Recurrent Varicose Veins: Incidence, Risk Factors and Groin Anatomy

Abstract

Objectives. To investigate the recurrence rate after sapheno-femoral junction (SFJ) ligation and great saphenous vein (GSV) stripping for varicose veins (VV), to evaluate risk factors for recurrence and to classify the anatomy of the recurrence in the groin. Design. Clinical follow-up study. Methods. Eighty-nine consecutive patients with 100 operated legs were reexamined clinically and with duplex after 6-10 years. Fourteen groins were re-explored, 13 after varicography. The anatomy in the groin was classified according to the Edinburgh system. The original medical records were examined to check for risk factors which could lead to a recurrence. Results. Fifty-seven legs had incompetent veins in the groin according to duplex. In 54 of them, it was possible to define whether the incompetent veins emanated from the former SFJ. Varicography and operative findings correlated well to duplex. The main difficulty was to distinguish neovascularization from residual branches. No significant risk factor for recurrence was found in the medical records. Conclusions. Recurrence of VV after SFJ ligation is common irrespective of perioperative difficulties or the surgeon's experience. The anatomy of recurrence in the groin is difficult to classify according to the Edinburgh system mainly because neovascularization is difficult to verify.

The care of patients with varicose veins and associated chronic venous diseases: Clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum

“…217 In a multicenter registry that included 199 limbs of 170 patients with REVAS, the most frequent sources of recurrent reflux were the SFJ (47.2%), followed by leg perforators (54.7%), neovascularization (20%), and technical failure (19%); both neovascularization and technical failure occurred in 17%, and in 35%, the cause was uncertain or unknown. 215 In a study of 279 limbs with recurrent varicose veins at the groin, Geier et al 223 found a long residual saphenofemoral stump in about two-thirds of cases, recurrences became apparent after a mean time interval of 6.3 years, and symptoms occurred after a mean of 8.5 years.…”

“…Recurrent varicose veins after surgery (REVAS) have been reported at rates ranging from 6.6% to 37% at 2 years 177,215,216 and up to 51% at 5 years. [217][218][219][220][221][222] Most studies reported 2-year clinical recurrence rates of 20% to 37% after conventional or cryostripping, when residual or recurrent varicose veins noted by both the patient and the surgeon were counted.…”

High ligation combined with stripping and endovenous laser ablation of the great saphenous vein: Early results of a randomized controlled study

“…3 We introduced EVLA rather tentatively at St Franziskus Hospital in 2002 and continued to dissect the SFJ, because correct SFJ dissection was deemed mandatory before the introduction of endovenous treatment to avoid high rates of groin recurrence. 4 Long-term data about groin recurrence after minimally invasive GSV treatment without SFJ dissection are not yet available.…”

Current treatment of varicose veins

“…The main disadvantages of varicose vein surgery are postoperative pains and discomfort, bruising and hyperpigmentation, lymphoceles and hematomas (mainly in obese patients and in the case of redo surgery in the groin), inesthetic scars, and a 20% to 60% rate of incidence of recurrent varicose veins [31,32]. Usually, inappropriate or incomplete ligation at the saphenofemoral/popliteal junction level, or more generally an inappropriate or incorrect original operation, an incorrect assessment of the varicose vein network, and lack of phlebologic follow-up are generally thought to be the main causes of recurrent varicose veins.…”