Recurrent varicose veins after surgery

Varicosity of the superficial veins of the leg is a common disease often requiring surgical treatment. Unfortunately varicose vein surgery is characterized by a very high recurrence rate of 20 to 40% after five years, and even higher after a longer period of follow-up. The present scientific work includes investigation of the reasons for this high incidence of postoperative recurrence and study of methods to prevent or limit recurrence.; Some causes of recurrence are obvious: insufficient insight into venous anatomy and haemodynamics of the superficial venous system, inadequate preoperative assessment and incorrect (too superficial) surgery. Recurrence has also been attributed to 'neovascularisation', a phenomenon of formation of new venous channels between the ligated stump and a retained saphenous trunk or other superficial veins. In a prospective duplex study one year after surgery a new vein (mainly <4 mm) was already present at the correctly ligated stump in 14% of limbs. Another study was performed to find out whether neovascularisation seen on postoperative duplex scan had any clinical relevance. The results of this study demonstrated that an important degree of neovascularisation is indeed associated with clinically obvious recurrent varicose veins, suggesting a causal relationship. Subsequently a method was investigated to mitigate neovascularisation whenever possible: the ligated stump of the great saphenous vein (GSV) in the groin was covered with a synthetic patch to contain neovascularisation ('patch saphenoplasty'). Such a patch aims to create an impervious barrier between the GSV stump and the surrounding tissue. Colour coded duplex scanning was performed at postoperative follow-up. It was found that silicone patch saphenoplasty prevented postoperative recurrence after sapheno-femoral junction (SFJ) ligation in primary as well as in recurrent varicose veins. Also after long-term follow-up, five years after surgery, the results of a group of limbs in which the SFJ was re-ligated with patch saphenoplasty were superior to those without this barrier technique. The good results of patch saphenoplasty further illustrate the conclusion that neovascularisation at the ligated stump plays an essential role in the development of recurrence after varicose vein surgery.