Recurrent varicose veins. Reflection of reflux pattern on the line of management

ABSTRACT

The aim of this study is to determine whether specific patterns of recurrent varicose veins are associated with the distribution of reflux sites detected clinically and proved by Doppler scanning; also to detect possible causes and evaluate different methods of management. Thirty nine patients with 64 affected limbs with recurrent varicose veins undergoing Doppler scanning and 3 methods of management [2 limbs for conservative therapy; 17 limbs for sclerotherapy; and 45 limbs for surgery]. The main outcome measures of this study is the type and time of previous surgery, sites and causes of reflux, type and sites of new interventions [conservative, sclerotherapy, and surgery], results-and complications. Recurrent varicose veins presented in both legs in 25 patients [64.1%], in left leg only in 9 patient [23.1%], and in right leg only in 5 patients. [12.8%]; ulceration was in 29 patients. [45.2%. Reflux was detected in 19 patients with residual problems in the groin of 28 / 64 affected limbs [43.8%]; 9 limbs [14.1%] with reflux came from epigastric and pudendal veins. Ulceration was associated with higher rates of deep reflux [45.2% versus 54.7% non-ulcerated limbs]. Groin re-dissection was done in 28 / 45 limbs [62.2%]; thigh communicators ligation in 1/64 limbs [2.2%]; and leg perforators sub-facial ligation in 16 / 64 limbs [35.6%]. Complications rate after surgery was encountered in 13 / 45 limbs [28.9%]. The saphenofemoral junction and long saphenous vein remains the key to varicose veins recurrence and Doppler scanning provides a valuable methodology not only to identify multiple sites of reflux hut also to evaluate the adequacy of previous surgery. Because of the efficacy of surgery in treating and preventing recurrence and ulceration, surgical procedures must be selected carefully and by appropriate expertise