Saphenofemoral junction reconstruction and recurrence after the treatment of superficial venous reflux disease with endovenous ablation methods

Background Recurrence of varicosities and reflux-related symptoms after endovenous ablation of the great saphenous vein (GSV) remains common. Standard ablation is delivered 1.5–2 cm distal to the saphenofemoral junction (SFJ), leaving the junctional tributaries and dilated proximal junction untreated, unlike conventional high ligation and stripping. We compared standard endovenous ablation with a technique combining open SFJ reconstruction and endovenous ablation. Methods We retrospectively reviewed patients treated for symptomatic primary GSV reflux. Group 1 underwent standard endovenous ablation (at our institution or referred from elsewhere). Group 2 underwent open SFJ reconstruction — ligation of the junctional tributaries, division of the saphenous vein, and reduction of the dilated common femoral vein — plus endovenous ablation of the GSV trunk. The protocol was introduced during the study period and applied selectively and non-randomly; patients with a body mass index ≥30 kg/m 2 , those aged ≥70 years and those with groin skin infection received standard ablation. Beyond a 3-month review, duplex follow-up was not standardised and was performed mainly when symptoms recurred. Symptomatic recurrence, recurrent visible varicosities, duplex recurrence patterns, reintervention and complications were reported separately. Results Group 1 included 115 patients (70 treated at our institution and 45 referred after treatment elsewhere) and Group 2 included 203. Mean age was 54.3 ± 10.9 and 48.7 ± 14.8 years, and 62.6% and 71.9% were female, respectively. Group 1 had a higher body mass index and more diabetes, hypertension and smoking (all P ≤ .003). During follow-up, 18 patients in Group 1 (15.7%) returned with symptomatic recurrence, compared with 7 (3.4%) in Group 2 ( p < .001; adjusted OR 0.14, 95% CI 0.05–0.40). No Group 2 patient showed a patent refluxing GSV trunk. In Group 2, six patients (3.0%) had groin wound complications, four managed with wound care and two requiring surgical revision, and one had a minor groin hematoma; one Group 1 patient developed deep vein thrombosis. There was no pulmonary embolism and no mortality. Conclusions In this selected, non-randomised cohort, adding open SFJ reconstruction to endovenous GSV ablation was associated with an acceptable complication rate, at the cost of reintroducing groin wound morbidity, and with lower symptomatic recurrence than standard ablation. Given the baseline imbalance, potential referral bias and non-standardised follow-up, these findings show an association rather than a preventive effect. Whether patients at particularly high risk of SFJ/anterior accessory saphenous vein-related recurrence benefit from this approach should be tested prospectively.