2012 Volume 122 Issue 5 Pages 1381-1388
We measured 3-month outcomes of surgical therapy for varicose veins in 38 legs between October 2008 and September 2009. We used the venous clinical severity score (VCSS), the visual analog scale (VAS), and duplex ultrasound (DU) scanning to evaluate outcomes. For flow reversal via the sapheno-femoral junction, partial stripping or high ligation was performed. For the flow reversal via the sapheno-popliteal junction, high ligation was performed. Insufficient perforating veins were interrupted under direct or endoscopic visualization. Saphenous varicose veins in all legs were treated with foam sclerotherapy. Thirty-two legs (84%) showed satisfactory progress, but 6 did not (16%). Their VCSS and VAS after surgery did not improve, and DU scanning revealed that reverse flow remained from the deep vein to the saphenous varicose vein via insufficient perforating veins. All cases were classified as C4 in the CEAP classification and had severe stasis dermatitis. The cause of failure was determined to be incomplete treatment of reverse flows via insufficient perforating veins. Insufficient perforating veins and deactivation of the sclerosing agent caused by reverse flow led to the survival of varicose veins. In cases with severe stasis dermatitis, complete treatment of reverse flows in combination with form sclerotherapy is important.