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Abstract

Objective

Neovascularisation in the region of the saphenofemoral junction after high ligation and stripping of the great saphenous vein is a well-known issue. Even after a re-crossectomy, new recurrences can occur. The aim of this study was to assess the occurrence of recurrent varicose veins after re-crossectomy with barrier implantation at the saphenofemoral junction.

Methods

Patients who had undergone re-crossectomy with barrier implantation were examined in follow-up visits. During follow-up, detailed duplex sonographic examinations of the treated legs were performed, with a focus on the saphenofemoral junction.

Results

A total of 135 patients with 173 re-crossectomies and barrier implantations were examined. The interval between re-crossectomy with barrier implantation and follow-up examination was 11.06 years (±2.04 years). Dacron was used as the barrier material in 26 cases (15.0%), while PTFE was used in 147 cases (85.0%). Duplex sonographic examination detected neovascularisation in 109 legs (63.0%), with five cases (2.9%) having a diameter greater than 5 mm, which were classified as haemodynamically relevant.

Conclusion

Neovascularisation in the saphenofemoral junction after varicose vein surgery is common. The pathological mechanism of neovascularisation remains unclear. Further prospective randomised studies are necessary to assess the long-term success of re-crossectomy with barrier implantation.

Keywords

recurrent varicosis barrier patch implantation vein surgery angiogenesis neovascularisation

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References

Fischer

Chandler

De Maeseneer

, et al. The unresolved problem of recurrent saphenofemoral reflux. J Am Coll Surg 2002; 195(1): 80–94. https://doi.org/10.1016/S1072-7515(02)01188-2

De Maeseneer

Vandenbroeck

Van Schil

. Silicone patch saphenoplasty to prevent repeat recurrence after surgery to treat recurrent saphenofemoral incompetence: long-term follow-up study. J Vasc Surg 2004; 40(1): 98–105. https://doi.org/10.1016/j.jvs.2004.03.025

Egan

Donnelly

Bresnihan

, et al. Neovascularization: an “innocent bystander” in recurrent varicose veins. J Vasc Surg 2006; 44: 1279–1284. https://doi.org/10.1016/j.jvs.2006.08.017

Mumme

Hummel

Burger

, et al. High ligation of the saphenofemoral junction is necessary. Phlebologie 2009; 38(3): 99–102. https://doi.org/10.1055/s-0037-1622261

Brake

Lim

Shepherd

, et al. Pathogenesis and etiology of recurrent varicose veins. J Vasc Surg 2013; 57(3): 860–868. https://doi.org/10.1016/j.jvs.2012.10.102

Lim

Gohel

Shepherd

, et al. Venous hypoxia: a poorly studied etiological factor of varicose veins. J Vasc Res 2011; 48(3): 185–194. https://doi.org/10.1159/000320624

Navarro

Delis

Ribeiro

. Clinical and haemodynamic significance of the greater saphenous vein diameter in chronic venous insufficiency. Arch Surg 2002; 137: 1233–1237. https://doi.org/10.1001/archsurg.137.11.1233

Schnyder

Gabler

Meier

, et al. Successful reduction of clinically relevant neovascularization with a modified crossectomy combined with a barrier technique after 10-year follow-up. Phlebology 2012; 27(8): 404–408. https://doi.org/10.1258/phleb.2011.011065

Hach

Mumme

Hach-Wunderle

. Venenchirurgie: operative, interventionelle und konservative Aspekte. Schattauer Verlag, 2012.

10.

Junod

. Varices et leurs complications: traitement chirurgical des cas difficiles. Helv Chir Acta 1971; 38: 167–170.

11.

Van Rij

Jones

Hill

, et al. Neovascularization and recurrent varicose veins: more histologic and ultrasound evidence. J Vasc Surg 2004; 40: 296–302. https://doi.org/10.1016/j.jvs.2004.04.031

12.

Anwar

Idrees

Aswini

, et al. Fate of the tributaries of saphenofemoral junction following endovenous thermal ablation of incompetent axial vein: a review article. Phlebology 2019; 34: 151–155. https://doi.org/10.1177/0268355518783635

13.

Spinedi

Stricker

Keo

, et al. Feasibility and safety of flush endovenous laser ablation of the great saphenous vein up to the saphenofemoral junction. J Vasc Surg Venous Lymphat Disord 2020; 8: 1006–1013. https://doi.org/10.1016/j.jvsv.2020.01.017

14.

Mohan

Liu

. Neovascularization, a cause of truncal varicose vein recurrence after endovenous laser ablation. Int Angiol 2025; 44: 437–444. https://doi.org/10.23736/S0392-9590.25.05417-3

15.

Sheppard

. A procedure for the prevention of recurrent saphenofemoral incompetence. Aust N Z J Surg 1978; 48(3): 322–326. https://doi.org/10.1111/j.1445-2197.1978.tb05240.x

16.

Stücker

Netz

Breuckmann

, et al. Histomorphologic classification of recurrent saphenofemoral reflux. J Vasc Surg 2004; 39: 816–821. https://doi.org/10.1016/j.jvs.2003.10.054

17.

Ehrler

Heim

Mouton

. Histopathology of neovascularisation observed during saphenofemoral re-do high ligation. Eur J Vasc & Endovasc Surg Vasc Forum 2021; 50: 10053. https://doi.org/10.1016/j.ejvsvf.2021.06.005

18.

Geier

Mumme

Hummel

, et al. Validity of duplex-ultrasound in identifying the cause of groin recurrence after varicose vein surgery. J Vasc Surg 2009; 49: 968–972. https://doi.org/10.1016/j.jvs.2008.10.058

19.

Blomgren

Johansson

Dahlberg-Akerman

, et al. Recurrent varicose veins: incidence, risk factors and groin anatomy. Eur J Vasc Endovasc Surg 2004; 27: 269–274. https://doi.org/10.1016/j.ejvs.2003.12.022

20.

Fischer

Linde

Duff

, et al. Late recurrent saphenofemoral junction reflux after ligation and stripping of the greater saphenous vein. J Vasc Surg 2001; 34: 236–240. https://doi.org/10.1067/mva.2001.115802

21.

Gerontopoulou

Kath

Rass

. Short-term efficacy of inguinal reoperation for recurrent saphenofemoral incompetence using the stump suture technique. Ann Vasc Surg 2018; 53: 197–204. https://doi.org/10.1016/j.avsg.2018.04.015

22.

Doncheva

Gerontopoulou

Altindas-Jürgensen

, et al. Long-term efficacy of inguinal reoperation for recurrent saphenofemoral incompetence. J Vasc Surg Venous Lymphat Disord 2026; 14: 102353. https://doi.org/10.1016/j.jvsv.2025.102353

23.

Eggen

CAM

Alozai

Pascal Pronk

, et al. Ten-year follow-up of a randomized controlled trial comparing saphenofemoral ligation and stripping of the great saphenous vein with endovenous laser ablation (980 nm) using local tumescent anesthesia. J Vasc Surg Venous Lymphat Disord 2022; 10(3): 646–653. https://doi.org/10.1016/j.jvsv.2021.08.008

Neovascularisation in the saphenofemoral junction after re-crossectomy with barrier implantation – A long-term follow-up

Abstract

Objective

Methods

Results

Conclusion

Keywords

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References