Silicone patch saphenoplasty to prevent repeat recurrence after surgery to treat recurrent saphenofemoral incompetence: long-term follow-up study.
OBJECTIVE
Barrier techniques have been proposed to improve the results of repeat surgery to treat recurrent saphenofemoral junction incompetence. We hypothesized that interposition of a silicone implant would contain postoperative neovascularization and thus reduce the incidence of clinical recurrence at 5-year follow-up.


METHODS
We compared the results of repeat interventions with use of silicone sheeting with a control group without artificial implants. The study was performed in hospitalized patients in a level 3 referral center (University Hospital). All patients underwent new flush ligation in the groin, with stab avulsion of recurrent varicosities. Two closure techniques were compared: in group A (33 limbs) the groin incision was closed in two layers; in group B (35 limbs) a piece of silicone sheeting was sutured on the saphenous stump. Clinical examination and duplex scanning were performed after 1 and 5 years postoperatively. Limbs operated on were checked in particular for the presence of recurrent thigh varicose veins. Color-coded duplex scanning was performed to assess for the presence of clinically relevant neovascularization, defined as the presence of a new vein with diameter at least 4 mm and with pathologic reflux in direct connection with incompetent varicose veins at thigh level.


RESULTS
Clinical examination after 1 year showed recurrent thigh varicosities in 24% of limbs in group A and 12% of limbs in group B (P =.369). After 5 years recurrent thigh varicosities were observed in 58% of limbs in group A and in 26% of limbs in group B (P =.009). Duplex scans after 1 year revealed neovascularization in 27% of limbs in group A and 6% of limbs in group B (P =.018). After 5 years neovascularization was present in 45% of limbs in group A and 9% of limbs in group B (P =.0007).


CONCLUSIONS
The use of a silicone patch at repeat operation to treat recurrent varicose veins caused by new incompetence at the level of the saphenofemoral junction is associated with a lower incidence of recurrent thigh varicosities and neovascularization compared with a control group in which no additional barrier technique was used.
De Maeseneer
Marianne G
MG
Department of Vascular Surgery, University Hospital Antwerp, Belgium. marianne.de.maeseneer@uza.be
Vandenbroeck
Chantal P
CP
Van Schil
Paul E
PE
D000328:Adult; D001672:Biocompatible Materials / Q000627:therapeutic use*; D005260:Female; D005268:Femoral Vein / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012501:Saphenous Vein / Q000601:surgery*; D055502:Secondary Prevention; D012828:Silicones / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*; D014689:Venous Insufficiency / Q000517:prevention & control / Q000601:surgery*
D001672:Biocompatible Materials; D012828:Silicones