Clinical and Ultrasound Semiotics of Varicose Vein Recurrence

Objective. To study clinical and ultrasound semiotics of primary varicose vein recurrence after invasive treatment. Material and methods. We analyzed 64 consecutive patients with varicose vein recurrence after invasive treatment (crossectomy, stripping (35 patients) and thermal obliteration (27 patients)). Ehere were 21 men (32.8%) and 43 women (67.2%) (mean age 50.8±1.6). Recurrence variants and their combinations were analyzed. Reflux sources were recorded in accordance with the REVAS classification. We estimated time interval after surgery, period between surgery and recurrence, the number of invasive interventions, localization of recurrent varicose veins, including their relationship with sites of previous interventions, CEAP class. Results. The median period after invasive treatment was 53 months. Recurrence within the area of previous procedure was registered in 14 patients (21.9%), outside these areas — in 11 patients (17.2%). Combined localization was revealed in 39 patients (60.9%). Recurrence due to disease progression was detected in 11 patients (17.2%), residual veins — in 2 patients (3.1%), recurrent veins — in 3 patients (4.7%), combination — in 48 patients (75%). Neovascularization was detected in 11 patients (17.2%). One source of reflux out of seven possible according to the REVAS classification was detected only in 7 patients (10.9%). Other 57 (89.1%) ones had two or more sources. Trunk insufficiency was detected in 53 patients (82.8%). Incompetent segments of the main saphenous veins after open and endovenous procedures were detected in 11 and 24 patients, respectively (35%/54.7%). Insufficiency of veins that were intact before the first procedure was detected in 18 (28.1%) patients. When analyzing the subgroups after high ligation with stripping and thermal ablation, we found significant differences in time after the first procedure, localization of recurrent varicose veins, incidence of trunk incompetence and previous treatment mistakes. Conclusion. The structure of recurrences is similar after high ligation with stripping and thermal obliteration with phlebectomy. Differences in rates of certain recurrence are probably associated with tactical and technical features of two treatment approaches.