CPT® Code 34510

1. Indications

The venous valve transposition procedure is indicated for patients suffering from severe venous insufficiency, which may present with various symptoms and conditions that necessitate surgical intervention. The following are the explicit indications for performing this procedure:

• Severe Venous Insufficiency - A condition characterized by the inability of the veins to adequately return blood to the heart, leading to symptoms such as swelling, pain, and skin changes.
• Malfunctioning Venous Valves - The presence of one or more valves in the veins that are not functioning properly, contributing to venous reflux and associated complications.
• Chronic Venous Disease - A long-term condition that may result in varicose veins, skin ulcers, or other complications due to poor venous circulation.

2. Procedure

The venous valve transposition procedure involves several critical steps to ensure successful outcomes. Each step is designed to carefully isolate and replace the malfunctioning valve with a healthy segment of vein.

• Step 1: Incision Over Healthy Vein - The procedure begins with an incision, typically made in the arm, to access a healthy vein. This incision allows the surgeon to obtain a segment of vein that contains one or two normal functioning valves.
• Step 2: Dissection of Healthy Vein Segment - The surgeon meticulously dissects the healthy vein segment free from surrounding tissue, ensuring that the valves remain intact. This step is crucial for preserving the functionality of the valves for later use.
• Step 3: Ligation and Division of Healthy Vein - Once the healthy vein segment is isolated, it is suture ligated and divided both proximally and distally. This prepares the segment for transposition by removing it from its original location.
• Step 4: Incision Over Affected Vein - A second incision is made over the affected vein, usually located in the leg. This incision allows access to the diseased vein segment that requires replacement.
• Step 5: Dissection of Affected Vein Segment - Similar to the first step, the surgeon dissects the affected vein free from surrounding tissue to prepare for the removal of the malfunctioning valve segment.
• Step 6: Application of Vascular Clamps - Vascular clamps are placed above and below the segment containing the malfunctioning valve. This step is essential for controlling blood flow during the removal of the diseased segment.
• Step 7: Removal of Diseased Vein Segment - The diseased segment of the vein, which contains the malfunctioning valve, is then divided and removed, clearing the path for the healthy vein segment.
• Step 8: Suturing Healthy Segment - The healthy segment of vein, now prepared, is sutured to the remaining ends of the affected vein. This step effectively replaces the malfunctioning valve with a functioning one.
• Step 9: Evaluation of Blood Flow - After the suturing is complete, the vascular clamps are released, and blood flow through the newly positioned valve is evaluated to ensure proper function.
• Step 10: Skin Incision Repair - Finally, the skin incision is repaired in layers, promoting optimal healing and recovery for the patient.

3. Post-Procedure

Post-procedure care following venous valve transposition is essential for ensuring proper recovery and monitoring for any complications. Patients are typically advised to follow specific guidelines, which may include rest and elevation of the affected limb to reduce swelling. Pain management may be necessary, and patients should be monitored for signs of infection at the incision sites. Follow-up appointments are crucial to assess the success of the procedure and the functionality of the newly positioned valve. Additionally, patients may be instructed on lifestyle modifications and exercises to promote venous health and prevent future complications.