Neovascularization is not a major cause of varicose vein recurrence

Abstract

Neovascularization is often seen as an important cause of varicose vein recurrence. Is this a convenient expression to explain some bad results in surgery? This clinical retrospective study (from 1/1/94 to 12/31/98) included 1880 patients (1348 females: 71.7%, 532 males: 28.3%, with the median age of 52) who received limb varicose vein operations. 2455 legs were operated on (575 bilateral). 1122 out of the 1880 patients (60.3%) were assessed by echotomography, 84% of them by the same investigator. All the recurrences were confirmed by echotomography. Surgical interventions consisted of long saphenous vein (LSV) stripping: 1822 (74.2%) and short saphenous vein (SSV) stripping: 304 (12.4%). Recurrence in LSV area was 258 (10.5%), in SSV area: 36 (1.5%), and miscellaneous perforators: 35 (1.4%). 91% of the patients showed good result. Bad results (9%) were documented by echotomography and were encountered in neglected lesions, multiple recurrences and obesity. Neovascularization was never observed, but in 14 cases (4.2%) was a primary cause of recurrence. In spite of the serpentine vessels at the saphenofemoral junction (SFJ), there was always a stump to function as a “feed faucet.” Thirty three recurrences (1.3%) localized at the groin area were due to perineal veins connected to the hypogastric system. Neovascularization, considered a normal process, is unable to remodel the anatomy of the SFJ. Prevention of neovascularization is incumbent upon accurate interpretation of duplex scanning, total resection of tributaries and a stripping of saphenous trunk.