title: Neovascularisation after surgery for recurrent saphenofemoral incompetence: does surgical dissection technique matter?
abstract: BACKGROUND
  The effect of the type of surgery on neovascularisation in the groin is unknown. The aim of the present study was to compare three different surgical techniques used for recurrent saphenofemoral incompetence in view of their effect on neovascularisation in the groin at short- and long-term follow-up after surgery.
  
  
  METHODS
  36 consecutive patients undergoing surgery for recurrent saphenofemoral incompetence were randomised. 12 patients underwent sharp dissection with knife or scissors and excision and ligation of scar tissue using absorbable suture material; 12 had dissection with electrocoagulation and 12 dissection with ultrasound (Ultracision Harmonic Scalpel). Clinical outcome was assessed using the venous clinical severity score and venous disability score, and the saphenofemoral junction was evaluated by means of duplex sonography three months and seven years after the operation respectively. If neovascularisation was present, the maximal diameter of new refluxing veins in the groin was measured.
  
  
  RESULTS
  There was no statistically significant difference between the three surgical techniques. Duplex ultrasound showed neovascularisation with an average maximal diameter (± standard error) of the newly formed refluxing vessel of respectively 2.00 (± 0.63) mm, 1.00 (± 0.45) mm and 0.50 (± 0.50) mm after three months and 4.29 (± 1.41) mm, 3.32 (± 0.90) mm and 3.00 (0.83) mm after seven years (no significant difference between groups). After seven years no reflux was detected in 8/36 patients, no varicose veins were found in 14/36 patients. The patients were less symptomatic than before our redo operation and no one needed reoperation within the seven years.
  
  
  CONCLUSIONS
  Dissection techniques in the groin did not influence the clinical and sonographic result at 3 months and at 7 years after redo surgery for recurrent varicose veins.
authors.affiliation: Department of Surgery, Spital STS AG Thun, Switzerland. wolfgang.mouton@spitalthun.ch
authors.forename: W G
authors.initials: WG
authors.lastname: Mouton
authors.forename: M M
authors.initials: MM
authors.lastname: Marklewitz
authors.forename: S
authors.initials: S
authors.lastname: Friedli
authors.forename: T
authors.initials: T
authors.lastname: Zehnder
authors.forename: H E
authors.initials: HE
authors.lastname: Wagner
authors.forename: D
authors.initials: D
authors.lastname: Heim
authors.forename: M G
authors.initials: MG
authors.lastname: De Maeseneer
mesh_terms: D000328:Adult; D000368:Aged; D004564:Electrocoagulation; D005260:Female; D005268:Femoral Vein / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008026:Ligation; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000209:etiology* / Q000503:physiopathology; D011446:Prospective Studies; D012008:Recurrence; D012086:Reoperation; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000601:surgery*; D012720:Severity of Illness Index; D013557:Switzerland; D013997:Time Factors; D016896:Treatment Outcome; D014464:Ultrasonic Therapy; D018616:Ultrasonography, Doppler, Duplex; D014648:Varicose Veins / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000009:adverse effects; D014689:Venous Insufficiency / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D055815:Young Adult