A Cochrane review [Abstract] 1 included 4 studies with a total of 273 subjects. All included studies investigated valvuloplasty for the treatment of patients with deep venous incompetence (DVI) due to primary valve incompetence (valves do not close properly because of laxity of the vein wall or valve cusps). No studies investigated the results of surgery for secondary valvular incompetence or the obstructive form of DVI. Studies did not include patients with severe DVI. It was not possible to pool the results of included studies due to differences in outcomes reported.
Ulcer healing and ulcer recurrence were not reported in 1 study, and the remaining 3 studies did not include participants with ulcers or active ulceration. Three studies reported no significant complications of surgery and no incidence of deep venous thrombosis (DVT) during follow-up, and 1 study did not report on the occurrence of complications.
Two small studies comparing external valvuloplasty using limited anterior plication in combination with ligation of incompetent superficial veins against ligation alone showed that ligation plus limited anterior plication produced significant improvement in ambulatory venous pressure (AVP): MD -15 mm Hg (95% CI -20.9 to -9.0) at 1 year and -15 mm Hg (95% CI -21 to -8.9) at 2 years. Sustainable statistically significant improvement in AVP and venous refilling time (VRT) was achieved by ligation and limited anterior plication at 10 years in 1 study. However, AVP values after surgery remained relatively high, causing its benefit to be questioned. Another study including participants who were deteriorating preoperatively showed sustained mild clinical improvement for 7 years in those subjected to valvuloplasty compared with participants undergoing superficial venous surgery alone. This benefit was lost when the condition of participants was stable preoperatively. One small study (n = 40) with grade 3 reflux and no participants with ulcers reported that external valvuloplasty of the femoral vein combined with surgical repair of the superficial venous system improved the haemodynamic status of the lower limbs, restored valvular function more effectively and achieved better outcomes than surgical repair of the superficial venous system alone.
Comment: The quality of evidence is downgraded by study limitations (lack of allocation concealment and blinding), by indirectness (differences between the population, interventions and outcomes of interest and those studied), and by imprecise results (few patients).
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