title: Residual varicose veins below the knee after varicose vein surgery are not related to incompetent perforating veins.
abstract: OBJECTIVE
  The objectives of this study were to investigate the occurrence of residual varicose veins (visible and ultrasonic) at the below-knee level after short-stripping the great saphenous vein (GSV) and to investigate the possible role of preoperative incompetent perforating veins (IPVs) on the persistence of these varicose veins.
  
  
  METHODS
  In this prospective study in 59 consecutive patients (74 limbs) with untreated primary varicose veins, a preoperative clinical examination and preoperative color flow duplex imaging were performed. Re-evaluation (clinical examination and color flow duplex imaging) was performed 6 months after surgery. Dissection of the saphenofemoral junction and short-stripping of the GSV from the groin to just below the knee level was performed without additional stab avulsions on the lower leg. The association between postoperative reflux in the three GSV branches below the knee level and preoperative IPV and the association between postoperative visible varicose veins in the GSV below knee level and preoperative IPV were determined with odds ratios with the help of a univariate and multivariate logistic regression analysis.
  
  
  RESULTS
  Preoperative varicosities in the GSV below the knee were visible in 62 limbs (70%) and were visible after surgery in 12 limbs (16%). The number of limbs with reflux in the 3 below-knee GSV branches was as follows: anterior branch, 34 (49%) before surgery and 31 (44%) after surgery; main stem, 59 (79%) before surgery and 62 (91%) after surgery; and posterior branch, 49 (67%) before surgery and 46 (63%) after surgery. No statistically significant association between postoperative reflux in the three GSV branches and preoperative IPV nor between postoperative visible varicose veins and preoperative IPV was found.
  
  
  CONCLUSIONS
  This study shows that reflux in the GSV below knee level after the short-stripping procedure persists in all below-knee GSV branches. Approximately 20% of patients with visible varicose veins in the GSV area below the knee level will have visible varicose veins in this area 6 months after the short-strip procedure. These clinical and ultrasonic residual varicose veins are not significantly related to the presence of preoperative IPV.
authors.affiliation: Department of Dermatology, Laurentius Hospital, Roermond, The Netherlands. P.vanNeer@lzr.nl
authors.forename: Pierre
authors.initials: P
authors.lastname: van Neer
authors.forename: Alphons
authors.initials: A
authors.lastname: Kessels
authors.forename: Ed
authors.initials: E
authors.lastname: de Haan
authors.forename: Rene
authors.initials: R
authors.lastname: Estourgie
authors.forename: Joep
authors.initials: J
authors.lastname: Veraart
authors.forename: Raf
authors.initials: R
authors.lastname: Lijnen
authors.forename: Martino
authors.initials: M
authors.lastname: Neumann
mesh_terms: D005260:Female; D005268:Femoral Vein / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007717:Knee; D008297:Male; D011446:Prospective Studies; D012008:Recurrence; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D018615:Ultrasonography, Doppler, Color; D014648:Varicose Veins / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000379:methods*