Deep vein surgery place in post-thrombotic reflux syndrome

The post-thrombotic syndrome presents two hemodynamic components: obstruction and reflux, frequently associated. When the disease affects the patient quality of life, operative treatments are advisable. Obstruction at iliocaval level should be treated first because at least half of the patients will improve consistently their clinical condition. However, the femoro-popliteal axial reflex due to valve destruction is responsible for severe symptoms and ulcer persistence /recurrence in a significant number of patients. Thus, valve reconstruction techniques play a relevant role in the management of those patients allowing the control of chronic venous insufficiency. Moreover, deep vein reflux surgery can be combined with obstruction correction in hybrid solutions, in those situations in which poor inflow at femoral confluence may impede adequate iliocaval correction. Deep vein open reconstructive techniques are today a safe and effective surgery, allowing a relevant quality of life improvement in patients affected by post-thrombotic syndrome.