title: Validity of the macroscopic identification of neovascularization at the saphenofemoral junction by the operating surgeon.
abstract: OBJECTIVE
  The intraoperative classification of recurrent veins at the saphenofemoral junction as neovascularization is based on certain macroscopic criteria. The validity of this neovascularization identification by the surgeon was evaluated by histologic and immunohistochemical examinations of the resected veins as the gold standard.
  
  
  METHODS
  One hundred-four patients (mean age 57 +/- 10.9 years) with 130 affected extremities underwent redo surgery of the saphenofemoral junction for recurrent varicose veins at a mean of 12.0 +/- 7.9 years after the initial stripping of the greater saphenous vein. The surgeon used intraoperative findings to classify the recurrent veins as neovascularization (group A), no neovascularization (group B), or unclear findings (group C). The resected veins then underwent histologic and immunohistochemical examinations and were again classified into the same three groups (a, neovascularization; b, no neovascularization; c, unclear) according to the histologic results.
  
  
  RESULTS
  The operating surgeon correctly recognized 16 (41%) of 39 histologically proven neovascularizations, whereas 22 (56%) were not identified. In contrast, 66 (84%) of 79 cases with no neovascularization were correctly identified during the operation. A definite classification by macroscopic criteria was not possible in 4 cases (3%) and the histologic examinations revealed unclear findings in 12 cases (9%). The macroscopic neovascularization identification had a sensitivity of 42.1% and a specificity of 85.7%. The positive predictive value reached 59.3% and the negative predictive value, 75%.
  
  
  CONCLUSIONS
  The validity of intraoperative neovascularization identification is poor, but the surgeon is able to recognize non-neovascularization recurrences with relatively high accuracy. The etiologic classification of recurrent veins at the saphenofemoral junction should not be solely based on macroscopic criteria.
authors.affiliation: Department of Vascular Surgery, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstr. 56, 44791 Bochum, Germany. bruno.geier@ruhr-uni.bochum.de
authors.forename: Bruno
authors.initials: B
authors.lastname: Geier
authors.forename: Sara
authors.initials: S
authors.lastname: Olbrich
authors.forename: Letterio
authors.initials: L
authors.lastname: Barbera
authors.forename: Markus
authors.initials: M
authors.lastname: Stücker
authors.forename: Achim
authors.initials: A
authors.lastname: Mumme
mesh_terms: D005260:Female; D005268:Femoral Vein / Q000473:pathology*; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000473:pathology*; D011237:Predictive Value of Tests; D012008:Recurrence; D012086:Reoperation; D012501:Saphenous Vein / Q000473:pathology*; D012680:Sensitivity and Specificity; D014648:Varicose Veins / Q000473:pathology* / Q000601:surgery