The National Institute for Health and Clinical Excellence (NICE) issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on lower limb deep vein valve reconstruction for chronic deep venous incompetence in May 2007. In accordance with the Interventional Procedures Programme Process Guide, guidance on procedures with special arrangements are reviewed 3 years after publication and the procedure is reassessed if important new evidence is available.
The guidance was considered for reassessment in May 2010 and it was concluded that NICE will not be updating this guidance at this stage. However, if you believe there is new evidence which should warrant a review of our guidance, please contact us via the email address below.
Chronic deep venous incompetence causes a range of symptoms and signs in the legs, including pain, swelling, skin changes (lipodermatosclerosis) and recurrent ulcers. The condition may be caused by incompetence of the valves in the deep veins (when valves do not close properly, allowing blood to reflux back down the veins), by obstruction of vein lumen (for example after deep vein thrombosis or trauma to the vein), or a combination of the two.
Deep venous valve reconstruction is usually performed under general anaesthesia. A number of techniques exist for reconstructing the venous valves, the most common of which is valvuloplasty (internal or external). The appropriate segment of vein is accessed through an incision in the leg and dissected free from surrounding tissue. Internal valvuloplasty involves tightening the valve cusps by stitches.
External valvuloplasty involves suturing a fold into the external vein wall to reduce the diameter of the vein and allow the valve cusps within to meet properly. A variation of this technique is limited anterior plication, which is carried out only on the anterior side of the vein after limited dissection of the anterior circumference of the vein.
L82.8 Other specified repair of valve of vein
A code from Chapter Z can be added to identify the site of the vein
Note: Y07.1 Ligation of organ NOC can be added (above the site code) if external banding is carried out.
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.