Duplex-derived Evidence of Reflux After Varicose Vein Surgery: Neoreflux or Neovascularisation?

Turton, Philip; Scott, D.; Richards, S.P; Weston, Mike; Berridge, David; Kent, P.; Kester, R. C.

doi:10.1053/ejvs.1998.0719

Cited by 74 publications

(62 citation statements)

References 9 publications

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“…There are several circumstances that would explain these data. First, the surgical approach for arch collateral veins reticular relapse occurs, possibly because of a neoangiogenesis 1,13,16,21 . The absence of side branches section prevents vascular endothelial cell seeding during surgery and the use of blunt dissection, avoiding sectioning lymph ducts in the triangle of Scarpa, prevents the development of lymph nodal blade which does happen after ligature of the saphenofemoral junction and its side branches, and the consequent alteration of drainage 17 .…”

Section: Discussionmentioning

confidence: 99%

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High crossectomy without vascular sectioning vs classic saphenectomy. Randomized clinical trial: analysis of recurrent varicose

Díaz

Velilla

Rodriguez

et al. 2013

Anales Sis San Navarra

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Section: Discussionmentioning

confidence: 99%

“…13 . None have proven to be more effective than the crossectomy with saphenectomy, because high percentage of recurrence after treatment (7 to 77%) is the principal problem of all surgical procedures for the treatment of varicose veins 1,14 . In the nineties, Vin and Chleir…”

Section: Materials Y Métodosmentioning

confidence: 99%

High crossectomy without vascular sectioning vs classic saphenectomy. Randomized clinical trial: analysis of recurrent varicose

Díaz

Velilla

Rodriguez

et al. 2013

Anales Sis San Navarra

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“…Many researchers think that the most common cause of recurrences was inaccurate surgery within perineum; no ligation and removal of all the tributaries (3,4,5,17,18,19). Only few publications describe early postoperative control ultrasonographic examinations which aim at explaining the causes of recurrences.…”

Section: Discussionmentioning

confidence: 99%

The Usefulness of Preoperative Doppler Ultrasonographic Evaluation of Saphenofemoral Complex For Improving Lower Limb Varicose Veins Surgery

Mikusek¹,

Arendt²,

Waniczek³

et al. 2008

Polish Journal of Surgery

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The aim of the study was to determine whether detailed preoperative Doppler ultrasonographic examination of saphenofemoral complex can improve the results of the lower limb varicose veins surgery. Two groups of patients (30 people each) were operated due to lower limbs primary varicose veins caused by saphenous vein insufficiency. All patients had a routine duplex examination performed. Group B had additional ultrasound examination before the operation to evaluate the number, diameter, and localization of the tributary vessels in the area of saphenofemoral junction. 30 days after the operation, in both groups control duplex examination was performed to evaluate the sparingness of the surgical procedure. The control ultrasonography showed 8 and 2 tributary vessels overlooked in groups A and B, respectively. The differences were statistically significant. The conformity of the preoperative ultrasound and the scene found during the operation in group B was 83.3%. The chance of overlooking peripheral vessels in group A increased 5.1 times. Preoperative Doppler ultrasound estimates localization of tributary vessels within the saphenofemoral junction, which makes detecting vessels during the operation much easier. It allows to minimize the number of technical mistakes and improve the lower limb varicose veins surgery results.

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“…5 Various suggestions have been made for the cause of this high rate of recurrence, including poor surgical technique, particularly by junior surgeons in training 6 ; anatomic variability and complexity of the SFJ 7 ; and persistent progressive venous disease. 1 However, it is now believed that the most common cause of this recurrence is angiogenesis with new vessel formation and reconnection of the venous channels. This is commonly referred to as neovascularization in the surgical literature and has been demonstrated in several clinicopathological and histological studies.…”

Section: Clinical Perspective P 74mentioning

confidence: 99%

“…1 Although surgery has been the standard treatment for varicose veins for many years, recurrence rates remain as high as 40% at 5 years. 2,3 Consequently, 20% of all varicose vein operations are performed for recurrent disease.…”

mentioning

confidence: 99%

Mechanical Inhibition of Angiogenesis at the Saphenofemoral Junction in the Surgical Treatment of Varicose Veins

et al. 2008

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Background-Saphenofemoral junction (SFJ) ligation has been a major component of surgical intervention for varicose veins; however, recurrence occurs in as many as 40%. Neovascularization with reconnection of the venous channels at the transected SFJ has been identified as the major cause of this recurrence. This randomized controlled study sought to evaluate mechanical suppression of neovascularization at the SFJ, with the use of a synthetic patch, to prevent recurrence after ligation surgery. Methods and Results-A total of 389 limbs (from 292 patients) were randomized into either control (SFJ ligation surgery) or patch (SFJ ligation with polytetrafluoroethylene patch of the transected SFJ) groups. All patients underwent clinical assessment, duplex imaging, and air plethysmography studies preoperatively and at 1, 6, 12, and 36 months postoperatively. The patch consistently halved the recurrence rate to 3 years postoperatively in all clinical subgroups. In those patched SFJs that still developed recurrence, evidence of neovascularization circumventing the polytetrafluoroethylene patch was observed by both ultrasound and histology. Conclusions-This study demonstrates that use of a polytetrafluoroethylene patch is an effective mechanical suppressant of neovasculogenesis at the SFJ and can be safely used as a strategy to improve long-term outcome of varicose vein surgery. (Circulation. 2008;118:66-74.)

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Duplex-derived Evidence of Reflux After Varicose Vein Surgery: Neoreflux or Neovascularisation?

Abstract: New sites of reflux, which may resolve spontaneously, occur in the early postoperative period despite adequate varicose vein surgery. It is our hypothesis that this is a manifestation of the effect of altered venous haemodynamics in a system of susceptible veins.

Cited by 74 publications

References 9 publications

High crossectomy without vascular sectioning vs classic saphenectomy. Randomized clinical trial: analysis of recurrent varicose

High crossectomy without vascular sectioning vs classic saphenectomy. Randomized clinical trial: analysis of recurrent varicose

The Usefulness of Preoperative Doppler Ultrasonographic Evaluation of Saphenofemoral Complex For Improving Lower Limb Varicose Veins Surgery

Mechanical Inhibition of Angiogenesis at the Saphenofemoral Junction in the Surgical Treatment of Varicose Veins

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