Neovascularization in Recurrence of Varices of the Great Saphenous Vein in the Groin: Surgical Anatomy and Morphology

Abstract

The hypothesis that recurrence of varicose veins in the groin develops through preexisting tributaries of the great saphenous vein as a result of failure to ligate this vein at the saphenofemoral junction has greatly influenced surgical treatment. The results of an investigation, in 152 limbs, of the role of neovascularization in recurrence of varices of the great saphenous vein in the groin are presented. A newly formed vessel or complex of vessels was found that was continuous proximally with a residual unresected portion of great saphenous vein or with the saphenofemoral junction and distally with this vein or with other varicose veins in the superficial venous network. The presence of several lumens in an irregular mass of vein tissue and of cords or bands traversing the lumen showed that the vessel was newly formed, not preexisting. Neovascularization may therefore result in recurrence even where the criterion of correctly performed saphenofemoral ligation has been observed.

Duplex Ultrasound Assessment of Neovascularization after Saphenofemoral or Sapheno-Popliteal Junction Ligation

“…The duplex appearance of the newly formed vein was completely in agreement with what was previously described in phlebographic and morphological studies on neovascularization [16,17]. The duplex image of grade 2 neovascularization also presents as a very tortuous incompetent vein which joins the anterior side of the CFV or the posterior side of the popliteal vein.…”

“…Despite the most careful preoperative assessment and the most accurate surgical procedure, some patients will redevelop incompetent veins exactly at the site of the previous ligation of the SFJ or SPJ. This phenomenon has been explained as generation of new veins or neovascularization at the ligation site by Sheppard [4] and Starnes et al [12] and was later extensively illustrated by Glass in various clinical and experimental studies [13][14][15][16][17]. The incidence and nature of this phenomenon still remain controversial.…”

The Role of Postoperative Neovascularisation in Recurrence of Varicose Veins: from Historical Background to Today’s Evidence

“…In 1989, GLASS further reported about the surgical anatomy and morphology encountered during re-exploration of the groin following previous surgical intervention and the potential role of neovacularisation in recurrence of varicose veins (33). In 161 limbs he re-explored the groin after previous saphenous ligation.…”

Can vein patch interposition after sapheno-femoral ligation prevent postoperative neovascularization at the saphenofemoral junction?

“…[1][2][3][4][5] Neovascularization is detected after both primary and repeat surgery. [6][7][8][9][10][11][12][13] This postoperative neovascularization at the level of the groin can be detected with duplex scanning. [14][15][16][17][18][19] Systematic use of a prosthetic patch (Silicon or PTFE) in the groin after SFJ ligation had a significant lower incidence of neovascularisation on duplex ultrasound scanning one year after SFJ ligation.…”