Neovascularization in Recurrent Sapheno-Femoral Incompetence of Varicose Veins: Surgical Anatomy and Morphology

Abstract

Objective:

To investigate the surgical anatomy and morphology of recurrent sapheno-femoral incompetence after correctly performed sapheno-femoral ligation. To test the hypothesis that such recurrence develops through neovascularization.

Design:

Prospective study of single patient group.

Setting:

Varicose vein clinic of teaching hospital.

Patients:

One hundred and twenty-eight patients (141 limbs) were reviewed 4 or more years after accurately performed sapheno-femoral ligation with catgut, silk or tantalum wire.

Intervention:

Clinical assessment, phlebography, surgical exploration and examination of recurrent veins by radiographic and histological methods.

Main outcome measures:

Presence of reflux through newly formed veins at the site of previous ligation.

Results:

Of 141 limbs, clinical or phlebographic evidence of sapheno-femoral recurrence was confirmed in 35 of 37 on surgical exploration. The continuity of the saphenous vein with the previously ligated sapheno-femoral junction was restored through a newly formed vein or complex of veins.

Conclusions:

Neovascularization was the cause of recurrent sapheno-femoral incompetence after correctly performed sapheno-femoral ligation.