Recurrent Varicose Veins and Primary Deep Venous Insufficiency: Relationship and Therapeutic Implications

Abstract

Objective: Evaluation of the relationship between deep venous insufficiency and recurrent varicose veins (RVV). Design: Retrospective analysis of patients affected by RVV submitted to clinical examination, continuous-wave (CW) Doppler, duplex scanning and descending phlebography in cases of incompetence at groin level. Setting: Department of Vascular Surgery, Istituto Dermopatico dell'Immacolata (IRCCS), Rome. Patients: Two hundred and thirty-nine patients affected by RVV. Main outcome measures: CW Doppler ultrasound, duplex ultrasound imaging and descending phlebography to assess venous incompetence. Results: Doppler examination revealed no reflux at the groin level in 80 limbs. In the remaining 166 limbs, descending phlebography showed a superficial venous reflux in 95 limbs (related to a sapheno-femoral junction recanalization or to an inadequate previous operation) while in 69 (28% of the 246 limbs examined) deep venous reflux was present (superficial femoral vein in 38 cases, profunda femoris vein in seven cases and both veins in 24 cases); in two cases reflux came from the pelvic veins. Conclusions: Our data suggest a possible role of primary deep venous insufficiency in the development of RVV and the value of descending phlebography in the planning of further surgery.

The appropriate length of great saphenous vein stripping should be based on the extent of reflux and not on the intent to avoid saphenous nerve injury

“…Furthermore, two thirds of the operated limbs with recurrence were found to develop venous reflux and varicose dilations in various new venous segments during the 5-year study period. These findings are in agreement with previous studies suggesting that primary CVD is a generalized disease with multifactorial etiology and developmental origin, [20][21][22] contributing significantly to recurrence after varicose vein surgery [22][23][24][25] as it could progressively involve any part of the lower limb's venous system.…”

Endoscopically directed external support of femoral vein valves

“…22,23 We did not attempt to correct the DFV reflux in this series. This may result in the presence of the popliteal reflux extremities with anatomic connection between the DFV and popliteal vein.…”

Regarding “Does surgical correction of the superficial femoral vein valve change the course of varicose disease?”

“…In the control group, the authors found 11% recurrent varicosities, and we found a PDVI in 28% of 246 extremities affected by recurrent varicose veins. 1 Concerning the discordance about the observations that superficial venous surgery abolishes the deep venous reflux, we feel that this finding is correlated above all to the reflux grade. In our experience a third-to fourth-grade reflux cannot be abolished by saphenous surgery, but a first-to second-grade can, which is in accordance with the overload theory.…”