Summary
The term “recurrent varicose veins” covers various entities. In the first instance,
recurrent varicose veins may be the progression of the underlying disease, as there
is a hereditary disposition to the condition, but we also find the phenomenon of neovascularisation,
and lastly we repeatedly see recurrent varices as a result of technical or strategic
surgical errors and the failure of endovenous procedures. No differentiation between
these different types of recurrent varicose veins has previously been made in the
literature, so that the numbers given vary between 6% and 60%. Up to the present time,
few data on the progression of the underlying disease are to be found in the literature.
Our own studies, on average 36 months postoperatively, demonstrated new varicose side
branches that could be interpreted as progression of the underlying disease in 56.8%
of the patients followed up.
Several recent publications demonstrate neovascularisation as a cause of recurrence.
While some authors give a figure of 24% for recurrence due to neovascularisation in
patients who have had surgery, other publications regard neovascularisation as the
main cause of postoperative recurrence.
The data on technical or strategic surgical errors and recanalisation after endovenous
procedures are also very varied. Numbers for technical errors as the cause of recurrent
varicose veins following surgery range from 10.7% to more than 70%. Published recanalisation
rates after endovenous laser therapy vary between 0% and 36%; the average recanalisation
rate in the available prospective randomised studies on radiofrequency obliteration
was 12.9%. Foam sclerotherapy has recanalisation rates between 69% and 86%, with a
mean follow-up of 32.2 months.
Given the different possible causes, it is extremely important, that recurrent varicose
veins should be classified. The authors have developed a simple classification that
can be used in routine daily practice. Recurrent varicose veins are given the acronym
REVAT (recurrent varices after treatment). Generally speaking, on the one hand there
is progression of the underlying disease (progression of disease = PD) and, on the
other hand, varicosities after treatment as a result of technical error or failure
of the method used (recurrence after treatment = RT). Progression of the underlying
disease can be further subdivided into neovascularisation at the saphenofemoral or
popliteal junction (progression of disease at the junction = PD-J) and new varices
arising in the treated vascular territory (progression of disease at the limb = PD-L).
In the case of recurrent varices after treatment we distinguish between a persisting
or a new reflux at the saphenofemoral or the popliteal junction (recurrence after
treatment at the junction = RT-J), untreated segments of the great or small saphenous
veins or recanalisation of the trunk (recurrence after treatment at the trunk = RT-T)
and untreated side branches or perforating veins (recurrence after treatment at side
branches = RT-S). With the help of these abbreviations a simple formula can be generated
to describe the recurrent varices, e.g. recanalisation of the left great saphenous
vein (GSV) after endovenous treatment and a new varicosis in the vascular territory
of the left great saphenous vein resulting from progression of the underlying disease:
vascular territory left great saphenous vein = GSV-L, technical or tactical error
due to recanalisation of the GSV = RT-T, progression of the underlying disease in
the vascular territory of the GSV = PD-L. This generates the formula: GSV-L : RT-T,
PD-L.
Since there are no exact figures on the incidence of the individual causes of recurrent
varicosis, a classification of recurrent varicosis is indispensable to ensure clarity
in the future.
Zusammenfassung
Mit Rezidivvarikose werden verschiedene Entitäten bezeichnet: natürliche Progression
der Grunderkrankung, Neovaskularisation und technische/taktische Fehler bzw. Versagen
einer Maßnahme als Ursache für die Rezidivvarikose. Um exakte Zahlen zur Rezidivhäufigkeit
und -ursache festzu stellen, ist eine genaue Definition und Klassifikation notwendig.
Eine internationale Expertengruppe prägte 1998 den Begriff REVAS. Diese ausführliche
Klassifikation ist in der klinischen Routine nicht anwendbar. Eine einfachere Klassifikation
wurde daher unter dem Akronym REVAT (Recurrent Varices After Treatment) entwickelt,
die die Rezidivvarikose in zwei Gruppen unterteilt: 1.) Progression der Grunderkrankung
(Progression of Disease = PD) und 2.) Varikose nach Behandlung (Recurrence After Treatment
= RT). Diese Oberbegriffe werden durch die Lokalisationsbezeichnungen des so genannten
Rezidives ergänzt.
Um klare Angaben zur Häufigkeit wieder auftretender Venen zu erhalten, sollte REVAT
künftig zur Klassifikation bei jedem Wiederholungseingriff angewendet werden.
Keywords Recurrent varicose veins - classification - REVAT
Schlüsselwörter Rezidivvarikose - Klassifizierung - REVAT
