Duplex Doppler assessment of results of saphenofemoral and saphenopopliteal junction ligation in patients with recurrent varicose veins

Abstract

Background. According to previously published studies, the most frequent localization of vascular lesions responsible for recurrent varicose vein (RVV) development is a previously ligated saphenofemoral junction (SFJ) site. Discovering the background of these lesions would allow the implementation of suitable methods to reduce their incidence and thus RVV development. Material and methods. We examined 240 patients (283 limbs) with RVV after classic surgical treatment of primary lower limb varicose veins. The reasons for varicose vein recurrence were determined with duplex ultrasound examination. Results. Faults of the surgical technique and neovascularization were causes for true recurrence of varicose veins (TRVV) in 87.6% of all limbs with RVV. Incompletely extirpated great saphenous veins (GSV) or small saphenous veins (SSV) were discovered in 25.1% of cases. Stumps with SFJ or SPJ tributaries were found in 76.3% of limbs. Persistent tributaries were present on stumps in 68.5% of cases, whereas in 18.7% of limbs neovascularization occurred. In half of all cases, the tributaries caused TRVV generation. The longer the stumps, the higher the incidence of persistent tributaries but at the same time the neovascularization occurred less frequently. Insignificantly higher stump incidence and their shorter lengths were observed in patients treated between 2001 and 2007, compared to patients operated on before the year 2001. Cribriform fascia closure with sutures had no influence on neovascularization incidence. Conclusions. The remaining SFJ stumps with tributaries are among the commonest technical faults and causes of TRVV generation. Stump incidence has increased slightly in recent years. Reconstruction of cribriform fascia did not decrease the frequency of neovascularization.
Acta Angiol 2010; 16, 3: 114–128