OPTIMIZING A VARICOSE-VEIN SERVICE TO REDUCE RECURRENCE

A prospective observational study of 63 legs in 49 patients was undert aken to evaluate the adequacy of primary varicose vein surgery perform ed by surgical trainees. Appropriate surgery was carried out by a surg ical senior house officer (SHO) under direct consultant supervision. A ll patients underwent pre- and postoperative duplex scanning. The preo perative duplex scan demonstrated incompetence of the saphenofemoral j unction (SFJ) or long saphenous vein (LSV) in 59 limbs, a mid-thigh pe rforator (MTP) in 11 limbs, and saphenopopliteal junction (SPJ) in 5 l imbs. Surgery successfully abolished all sites of pre-existing reflux. The postoperative duplex scan revealed that 17 new sites of reflux, n ot identified preoperatively, had developed in 12 limbs. With a consul tant-led service and accurate preoperative identification of sites of reflux, the surgical trainee can adequately perform varicose vein surg ery. This would seem a reasonable approach to training and eliminating recurrence owing to inadequate surgery. The development of new sites of reflux within 6 months of varicose vein surgery may be owing to alt ered venous haemodynamics consequent upon this surgery.