because of the unusually large amount of blood. This automatically leads to the inefficiency of other valves in the vessel, which is now too broad. The illness and the dilatation of the vessel consequently advance downward.

Since we naturally attempt to preserve every vein, and because the great saphenous vein additionally represents an ideal graft for any future cardiovascular surgery, we try to spare this vein as much as possible. In cases where the saphenous vein has not developed too extensively and where intensive varicose veins have not yet formed, and especially when the illness and the dilatation of the vein is still limited to the last (upper) centimetres of the great saphenous vein, we can choose to use a vein surgery procedure that frequently provides some help here:

• Here, a cuff made of Dacron® is laid around the mouth of the great saphenous vein so that it can be constricted to once again more or less to its normal width.
• During this vein surgery, an inguinal incision is performed under anaesthesia or, alternatively, the saphenofemoral junction ("cross") is exposed under local anaesthesia and the cuff of Dacron® is then placed around the vessel.

The process, "the Jessup procedure", is named after the individual who first described it and is known in medical terms as "extravascular valvuloplasty".

There are no large scientific studies on long-term results and investigations performed to date have revealed varying rates of success for this type of vein surgery. In many cases the treated vessel recovered and diameters (measured by ultrasound) returned, for the most part, to normal values. In other cases, the operation showed no substantially positive effects and the great saphenous vein subsequently had to be removed.

The intervention is indeed relatively minor and displays no typical, disproportionately high risks. Nevertheless, it is associated with the introduction of foreign material (although only a relatively small amount) and can lead to scarring in the region of the saphenofemoral junction ("cross"), which can complicate a later open intervention (e.g., the open "crossectomy"). The radiofrequency catheter procedure, in contrast, is largely unaffected (here, no incision at the cross is necessary) and can be performed normally.

In suitable cases, we can perform this vein surgery both on outpatients and inpatients.