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External Valvuloplasty as a treatment option for Saphenofemoral Venous Reflux

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    By Katherine Kozlowski, medical author and contributor to Vein News and VeinsVeinsVeins.com

    External valvuloplasty (eVP) is done by implanting a U-shaped patch at the junction where the femoral and saphenous veins meet in the groin (saphenofemoral junction). The patch covers the great saphenous vein, reducing the diameter, thus allowing the valve to close properly and prevent back-flow of blood in the legs.


    In past single-center studies, researchers found improved venous circulation and a recurrence rate of 4.6% after approximately 5.5 years.


    Researchers from Germany performed a multi-center study and assessed the short-term safety and efficacy of eVP.




    5 Vein Centers were included, 210 patients enrolled.


    58% of patients successfully followed-up.


    Follow up measures were Venous Clinical Severity Score (VCSS), C (clinical) class of CEAP Classification scale, and duplex ultrasound findings.




    95.24 % of patients had sufficient functionality of the valve post-operatively.


    Average great saphenous vein diameters decreased significantly from:

    • 4.4 mm to 3.9 mm measured 4 cm from the saphenofemoral junction.

    • 3.7 mm to 3.5 mm measured at the mid-thigh.

    • 3.6 mm to 3.3 mm measured at the knee.

    • 3.1 mm to 2.9 mm at the mid-calf.


    VCSS scores decreased significantly from an average of 4.76 before surgery to 1.77 6 months post-operatively.


    Significant changes in the clinical portion of the CEAP Scores are as follows:

    • C1 (Telangiectasias/Reticular Veins): Before = 9 patients /after = 137 patients.

    • C2 (Varicose Veins): Before = 111 patients / after = 25 patients.

    • C3 (Swelling): Before = 50 patients / after = 0 patients.

    • C4 (Hyperpigmentation): Before = 3 patients / After = 1 patient.


    4.9% of patients had treatment failure after 6 months.




    eVP is a generally successful treatment strategy to reduce venous reflux at the saphenofemoral junction.


    The C class of the CEAP Classification System, and VCSS scores improved significantly.


    Diameters of the great saphenous vein decreased significantly by 6 months post-procedure.




    Mühlberger D, Brenner E, Frings N et al. Functional repair of the great saphenous vein by external valvuloplasty reduces the vein’s diameter: 6 month results of a multicentre study. J Int Med Res 2021; 49(5).