title: A prospective study of the fate of venous leg perforators after varicose vein surgery.
abstract: OBJECTIVE
  To describe the fate of perforator veins after surgical treatment of varicose veins and factors that influence this.
  
  
  METHODS
  This prospective study of 104 patients assessed perforator veins by using duplex ultrasound scanning in 145 limbs before superficial vein surgery for varicose veins. Veins were marked preoperatively with ultrasound guidance and ligated with an open procedure; those missed were later treated with sclerotherapy. Duplex ultrasound scans and air plethysmography were used to confirm surgical success within 1 month and to monitor recurrence at 6 months, 1 year, and 3 years.
  
  
  RESULTS
  A total of 850 incompetent perforators were treated, but 5.7% were missed and required further ablation. After 3 years, 75.8% of the limbs had developed further incompetent perforators for a total of 380 incompetent perforators. The number of ultrasound-detectable competent perforators had also increased from 356 to 1047 in that time. The incompetent perforators arose by (1) new vessel formation at the site of previous ligation in 152 (40.4%), (2) changes in pre-existing perforator vessels at other sites in 225 (59.2%), and (3) vessels missed at treatment (< 1%). The diameter of the neovascular channels (3.0 +/- 1.0 mm) was greater than the other incompetent perforators (2.7 +/- 1.0 mm; P < .001). The anatomic distribution of the neovascular recurrences was also different, with 63% found in the paratibial region. The number of new incompetent perforators in a limb was associated with the clinical and physiologic severity of venous disease before surgery, but not to body mass index, gender, or age (P < .01).
  
  
  CONCLUSIONS
  This study shows that incompetent perforator recurrence after surgery is far more common than previously recognized and is primarily due to either neovascularization of previously ligated perforators or the development of incompetence in newly detected perforators in association with persistent venous disease rather than due to poor surgery.
authors.affiliation: Department of Surgery, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand. andre.vanrij@stonebow.otago.ac.nz
authors.forename: Andre M
authors.initials: AM
authors.lastname: van Rij
authors.forename: Gerry
authors.initials: G
authors.lastname: Hill
authors.forename: Chris
authors.initials: C
authors.lastname: Gray
authors.forename: Ross
authors.initials: R
authors.lastname: Christie
authors.forename: Josie
authors.initials: J
authors.lastname: Macfarlane
authors.forename: Ian
authors.initials: I
authors.lastname: Thomson
mesh_terms: D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010991:Plethysmography; D011184:Postoperative Period; D011446:Prospective Studies; D012008:Recurrence; D012720:Severity of Illness Index; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014648:Varicose Veins / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D014656:Vascular Surgical Procedures