title: Optimising a varicose vein service to reduce recurrence.
abstract: A prospective observational study of 63 legs in 49 patients was undertaken to evaluate the adequacy of primary varicose vein surgery performed by surgical trainees. Appropriate surgery was carried out by a surgical senior house officer (SHO) under direct consultant supervision. All patients underwent pre- and postoperative duplex scanning. The preoperative duplex scan demonstrated incompetence of the saphenofemoral junction (SFJ) or long saphenous vein (LSV) in 59 limbs, a mid-thigh perforator (MTP) in 11 limbs, and saphenopopliteal junction (SPJ) in 5 limbs. Surgery successfully abolished all sites of pre-existing reflux. The postoperative duplex scan revealed that 17 new sites of reflux, not identified preoperatively, had developed in 12 limbs. With a consultant-led service and accurate preoperative identification of sites of reflux, the surgical trainee can adequately perform varicose vein surgery. This would seem a reasonable approach to training and eliminating recurrence owing to inadequate surgery. The development of new sites of reflux within 6 months of varicose vein surgery may be owing to altered venous haemodynamics consequent upon this surgery.
authors.affiliation: Department of Vascular and Endovascular Surgery, St James's and Seacroft Teaching Hospital Trust, Leeds.
authors.forename: E P
authors.initials: EP
authors.lastname: Turton
authors.forename: S
authors.initials: S
authors.lastname: McKenzie
authors.forename: M J
authors.initials: MJ
authors.lastname: Weston
authors.forename: D C
authors.initials: DC
authors.lastname: Berridge
authors.forename: D J
authors.initials: DJ
authors.lastname: Scott
mesh_terms: D000328:Adult; D000368:Aged; D002983:Clinical Competence; D004503:Education, Medical, Graduate; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011446:Prospective Studies; D012008:Recurrence; D018616:Ultrasonography, Doppler, Duplex; D014648:Varicose Veins / Q000000981:diagnostic imaging / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000193:education*