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Venous Insufficiency Treatment: Valve Repair and Transposition

In healthy veins, there is continuous flow of blood from the limbs back toward the heart. There are valves within the veins of the legs that prevent the backflow of blood. Venous insufficiency occurs when forward flow through the veins is obstructed, as in the case of a blood clot, or if there is backward leakage of blood flow through damaged valves.

Valves can be damaged due to a trauma, like a blood clot. Other times, however, the valves just don't work right. They may have developed wrong, or they may have changed slowly over time — but there is no obvious underlying reason why they don't work. In those cases it is termed "primary" reflux (if it's after an injury like a deep vein thrombosis, then it is termed "secondary" reflux).

Valve repair or valve transposition is typically performed in individuals who have severe venous insufficiency associated with leg swelling and chronic ulceration that has been resistant to standard medical therapies. These procedures are performed in the hospital by a vascular surgeon and require a hospital stay. Each patient is evaluated, and treatment will be individualized for the patient’s circumstances.

Are there risks to valve repair or transposition?

Every procedure has risks and benefits. Your doctor will discuss the specific risks and potential benefits of the recommended procedure with you.

These procedures usually have no complications, but there may be a risk of injury to the blood vessel, leg swelling, bleeding, wound complications and, while rare, the development of a blood clot in the vein. Special precautions are taken to decrease these risks. When you meet with your doctor, please ask questions to make sure you understand the risks of the procedure and why the procedure is recommended.

In valve repair, the surgeon shortens the valves inside the vein to improve valve function.

How do I prepare for the procedure?

A few days before the procedure, pre-procedure tests may be performed to ensure that it is safe to perform the surgery. You may need to discontinue certain medications before the procedure. Your health care team will provide specific instructions to help you prepare for the procedure.

What happens during the procedure?

The procedure will be performed under general or epidural anesthesia. The surgeon accesses the affected vein through a small skin incision and folds or tucks the valve flaps of the vein to allow the valve edges to be beside each other. The surgeon may place a fabric sleeve around the outside of the affected vein to help prevent the vein from dilating beyond the point at which the valve edges would not be next to each other. The exact type of valve repair will be determined by your surgeon, and it will depend on the anatomy of your valves that require repair.

How long does the procedure last?

The procedure itself generally takes three to five hours, but the preparation and recovery time add several hours. The surgery may require a minimum hospital stay of four to seven days. What happens after the procedure?

Some patients require admission to an intensive care unit for close monitoring for about one to two days after the surgery, but this is not routine. Once the patient is transferred to the nursing unit, the hospital stay is about three to seven more days.

Most patients will receive physical therapy during the recovery period. Most patients will require anti-coagulation treatment following the procedure, and this will be continued after hospital discharge. The duration of anti-coagulation treatment will be determined on an individual basis by your surgeon.

Your doctor will provide specific guidelines for your recovery.

Are there any side effects of the treatment?

As with any surgical procedure, you will feel somewhat tired for a few weeks. You will have mild pain along the incisions, and you may experience mild leg swelling.

What are typical results of the procedure?

Restoring blood flow by performing valve repair usually provides good relief of symptoms in the right patients. Your doctor will discuss the results of the procedure with you.

What is a valve transposition for venous disease?

A valve transposition takes place when a surgeon uses a portion of vein with a normal-functioning valve from another part of the body to replace a section of vein with a non-functioning valve.

How do I prepare for the procedure?

A few days before the procedure, pre-procedure tests may be performed to ensure that it is safe to perform the surgery. You may need to discontinue certain medications before the procedure. Your healthcare team will provide specific instructions to help you prepare for the procedure.

What happens during the procedure?

The procedure will be performed under general anesthesia. Through a skin incision, the surgeon removes a portion of a vein with a normal-functioning valve from another part of the body (usually the upper arm). The arm has multiple veins that allow blood to drain from it, and rarely do patients develop any problems due to the removal of this short piece. A segment of the vein that has one to two normal functioning valves is dissected free of the surrounding tissue. That segment of the vein is excised, and its cut ends are tied off with suture.

The surgeon then replaces the non-functioning valve with the good one. Typically, blood flow in the diseased vein is temporarily stopped with special clamps. A portion of the diseased vein, which does not have functioning valves, is excised. The healthy segment of vein is then sewn in place, taking the place of the excised, diseased segment.

How long does the procedure last?

The procedure itself generally takes three to five hours, but the preparation and recovery time add several hours. The surgery may require a minimum hospital stay of four to seven days. What happens after the procedure?

Some patients require admission to an intensive care unit for close monitoring for about one to two days after the surgery, but this is not routine. Once the patient is transferred to the nursing unit, the hospital stay is about three to seven more days. Most patients will receive physical therapy during the recovery period. Most patients will require anticoagulation in the post-operative period, and many will require long-term anticoagulation with medications such as Coumadin. The exact duration of anticoagulation therapy is patient specific and will be determined by your surgeon.

Your doctor will provide specific guidelines for your recovery.

Are there any side effects of the treatment?

As with any surgical procedure, you will feel somewhat tired for a few weeks. You will have mild pain along the incisions, and you may experience mild leg swelling.

What are typical results of the procedure?

Restoring blood flow by performing a valve transposition usually provides good relief of symptoms in the right patients. Your doctor will discuss the results of the procedure with you.

How do I find out if I am a candidate for this procedure?

To find out if you are a candidate for this procedure, please call the Vascular Surgery Department to make an appointment at 216.444.4508 or 800.223.2273 ext. 4-4508.

Doctors vary in quality due to differences in training and experience; hospitals differ in the number of services available. The more complex your medical problem, the greater these differences in quality become and the more they matter.

Clearly, the doctor and hospital that you choose for complex, specialized medical care will have a direct impact on how well you do. To help you make this choice, please review our Miller Family Heart and Vascular Institute Outcomes.

Cleveland Clinic Heart and Vascular Institute Vascular Medicine Specialists and Surgeons

Choosing a doctor to treat your vascular disease depends on where you are in your diagnosis and treatment. The following Heart and Vascular Institute Sections and Departments treat patients with all types of vascular disease, including blood clotting disorders:

Section of Vascular Medicine: for evaluation, medical management or interventional procedures to treat vascular disease. In addition, the Non-Invasive Laboratory includes state-of-the art computerized imaging equipment to assist in diagnosing vascular disease, without added discomfort to the patient. Call Vascular Medicine Appointments, toll-free 800-223-2273, extension 44420 or request an appointment online.

Department of Vascular Surgery: surgery evaluation for surgical treatment of vascular disease, including aorta, peripheral artery, and venous disease. Call Vascular Surgery Appointments, toll-free 800-223-2273, extension 44508 or request an appointment online.

IVC Filter Retrieval Clinic - to make an appointment, call Vascular Medicine at 216.444.4420. Ask for Dr. Bartholomew in the Filter Retrieval Clinic. Your appointment will include a consultation with Dr. Bartholomew and the physicians who will perform the IVC filter retrieval procedure.

You may also use our MyConsult second opinion consultation using the Internet.

The Heart and Vascular Institute also has specialized centers and clinics to treat certain populations of patients:

Learn more about experts who specialize in the diagnosis and treatment of vascular and arterial disease.

Contact

If you need more information, click here to contact us, chat online with a nurse or call the Miller Family Heart and Vascular Institute Resource & Information Nurse at 216.445.9288 or toll-free at 866.289.6911. We would be happy to help you.

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Reviewed: 02/16