[Recurrent varicose veins in the groin after surgery]

Abstract

Recurrence of varicose veins following surgery of the long saphenous system are common. It is important to differentiate several causes. These, in fact, dictate the therapeutic decision. Physiopathologically, there are different types of recurrences: persistent reflux from the femoral veins into the superficial varicose network due to: an incomplete long sapheno-femoral high ligation (crossectomy), a neoangiogenesis at the level of the previous sapheno-femoral junction. separate termination of an incompetent long saphenous vein (LSV) into the common femoral vein or the superficial femoral vein (antero lateral or postero medial tributaries of LSV); persistent reflux from perineal and (or) paricto-abdominal veins into the varicose network of the thigh. Dynamic popliteal phlebography was, until the advent of echo-doppler, the author's method of choice for investigation as it was easier to interpret than varicography. At the present time it is only requested on the rare occasions where doubt persists even after echo-doppler. Additionally, with this investigation, the reflux (major or minor) can be analysed at its point of origin and a map of the underlying varicose network can be drawn. Therapeutically, we make the following suggestions: in the presence of a site of major reflux (incomplete crossectomy, high flow neoangiogenesis, separate termination of the saphenous tributaries), a further operation would be justified. The removal of the site of reflux can be associated with the placing of a PTFE patch on the common femoral vein. in the presence of a site of minor reflux, sclerotherapy or, preferably, echosclerotherapy would appear to be the treatment of choice. Elimination of the site (s) of reflux must be associated with suppression of the underlying varicose network by sclerotherapy or phlebectomy.