title: Recurrent varicose veins: causes and neovascularisation. A 17-year experience.
abstract: OBJECTIVE
  The aim of the paper was to determine the causes of varicose vein recurrence and, when neovascularisation is suspected, to confirm or exclude its presence and to establish its contribution to the recurrence of varicose veins.
  
  
  METHODS
  A retrospective analysis of a set of 217 legs reoperated in our department over a period of 17 years with a two-year prospective histological and histochemical (nestin) analysis of resected veins.
  
  
  RESULTS
  Reflux as a cause of varicose vein recurrence was identified in 93% of the limbs. It was most commonly found in the area of the saphenofemoral junction, followed by the area of the saphenopopliteal junction. Reflux in the perforating veins was almost invariably linked to that in the saphenofemoral junction or saphenopopliteal junction; an isolated damage to the perforating veins was only present in three limbs. Histological and histochemical analysis was performed for the samples of eleven veins in which neovascularisation was suspected based on preoperative duplex ultrasonography evaluation. Neovascularisation was confirmed in none of these veins and none of them was the cause of recurrence.
  
  
  CONCLUSIONS
  The major cause of varicose vein recurrence is a reflux left unresolved during the primary surgery, particularly in the area of the saphenofemoral junction. A less common cause is progression of the disease and the occurrence of a new reflux. Neovascularisation is of no importance for the recurrence of varicose veins.
authors.affiliation: Department of Surgery II, Vascular and Transplantation Surgery, Palacky University, Cardiovascular Centre, Olomouc, Czech Republic - jiriherman@seznam.cz.
authors.forename: J
authors.initials: J
authors.lastname: Herman
authors.forename: D
authors.initials: D
authors.lastname: Musil
authors.forename: M
authors.initials: M
authors.lastname: Tichy
authors.forename: P
authors.initials: P
authors.lastname: Bachleda
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000378:metabolism; D018153:Czech Republic; D018450:Disease Progression; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic; D064231:Nestin / Q000378:metabolism; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014648:Varicose Veins / Q000175:diagnosis / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000009:adverse effects; D014680:Veins / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor; C577484:NES protein, human; D064231:Nestin