Prevention of Sapheno-Femoral and Sapheno-Popliteal Recurrence of Varicose Veins by Forming a Partition to Contain Neovascularization

Abstract

Objective:

To test the hypothesis that sapheno-femoral recurrence of varicose veins may be prevented by containment of neovascularization.

Design:

Prospective minimum 4-year follow-up by surgical exploration and morphological examination of recurrent vessels in all limbs with clinical or phlebographic evidence of sapheno-femoral recurrence.

Setting:

Varicose vein clinic of a teaching hospital.

Interventions:

Sapheno-femoral ligation and multiple ligation (group 1); sapheno-femoral ligation, interposition of cribriform fascia and multiple ligation (group 2); sapheno-femoral ligation, interposition of artificial implant and stripping (group 3).

Main outcome measures:

Incidence of sapheno-femoral recurrence.

Results:

The incidence of sapheno-femoral recurrence through neovascularization was lower (p < 0.001) in groups 2 and 3 after containment of neovascularization at the sapheno-femoral junction by cribriform fascia or artificial implant than in group 1 after ligation alone (3% and 1% vs 25%, respectively). The incidence of recurrent or persistent varices distal to the groin was lower (p < 0.001) after stripping (group 3, 57%) than after multiple ligation (group 1, 93%; group 2, 81%).

Conclusions:

Sapheno-femoral ligation, interposition of cribriform fascia or artificial implant at the sapheno-femoral junction, and stripping is a more effective treatment of varicose veins than sapheno-femoral ligation and multiple ligation.