Management of recurrent varicose veins: Redo open surgery versus endovascular approaches

Abstract

ObjectiveRecurrent varicose veins (RVVs) following open surgical procedures are common and present significant treatment challenges. Redo open surgery (rOS) presents risks leading to a need for alternative treatment options. This study compares the safety and efficacy of ultrasound-guided foam sclerotherapy (UGFS), used to treat recurrent reflux and remove neovascular and tributary venous networks in the thigh, to redo open surgery (rOS) for the treatment of C2r.Materials and methodsA retrospective review was conducted on 133 patients with symptomatic C2r treated between 2018 and 2020. Of these, 91 patients received UGFS-based mini-invasive treatment (Group A), and 42 underwent rOS (Group B). Data were collected during perioperative, intraoperative, and postoperative times. Clinical outcomes were assessed using the CEAP and rVCSS scoring systems. Follow-up occurred within 1 week, at 1-6 months, and annually thereafter.ResultsUGFS showed a significantly shorter average procedure time (21 ± 7 minutes) compared to rOS (47 ± 13 minutes, p < .001) and time spent in the hospital (3 ± 0.5 hours vs 16 ± 2 hours, p < .001). Both groups achieved high technical success rates. The anterior saphenous vein (ASV) was found to be incompetent in 32 patients (24%). In Group A, it was treated with radiofrequency ablation (RFA) in 10 cases and with foam sclerotherapy in 11. In contrast, all ASV cases in Group B were managed with surgical stripping. UGFS patients experienced a more rapid clinical improvement within the first-week post-treatment (p < .001). The freedom from recurrences was 88.9% in the Group A, and 87.8% in the Group B at 3-year (p = .85). The freedom from reintervention was 90.9% in the Group A, and 88.5% in the Group B at 3-year (p = .89).ConclusionsUGFS is a safe and effective alternative to rOS for treating C2r, offering significant advantages in shorter procedure times, faster recovery, and similar medium-term outcomes. This approach provides a viable option for C2r patients seeking effective treatment with reduced recovery periods.

Keywords: Varicose veins recurrence; accessory saphenous vein; great saphenous vein; radiofrequency thermal ablation; ultrasound-guided sclerotherapy.