The effect of pregnancy on venous valve repair to the sapheno-femoral junction for varicose veins

Objectives: Pregnancy represents a special situation where both the mechanical and hormonal instigating factors of varicose veins are reversible with the venous valve cusps preserved. Exostent venous valve repairs are a physiological alternative which minimises stimulus to collateral growth (recurrence). The study purpose was to assess the effect of pregnancy on the durability of valve repairs.

Methods: In a prospective study of 36 limbs, 20 young females (30±4.7 years) had an exostent implanted to the terminal valve of the saphenofemoral junction for varicose veins. At routine long-term follow up (9.7±3.8 years), 38 pregnancies were completed (mean: 1.8, range: 1–4). The controls were a non-pregnant group of limbs (n=386).

Results: At 9.7 years, the internal diameter of the greater saphenous vein (GSV) changed from 7.8±2.8?mm preoperatively to 4.5±1.4?mm post-operatively. Recurrence was associated with reflux, preoperative deep system and ovarian vein involvement. Pregnancy induced 33.3% recurrences compared with non-pregnant controls (4.7%) similarly treated or 22.8% compared with non-pregnant ablative controls. At 9.7 years, symptomatic improvement continued with significantly better CEAP status (described later) (31CSEAP preoperative to 6CSEAP) with no further truncal ablation (strip, laser) required.

Conclusions: Venous valve repairs can withstand the special stresses of pregnancy. There is no need to ablate the GSV. This approach is contrary to the traditional dictum; the treatment of varicose veins should be delayed until the family is completed.