title: Femoral vein valve incompetence as a risk factor for junctional recurrence.
abstract: Background Recurrent varicose veins occur up to 80% of procedures. The sapheno-femoral junction can be involved in more than 50% of cases. A detailed pathophysiological explanation of the phenomenon is still missing. The aim of the present work is to evaluate the role of femoral vein incompetence as risk factor for sapheno-femoral junction recurrence. Methods Three-hundred-eighty-one patients presenting an incompetent great saphenous vein system and eventually also an incompetent femoral tract (C2-6EpAsdPr) underwent a great saphenous vein high ligation with flush ligation also of the incompetent tributaries along the leg, sparing the saphenous trunk. Pre-operatively, all patients underwent a sonographic evaluation assessing the superficial and deep venous systems, including a detailed analysis of the iliac-femoral vein tract above the sapheno-femoral junction. A retrospective statistical analysis assessed the recurrence risk associated with iliac-femoral vein tract incompetence. Results In a 5.5 ± 1.9 years follow-up, great saphenous vein trunk reflux recurrence was detected in 45/381 (11.8%) cases. The reflux source was found in a reconnected sapheno-femoral stump in 11/45 cases (24.5%), in the pelvic network in 8/45 cases (17.8%), in a neovascularization process in 7/45 (15.5%) and in a newly incompetent great saphenous vein tributary in 19/45 (42.2%). At the pre-operative assessment, iliac-femoral vein tract reflux was present in 7 (26.9%) of the 26 cases who developed a sapheno-femoral junction recurrence and in 25 (7%) of the 355 patients who did not demonstrate sapheno-femoral junction recurrence (odds ratio: 4.8; confidence interval 95%: 1.8-12.6; p < .003). Discussion Despite many technical diagnostic and therapeutic refinements, varicose veins recurrence remains a frequent event. The present investigation points out the association among iliac-femoral vein tract incompetence and sapheno-femoral junction recurrences after high ligation.
authors.affiliation: Vascular Disease Center, University of Ferrara, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Gianesini
authors.affiliation: Vascular Disease Center, University of Ferrara, Italy.
authors.forename: Savino
authors.initials: S
authors.lastname: Occhionorelli
authors.affiliation: Vascular Disease Center, University of Ferrara, Italy.
authors.forename: Erica
authors.initials: E
authors.lastname: Menegatti
authors.affiliation: Vascular Disease Center, University of Ferrara, Italy.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Malagoni
authors.affiliation: Vascular Disease Center, University of Ferrara, Italy.
authors.forename: Mirko
authors.initials: M
authors.lastname: Tessari
authors.affiliation: Vascular Disease Center, University of Ferrara, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Zamboni
mesh_terms: D000368:Aged; D005260:Female; D005268:Femoral Vein / Q000473:pathology / Q000503:physiopathology; D005500:Follow-Up Studies; D006801:Humans; D007084:Iliac Vein / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D014689:Venous Insufficiency / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology / Q000628:therapy
keywords: Chronic venous disease; duplex ultrasound; great saphenous vein; recurrent varices; saphenofemoral junction