2016 Volume 27 Issue 3 Pages 323-330
Background: Recurrent varices after surgery (REVAS) remain a common problem. Some REVAS can be avoided using accurate operative skills and specific surgical treatment strategies at the time of the first surgery. Treatment strategies for REVAS are also important, and analysis of cases of REVAS may prove useful in determining systematic strategies to prevent recurrence after the first surgery. Patients and Methods: One hundred and eight limbs (7.1%) among a total of 1519 limbs in which varicose vein surgery were conducted, required surgery for REVAS between January 2008 and July 2015. Of those limbs, 67 limbs among 56 patients had REVAS due to reflux from subfascial veins or saphenous vein trunks in the thighs that contained reflux from the region of the sapheno-popliteal junction. Analysis of REVAS was conducted using venous ultrasonography. Results: Previous surgery before REVAS limbs consisted of high ligation and stripping of the greater saphenous vein (GSV) in 35 limbs, resection of tributary veins in 12 limbs, and high ligation and stripping of the smaller saphenous vein (SSV) in 9 limbs. Veins with reflux causing recurrence were identified as SSVs in 29 limbs, GSVs in 18 limbs, and tributary veins from the stump on the sapheno-femoral junction (SFJ) after high ligation and stripping (sclerotherapy in one case) of GSVs in 12 limbs. In 79% of REVAS caused by tributary veins on the SFJ, the veins joined to the stump of GSV less than 1.5 cm from the SFJ. In three limbs, repeated resection and sclerotherapy to tributary veins resulted in REVAS and severe skin lesions. Conclusion: Veins with reflux should be addressed during the original surgery to avoid REVAS. Some cases require high ligation of the GSV and SSV, and to make sure of this point at the time of the first surgery is thought to be a future problem.
