The substitute "valve" operation by Technique II using a silicone tendon designed to produce a valve-like mechanism on the popliteal vein is described. The results obtained in 55 limbs with chronic venous insufficiency due to reflux in the deep veins have been assessed by phlebography and by measurements of ambulatory venous pressure before and one week after the operation; 23 limbs were followed up two years after the operation. Clinical improvement in 50 of 55 limbs was associated with reduction in the ambulatory venous pressure and with phlebographic evidence of a functioning "substitute valve." After using the Doppler ultrasound the abolition of the popliteal reflux in 11 limbs after substi tute valve operation by Technique II was studied; they had had a marked popli teal reflux and a high ambulatory venous pressure before the operation.
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