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Among 211 limbs with nonobstructive chronic venous insufficiency, valve reflux of
the deep system was the predominant (more than 70%) pathologic condition. Superficial
venous or perforator incompetence when present invariably occurred in combination
with valve reflux of the deep veins, suggesting that the latter is a common denominator
for symptom production. Single level-single system reflux was only occasionally symptomatic
(10%), whereas the incidence of single level-multisystem reflux (25%) and multilevel-multisystem
reflux (65%) in symptomatic limbs was much higher. Our experience with 107 venous
valve reconstructions with a 2- to 8-year follow-up is described. Different techniques
of valve reconstruction employed are detailed. The most common pathologic feature
is a redundant valve with malcoaptation probably of nonthrombotic origin. Valsalva
foot venous pressure elevation is a useful hemodynamic technique for assessing surgical
results. Valvuloplasty may be superior to other reconstruction techniques in relieving
symptoms of stasis, including stasis ulceration.