title: Persistent reflux below the knee after stripping of the great saphenous vein.
abstract: OBJECTIVE
  This prospective study investigated persistent reflux of the below knee great saphenous knee (GSV) 2 years after stripping the above knee GSV and the effect on reflux of postoperative incompetent perforating veins (IPVs).
  
  
  METHODS
  Included were 59 consecutive ambulatory patients in a community hospital with untreated primary varicose veins and reflux of the saphenofemoral junction and at least the GSV in the upper leg. Patients underwent a preoperative clinical examination and color flow duplex ultrasound imaging. Postoperative evaluations were at 6 months and 2 years, and 67 limbs were re-evaluable. This analysis was adjusted for age, CEAP, follow-up period, and preoperative reflux using a multivariate logistic regression model. The difference in diameter of the GSV below the knee before and after surgery was measured and tested with the paired t test.
  
  
  RESULTS
  Clearly visible varicose veins in the GSV below the knee were seen in 49 limbs (73%) before surgery and after surgery in 11 limbs (16%) at 6 months and in 15 limbs (22%) at 2 years. Reflux in the below knee main stem increased from 81% before surgery to 84% at 6 months and 91% at 2 years after surgery. Reflux in the posterior calf tributary of the GSV decreased from 67% before surgery to 64% at 6 months and 59% at 2 years after surgery. The mean diameter of the below knee GSV main stem decreased from 4.7 mm before surgery to 3.3 mm 6 months after surgery (P < .001), but increased to 3.6 mm 2 years after surgery (P < .05). The mean diameter of the posterior calf tributary of the GSV decreased from 3.5 mm before surgery to 2.7 mm at 6 months (P < .001), but increased to 2.9 mm at 2 years (P < .05). Univariate and multivariate logistic regression shows no association between reflux in one of the GSV below knee branches and postoperative IPVs.
  
  
  CONCLUSIONS
  Many patients (91%) that undergo a short stripping procedure will have a persistent reflux of the remnant below knee GSV tributaries postoperatively. This incompetence of the distal GSV is independent from the proximal GSV as well from insufficient perforating veins. There seems to be a tendency to worsening of the clinical signs and symptoms between 6 months and 2 years after surgery, and this goes along with an increase of reflux and diameters of the GSV below knee remnants.
authors: Department of Dermatology, Laurentius Hospital, Roermond, The Netherlands. P.vanNeer@lzr.nl
authors: Pierre
authors: P
authors: van Neer
authors: Fons G
authors: FG
authors: Kessels
authors: Rene J
authors: RJ
authors: Estourgie
authors: Ed F
authors: EF
authors: de Haan
authors: Martino A
authors: MA
authors: Neumann
authors: Joep C
authors: JC
authors: Veraart
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics; D006801:Humans; D015994:Incidence; D007717:Knee; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D012039:Regional Blood Flow; D018570:Risk Assessment; D012501:Saphenous Vein / Q000601:surgery*; D012720:Severity of Illness Index; D018615:Ultrasonography, Doppler, Color; D014648:Varicose Veins / Q000000981:diagnostic imaging / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D014689:Venous Insufficiency / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D055422:Venous Valves