Duplex-derived evidence of reflux after varicose vein surgery: neoreflux or neovascularisation?
BACKGROUND
Recurrent varicose veins remain a problem in surgical practice despite improvements to the preoperative investigation of, and surgery for varicose veins. Neovascularisation accounts for some cases of recurrence within a few years of surgery, but other factors relating to disease progression must also play a part. We investigated whether new venous reflux (neoreflux) could occur in the early postoperative period (within 6 weeks) following successful varicose vein surgery.


METHODS
Eighteen-month prospective observational study in the dedicated vascular surgery unit of a university teaching hospital. Forty-six patients, with primary saphenofemoral junction reflux, awaiting varicose vein surgery were chosen consecutively from the waiting list. All saphenofemoral surgery was performed in a standardised fashion. Assessments were performed prior to, at 6 weeks and at 1 year after surgery. Duplex ultrasound was used to identify and locate sites of reflux.


RESULTS
Neoreflux was present at the 6-week postoperative scan in nine limbs after varicose vein surgery (19.6%), and resolved in 55.6% of patients within 1 year. Neovascularisation was noted in two limbs at the 1-year scan.


CONCLUSIONS
New sites of reflux, which may resolve spontaneously, occur in the early postoperative period despite adequate varicose vein surgery. It is our hypothesis that this is a manifestation of the effect of altered venous haemodynamics in a system of susceptible veins.
Turton
E P
EP
Department of Vascular and Endovascular Surgery, St. James's and Seacroft Teaching Hospital Trust, Leeds, U.K.
Scott
D J
DJ
Richards
S P
SP
Weston
M J
MJ
Berridge
D C
DC
Kent
P J
PJ
Kester
R C
RC
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007866:Leg / Q000098:blood supply* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging*; D011184:Postoperative Period; D011446:Prospective Studies; D012008:Recurrence; D013997:Time Factors; D018616:Ultrasonography, Doppler, Duplex / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data; D014648:Varicose Veins / Q000000981:diagnostic imaging* / Q000601:surgery