title: Neovascularization: an "innocent bystander" in recurrent varicose veins.
abstract: OBJECTIVE
  Varicose vein recurrence after surgery occurs in up to 60% of patients. A variety of technical factors have been implicated, but biological factors such as neovascularization have more recently been proposed. The objective of this study was to characterize the relative contribution of technical and biological factors to recurrence in a large prospective series of recurrent varicose veins.
  
  
  METHODS
  Duplex and operative findings were recorded prospectively in a consecutive series of 500 limbs undergoing surgery for recurrent varicose veins between 1995 and 2005 in a university teaching hospital. Only limbs with previous saphenofemoral junction surgery were included. All limbs had preoperative duplex mapping by an accredited vascular technician who assessed the status of the great saphenous vein (GSV) in the thigh and groin, sought sonographic evidence of neovascularization, and reported on the presence of reflux in the short saphenous vein and perforator sites (typical and atypical). All operations were performed with an attending vascular surgeon as the lead operator.
  
  
  RESULTS
  Primary GSV surgery was incomplete in 83.2% of limbs. A completely intact GSV system was present in 17.4% of limbs. An incompetent thigh saphenous vein was present in 44.2% of limbs, 37.6% had GSV stump incompetence with one or more intact tributaries, and 16% had both a residual thigh GSV and an incompetent stump with intact tributaries. Non-GSV sites of reflux were identified in 25% of limbs. Neovascularization was identified on duplex scanning in 41 (8.2%) limbs. However, in 27 of these, surgical exploration revealed a residual GSV stump with 1 or more significant tributaries. Each of the remaining 14 (2.8%) limbs had a residual incompetent thigh GSV.
  
  
  CONCLUSIONS
  Despite reports to the contrary, neovascularization occurs in a relatively small proportion of patients with recurrent varicose veins. All recurrent varicose veins associated with duplex-diagnosed neovascularization are also associated with persistent reflux in the GSV stump tributaries, thigh GSV, or both. Recurrence after primary varicose vein surgery is associated with inadequate primary surgery or progression of disease, and neovascularization alone is not a cause of recurrent varicose veins.
authors.affiliation: Department of Vascular Surgery, The Adelaide and Meath Hospital incorporating the National Children's Hospital, Tallaght, Dublin, Ireland.
authors.forename: Bridget
authors.initials: B
authors.lastname: Egan
authors.forename: Michael
authors.initials: M
authors.lastname: Donnelly
authors.forename: Mary
authors.initials: M
authors.lastname: Bresnihan
authors.forename: Sean
authors.initials: S
authors.lastname: Tierney
authors.forename: Martin
authors.initials: M
authors.lastname: Feeley
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging / Q000209:etiology*; D011446:Prospective Studies; D012008:Recurrence; D012086:Reoperation; D012501:Saphenous Vein / Q000000981:diagnostic imaging* / Q000601:surgery; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014648:Varicose Veins / Q000150:complications* / Q000000981:diagnostic imaging / Q000517:prevention & control / Q000601:surgery; D014656:Vascular Surgical Procedures; D014689:Venous Insufficiency / Q000150:complications* / Q000000981:diagnostic imaging / Q000517:prevention & control / Q000601:surgery