title: Causes of re-recurrence after polytetrafluoroethylene patch saphenoplasty for recurrent varicose veins.
abstract: BACKGROUND
  The aim of this study was to determine whether a polytetrafluoroethylene (PTFE) patch sutured over the religated saphenofemoral junction could reduce the rate of recurrence after operation for recurrent varicose veins.
  
  
  METHODS
  Fifty patients who had surgery for recurrent long saphenous incompetence (81 legs had a small PTFE patch sutured over the religated saphenofemoral junction. There were no major complications following surgery. Three patients had a wound infection or delayed healing. All patients were invited for clinical examination and duplex imaging at a median of 19 (range 6-39) months after operation.
  
  
  RESULTS
  Some 38 of 43 patients (70 legs) remained satisfied with the results of surgery; 16 (23 per cent) of 70 legs had visible veins on inspection and eight of these (11 per cent) involved symptomatic recurrence. Duplex imaging showed that recurrence was due to saphenofemoral junction incompetence in ten legs; two appeared to have a major groin connection but the other eight appeared to have neovascularization. Other causes were thigh perforator reflux (three legs) and cross-groin collaterals (three). Eleven of the 16 legs with recurrence had varicography but in two the procedure was a technical failure. Two legs had evidence of a significant connection (more than 3 mm) and two a minor connection (less than 3 mm) to the femoral vein at the level of the PTFE patch, but in the remainder recurrence was due to upper thigh perforating veins. There was good concordance between duplex imaging and varicography.
  
  
  CONCLUSIONS
  PTFE patch saphenoplasty appears to be safe. Although these are early results, the technique seems potentially as effective as other barrier methods that have been investigated; in ten legs (12 per cent) recurrence was attributed to failure at the level of the PTFE patch.
authors.affiliation: Gloucestershire Vascular Group, Gloucestershire Royal Hospital, Great Western Road, Gloucester GL1 3NN, UK.
authors.forename: T S
authors.initials: TS
authors.lastname: Bhatti
authors.forename: B
authors.initials: B
authors.lastname: Whitman
authors.forename: K
authors.initials: K
authors.lastname: Harradine
authors.forename: S G
authors.initials: SG
authors.lastname: Cooke
authors.forename: B P
authors.initials: BP
authors.lastname: Heather
authors.forename: J J
authors.initials: JJ
authors.lastname: Earnshaw
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene / Q000627:therapeutic use*; D011859:Radiography; D012008:Recurrence; D012501:Saphenous Vein; D013524:Surgical Flaps; D013536:Suture Techniques; D018616:Ultrasonography, Doppler, Duplex; D014648:Varicose Veins / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D014945:Wound Healing
chemical_list: D011138:Polytetrafluoroethylene