Assessment of recurrent varicose veins after surgery

ABSTRACT

The recurrence of varicose veins is a common and costly consequence of varicose vein surgery. Despite the long history and vast experience of varicose vein surgery, the exact cause of recurrence is still unknown. It may arise due to either inadequate first time surgery where missed branches can cause problems later or due to neovascularization, which is the growth of new fine veins as a consequence of the progression of the venous insufficiency disease. Investigate the aetiological background behind recurrence of varicose veins after surgery. 39 patients with 42 lower limbs with recurrent varicose veins [RVV] after surgery were divided into 3 groups. Group [A] included patients with early recurrence [within 12 weeks of their first surgery], group [B] included patients with delayed recurrence [after 12 weeks of the first surgery up to two years], while group [C] included patients with late recurrence [after two years]. All patients were clinically examined and investigated for the presence of venous reflux and/or obstruction of the superficial, deep and perforating veins using duplex scanning. Suitable management was undertaken in accordance to the duplex finding and patient's compliance. 18 [43%] lower limbs were found to have recurrence at significant sites whether sapheno-femoral junction, long saphenous vein or perforating veins. Re-do surgery was considered in 11 limbs. Injection compression sclerotherapy was considered in 18 limbs. Elastic compression socks solely were advised for the rest 13 limbs for regular follow-up. There is no way of guaranteeing that varicose veins do not recur following surgery. The risk of recurrence may be reduced by thorough, accurate surgery performed in a specialized unit and based on the results of pre-operative duplex ultrasound scan